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Resources
Articles and research about neighborhood AEDs.
Community Responders Study

In 2018, a study designed by cardiologists at the University of Arizona Sarver Heart Center demonstrated that a neighborhood local volunteer response network improves response time for cardiac arrest. The principal investigators were Dr. Karl Kern, the Gordon A. Ewy, MD Distinguished Endowed Chair of Cardiovascular Medicine of the UA Sarver Heart Center, and Dr. Marvin Slepian, Professor of Medicine (Cardiology) and BioMedical Engineering and founder and director of the Arizona Center for Accelerated Biomedical Innovation.

Minutes are crucial in the treatment of out-of-hospital cardiac arrest (CA). Immediate chest compressions and early defibrillation are keys to good outcomes. Local neighborhood volunteer (vol) response programs may decrease delays to early CPR and AED use. The study hypothesized that a coordinated effort of alerting trained neighborhood volunteers simultaneously with 911 activation of professional EMS providers would provide earlier CPR and defibrillation in such communities.

The study was based on simultaneously alerting CPR and AED trained neighborhood vols and the local EMS system for cardiac arrest events in Green Valley, a retirement community in Southern Arizona, encompassing approximately 17,300 homes and 21,500 residents. EMS services are provided by 5 stations within the community boundaries. Within a single housing development neighborhood of 442 homes (The Springs), 9 vols and the closest EMS system were involved in 3 days of mock CA notifications (total of 12 different alerts at various times during daytime hours were sent). This provided a total of 120 response opportunities, 12 for EMS and 108 for vols. The distance to the mock event and the time from alert to arrival were recorded and compared.

Results: In the selected 55+ neighborhood, the two groups differed significantly in both distance to the mock cardiac arrest event and in response times. The volunteers average 0.33±0.19 miles from the mock CA incidences while the closest EMS station was 3.3 miles from the tested neighborhood (p<0.0001). Response times (time from call to arrival) were also different.

Earliest Vol 2 Vols & AED All arriving Vols EMS
1 min 30 sec* 1 min 38 sec* 3 min 23 sec* 7 min 20 sec
±48 sec ±53 sec ±1 min 23 sec ±1 min 13 sec
*p<0.0001 vs EMS

In order to confirm the likely availability of the volunteers over a longer period of time, four additional trials were conducted randomly over a two-week window of time. Volunteers in all trials were instructed to go about their daily routines and to respond only if they were in the neighborhood and could travel safely to the mock emergency address. In these trials, volunteers entered the home, performed CPR on a mannikin, and simulated the use of an AED. Response times were similar to those noted above for the original 12 trials with at least three volunteers always arriving.

Conclusion: When the neighborhood volunteers in this testing period were geographically closer to the mock CA event, they arrived significantly sooner to the scene than did the EMS service. The mean time of arrival for at least 2 vols with an AED was 5 min 42 sec faster than the professional rescuers. The implications for such a time saving could be as high as a 240% increase (25% to 85%) in survival for those with shockable rhythms.

Here is a link to a story in the Green Valley News regarding the study
Neighbors Saving Neighbors Case

A community network of that recruits, trains, and alerts volunteers to cardiac arrest emergencies was founded in The Villages in Florida over 14 years ago. The program, known as Neighbors Saving Neighbors, has grown from an initial enclave of 55 homes to encompass well over 100 neighborhoods encompassing 16,000 homes. This program is a partnership between the local public safety department, Rural Metro Fire, and the participating neighborhoods. Informally, the program reports that it has achieved an average response time of 90 seconds and can recount numerous successful resuscitations.

In the participating neighborhoods, when a suspected cardiac arrest is witnessed, and a call is placed to 911 regarding an unconscious victim apparently not breathing, the Neighbors Saving Neighbors system receives an emergency alert message at the same time that EMS teams are dispatched. The alert message is checked against a database containing all covered addresses; if there is a match, volunteers associated with the specific neighborhood receive a text message, cell phone call, and a land line call containing the address of the emergency.

Here is a link to an article in The Villages Daily Sun

Frequently Asked Questions
Here is a list of the most frequently asked questions about sudden cardiac arrest a neighborhood volunteer program like RAINTM:
  1. What is sudden cardiac arrest?
    The heart stops beating normally and enters a state called fibrillation, a rapid fluttering that fails to maintain the circulation of freshly oxygenated blood throughout the body. The first sign of sudden cardiac arrest is that the victim loses consciousness and stops breathing.
  2. Is that the same as a heart attack?
    No. In a heart attack, blockages in an artery supplying blood to the heart cause portions of the heart muscle to die, but the heart usually continues to function at some level, at least for a period of time. Chest pain, fatigue, and other discomfort frequently associated with a heart attack are not present in sudden cardiac arrest.
  3. How many cardiac arrests occur each year?
    Sudden cardiac arrest claims about 350,000 victims each year in the US, making it the leading cause of death in this country. The fatality rate is highest in residential areas where 80% of the cases occur; less than 10% are successfully revived.
  4. How does sudden cardiac arrest kill the victim?
    The human brain needs a constant flow of oxygen to function; when that flow is interrupted, brain cells begin to die almost immediately. The victim loses consciousness and stops breathing. Unless revived within 3-5 minutes, the victim will die or suffer severe impairment.
  5. Can a sudden cardiac arrest victim be revived?
    Yes, if CPR is started promptly and an Automatic External Defibrillator (AED) is used within minutes. The blood supply in a human contains some residual oxygen. Consequently, CPR as practiced today can sustain a helpful although greatly reduced blood circulation but only the administration of a shock to the heart by an AED will restore normal heart function.
  6. Isn’t it enough just to call 911?
    The American Heart Association ideal standard of care recommends that CPR and use of an AED begin with 3-5 minutes of a cardiac arrest event. When the EMS teams are stationed very close by and can arrive within 3-5 minutes, that may be sufficient. On average nationwide, EMS teams arrive in just over 8 minutes, usually too late to revive the victim.
  7. Why is the fatality rate so high in residential areas?
    Many residential areas are located eight or more minutes away from the nearest EMS station. Very few have accessible AEDs readily available in case of need. They also lack public awareness and CPR training programs focused on their residents. As a result, treatment of the victim does not begin in time to save them.
  8. What is a HeartSafe Community?
    HeartSafe Communities is a national program that encourages greater communication, collaboration, and coordination among local residents, first responders, and area hospitals to promote widespread CPR instruction, public access defibrillators, and aggressive resuscitation protocols.
  9. Can you share an example of a HeartSafe community?
    Over 125 neighborhoods in The Villages in Florida comprising 16,000 homes operate a program called Neighbors Saving Neighbors. Volunteers receive CPR and AED training, accessible AEDs are located in each neighborhood, the local 911 call centers share alerts noting the address of reported cardiac emergencies with volunteers. Available resident volunteers then respond and begin CPR and use an AED if they arrive before EMS teams. The program is 14 years old and has achieved an average volunteer response time of 90 seconds.
  10. Has the effectiveness of HeartSafe community programs been scientifically studied?
    Doctors in the Department of Cardiology of the Sarver Heart Center conducted a study in a Tucson area community in 2018 to determine whether a coordinated effort of alerting trained neighborhood volunteers simultaneously with 911 activation of professional EMS providers would provide earlier CPR and defibrillation in such communities.
  11. How was the community chosen for the study?
    The Springs in Green Valley community is a 55+ development of 442 homes. It is 3.3 miles away from the nearest fire station. It was selected as a good test of the effectiveness of a volunteer program. Trials were also conducted in parts of Green Valley closer to the assigned fire station.
  12. How was the study conducted?
    Twenty mock cardiac arrest trials were conducted in The Springs (12 trials) and other parts of Green Valley (4 trials). In twelve of the 20 trials, volunteers were alerted to the mock event by text messages at the same time as the fire department. In four of the mock trials, only the volunteers were alerted. Arrival times of all responders were observed and recorded.
  13. What were the results of the study?
    Volunteers living in The Springs took between 1 and 3 minutes to respond to a mock event; the closest fire department took on average 7.3 minutes to arrive at each mock emergency. In a real emergency, the doctors estimated the possibility of a 240% increase in successful resuscitations, from 25% to 85%. In the mock events elsewhere in Green Valley in which volunteers and the fire department were roughly the same distance away, the fire department always arrived first.
  14. Are the volunteers who participate protected by Good Samaritan laws?
    Yes, good Samaritan laws at the state level in Arizona and at the Federal level cover anyone who attempts to provide assistance to any kind of victim, including sudden cardiac arrest.
  15. What kind of training should be provided to the volunteers?
    At a minimum, a HeartSafe Community training program will cover CPR and the use of an AED. All volunteers would be expected to complete this training. In addition, volunteers will receive training regarding when and how they should respond, generally only when they are already in the community and can travel safely to the emergency.
  16. How are volunteers alerted to emergencies?
    As in the case of The Villages Neighbors Saving Neighbors program, Volunteers will receive alerts only in cases that are coded as cardiac arrest by 911 dispatchers. Alerts will be passed to computer software that matches the address of the emergency as transmitted by the 911 system to addresses of residents who have “opted in” to the service. If there is a match, alerts will be sent from the software to all volunteers.
  17. How many volunteers are needed for the program be a success?
    This depends on the size and density of a community. The study just completed in The Springs was based on alerting between 9 and 15 volunteers. In 16 trials conducted specifically in The Springs at random times of day over time windows as long as two weeks, the minimum number of volunteer responders was three and the largest number that showed up was 7.
  18. How many AEDs are needed for the program?
    The study noted above did not notice a significant difference in arrival times when AEDs were made available in six locations versus only one. As a result, two AEDs appear to provide sufficient coverage in The Springs program.
  19. What else is needed to implement and operate the program?
    The primary initial activity is educational outreach to the community to offer each resident the opportunity to understand the program and to opt in or out (some residents have documented medical directives such as “Do Not Resuscitate”). A data base will be created and maintained that lists all participating addresses in the community and current contact information for all volunteers. An interface to the computer aided dispatch (CAD) system used by the 911 call center will be implemented to enable the program to receive and match alerts to covered addresses and notify volunteers.
  20. What are the benefits of becoming a HeartSafe Community?
    In addition to providing an extra layer of life saving protection, such a program will differentiate any community from other neighborhoods and enhance the already strong sense of community pride among residents. Implementing such a program enables the community to post signs at the entrance announcing that achievement. There may be financial benefits in terms of property values.
  21. Where can I get more information?
    If you have further questions, please call me at 847 421 0254 or email me at tomcolberg@aol.com. I will be happy to answer your questions of point you in the right direction to get an answer.
  22. Top 10 causes of death in 2016
    (Source)

    1. Heart disease 635,260
    2. Cancer 598,038
    3. Accidents (unintentional injuries) 161,374
    4. Chronic lower respiratory diseases 154,596
    5. Stroke (cerebrovascular diseases) 142,142
    6. Alzheimer’s disease 116,103
    7. Diabetes 80,058
    8. Influenza and Pneumonia 51,537
    9. Nephritis, nephrotic syndrome and nephrosis 50,046
    10. Intentional self-harm (suicide) 44,965
    Total all causes 2,744,248