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Improving public-access automated external defibrillator use in a volunteer first-responder system for out-of-hospital cardiac arrest
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Smith, Christopher Matthew (2020) Improving public-access automated external defibrillator use in a volunteer first-responder system for out-of-hospital cardiac arrest. PhD thesis, University of Warwick.
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Official URL: http://webcat.warwick.ac.uk/record=b3711412
Abstract
Introduction: Bystander cardiopulmonary resuscitation (CPR) and Automated External Defibrillator (AED) use improve survival in out-of-hospital cardiac arrest. Volunteer first-responder systems may facilitate this. In the UK, the GoodSAM mobile-phone app alerts responders to a nearby patient if the ambulance service diagnoses cardiac arrest during a 999 call. In this PhD I investigate the effect of GoodSAM on out-of-hospital cardiac arrest outcomes and how to optimise public-access AED use during an alert.
Methods: I performed a scoping review into barriers and facilitators to public-access AED use; evaluated the impact of GoodSAM use on survival to hospital discharge; examined the potential for bystander public-access AED use; interviewed GoodSAM responders to identify barriers to public-access AED use during an alert; developed interventions to overcome these barriers using the Behaviour Change Wheel and; determined an optimum alerting distance for GoodSAM responders.
Results: GoodSAM alert acceptance was associated with improved survival to hospital discharge in London (2016–2017) – adjusted odds ratio 3.15, 95% confidence interval 1.19-8.36;p=0.021 – and East Midlands (2018) – adjusted odds ratio 3.19, 95% confidence interval 1.17-8.73;p=0.024. These findings could not be validated in 2019 datasets for either region. Few out-of-hospital cardiac arrests occur within 100m of a public-access AED, and calculating real-world travel routes substantially reduces this estimate. GoodSAM responders can use public-access AEDs but perceive a lack of opportunity to do so, and are concerned that delaying arrival at the patient would worsen outcome. Using the Behaviour Change Wheel, I proposed ten interventions to improve public-access AED use during a GoodSAM alert. Travel distance during an alert did not predict whether or not a GoodSAM responder reached the patient.
Conclusion: I did not find conclusive evidence of a benefit from GoodSAM in out-of-hospital cardiac arrest. We might improve public-access AED use during an alert by testing the interventions developed in this PhD.
Item Type: | Thesis (PhD) | ||||
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Subjects: | R Medicine > R Medicine (General) R Medicine > RC Internal medicine |
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Library of Congress Subject Headings (LCSH): | CPR (First aid), Defibrillators, Cardiac arrest -- Treatment, Assistance in emergencies | ||||
Official Date: | November 2020 | ||||
Dates: |
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Institution: | University of Warwick | ||||
Theses Department: | Warwick Medical School | ||||
Thesis Type: | PhD | ||||
Publication Status: | Unpublished | ||||
Supervisor(s)/Advisor: | Perkins, Gavin D. ; Griffiths, Frances ; Lall, Ranjit | ||||
Format of File: | |||||
Extent: | 372 leaves : illustrations | ||||
Language: | eng |
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