Strategic Mapping and Placement of Automated External Defibrillators in Remote Areas. The case of the Region of Western Macedonia Greece

Abstract

Background: In Europe, sudden cardiac arrest is one of the dominant causes of death. Considering the fact that defibrillation within 3-5 minutes of collapse can cause survival rates as high as 50-70%, programs for public access defibrillation should be actively implemented. So far, the international research is focused on optimised methods for Automated External Defibrillator (AED) placements in cities and densely populated areas but there is not any concrete approach in connection with geographic information systems to covering the remote rural areas which have different dynamics, demographics and of course accessibility to medical care. This gap is what this paper will try to fill. The work of the current study unfolds in the Region of Western Macedonia (RWM) in Greece for a pilot AED placement program for the Governance of RWM. The initial number of the defibrillators (120) that are needed to be distributed is very small and by far it cannot cover the needs for every major town or rural area. This paper focuses only on the rural dimension for the allocation. Methods: All existing Regional Medical facilities, Health centers and Hospitals were identified and mapped. Subsequently, all types of road network were mapped and classified, which differ in conditions and maintenance, in order to do a network analysis. In addition, the type of land uses, demographics, population densities and seasonal dynamics were also taken into consideration in the mapping process in order to do a priority ranking for the allocation of the AEDs. Results: Based on the methodology the optimised sites and allocated AEDs covered the major rural areas that are most in need for immediate relief in the event of a cardiac episode. The results show a promising future for the foundation and expansion of optimised AED placements in rural areas. Conclusions: The progress of this pilot project must be monitored and there are many problems and obstacles that need to be tackled in order to provide a robust allocation of future defibrillators. Further research is needed to deepen our understanding on optimization approaches to enhance the functionality of the medical services as well as create a stable network of engaged and informed citizens ready to act.