Rapid response systems| Volume 174, P24-30, May 2022

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Incremental gains in response time with varying base location types for drone-delivered automated external defibrillators



      Drone-delivered automated external defibrillators (AEDs) may reduce delays to defibrillation for out-of-hospital cardiac arrests (OHCAs). We sought to determine how integration of drones and selection of drone bases between emergency service stations (i.e., paramedic, fire, police) would affect 9-1-1 call-to-arrival intervals.


      We identified all treated OHCAs in southern Vancouver Island, British Columbia, Canada from Jan. 2014 to Dec. 2020. We developed mathematical models to select 1–5 optimal drone base locations from each of: paramedic stations, fire stations, police stations, or an unrestricted grid-based set of points to minimize drone travel time to OHCAs. We evaluated models on the estimated first response interval assuming that drones were integrated with existing OHCA response. We compared median response intervals with historical response, as well as across drone base locations.


      A total of 1610 OHCAs were included in the study with a historical median response interval of 6.4 minutes (IQR 5.0–8.6). All drone-integrated response systems significantly reduced the median response interval to 4.2–5.4 minutes (all P < 0.001), with grid-based stations using 5 drones resulting in the lowest response interval (4.2 minutes). Median response times between drone base location types differed by 6–16 seconds, all comparisons of which were statistically significant (all P < 0.02).


      Integrating drone-delivered AEDs into OHCA response may reduce first response intervals, even with a small quantity of drones. Implementing drone response with only one emergency service resulted in similar response metrics regardless of the emergency service hosting the drone base and was competitive with unrestricted drone base locations.


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        • Valenzuela T.D.
        • Roe D.J.
        • Cretin S.
        • Spaite D.W.
        • Larsen M.P.
        Estimating effectiveness of cardiac arrest interventions: a logistic regression survival model.
        Circulation. 1997; 96: 3308-3313
        • Kronick S.L.
        • Kurz M.C.
        • Lin S.
        • Edelson D.P.
        • Berg R.A.
        • Billi J.E.
        • et al.
        Part 4: systems of care and continuous quality improvement.
        Circulation. 2015; 132: S397-S413
        • Folke F.
        • Gislason G.H.
        • Lippert F.K.
        • et al.
        Differences between out-of-hospital cardiac arrest in residential and public locations and implications for public-access defibrillation.
        Circulation. 2010; 122: 623-630
        • Masterson S.
        • Wright P.
        • O’Donnell C.
        • et al.
        Urban and rural differences in out-of-hospital cardiac arrest in Ireland.
        Resuscitation. 2015; 91: 42-47
        • Sondergaard K.B.
        • Wissenberg M.
        • Gerds T.A.
        • et al.
        Bystander cardiopulmonary resuscitation and long-term outcomes in out-of-hospital cardiac arrest according to location of arrest.
        Eur Heart J. 2019; 40: 309-318
        • Portner M.E.
        • Pollack M.L.
        • Schirk S.K.
        • Schlenker M.K.
        Out-of-hospital cardiac arrest locations in a rural community: where should we place AEDs?.
        Prehospital Disast Med. 2004; 19: 352-355
        • Ströhle M.
        • Paal P.
        • Strapazzon G.
        • Avancini G.
        • Procter E.
        • Brugger H.
        Defibrillation in rural areas.
        Am J Emerg Med. 2014; 32: 1408-1412
        • Hansen S.M.
        • Hansen C.M.
        • Folke F.
        • et al.
        Bystander defibrillation for out-of-hospital cardiac arrest in public vs residential locations.
        JAMA Cardiol. 2017; 2: 507-514
        • Karlsson L.
        • Malta Hansen C.
        • Wissenberg M.
        • et al.
        Automated external defibrillator accessibility is crucial for bystander defibrillation and survival: a registry-based study.
        Resuscitation. 2019; 136: 30-37
        • Pulver A.
        • Wei R.
        • Mann C.
        Locating AED enabled medical drones to enhance cardiac arrest response times.
        Prehospital Emergency Care. 2016; 20: 378-389
        • Claesson A.
        • Fredman D.
        • Svensson L.
        • et al.
        Unmanned aerial vehicles (drones) in out-of-hospital-cardiac-arrest.
        Scand J Trauma Resuscitation Emerg Med. 2016; 24
        • Claesson A.
        • Bäckman A.
        • Ringh R.N.M.
        • et al.
        Time to delivery of an automated external defibrillator using a drone for simulated out-of-hospital cardiac arrests vs emergency medical services.
        JAMA - J Am Med Assoc. 2017; 317: 2332-2334
        • Boutilier J.J.
        • Brooks S.C.
        • Janmohamed A.
        • et al.
        Optimizing a drone network to deliver automated external defibrillators.
        Circulation. 2017; 135: 2454-2465
        • Van de Voorde P.
        • Gautama S.
        • Momont A.
        • Ionescu C.M.
        • De Paepe P.
        • Fraeyman N.
        The drone ambulance [A-UAS]: golden bullet or just a blank?.
        Resuscitation. 2017; 116: 46-48
        • Zègre-Hemsey J.K.
        • Bogle B.
        • Cunningham C.J.
        • Snyder K.
        • Rosamond W.
        Delivery of automated external defibrillators (AED) by drones. Implications for emergency cardiac care.
        Curr Cardiovas Risk Rep. 2018; 12
        • Bogle B.M.
        • Rosamond W.D.
        • Snyder K.T.
        • Zègre-Hemsey J.K.
        The case for drone-assisted emergency response to cardiac arrest: an optimized statewide deployment approach.
        N C Med J. 2019; 80: 204-212
        • Cheskes S.
        • McLeod S.L.
        • Nolan M.
        • et al.
        Improving access to automated external defibrillators in rural and remote settings: a drone delivery feasibility study.
        J Am Heart Assoc. 2020; 9e016687
        • Chu J.
        • Leung K.H.B.
        • Snobelen P.
        • et al.
        Machine learning-based dispatch of drone-delivered defibrillators for out-of-hospital cardiac arrest.
        Resuscitation. 2021; 162: 120-127
        • Schierbeck S.
        • Nord A.
        • Svensson L.
        • et al.
        National coverage of out-of-hospital cardiac arrests using automated external defibrillator-equipped drones—a geographical information system analysis.
        Resuscitation. 2021; 163: 136-145
      1. Schierbeck S, Hollenberg J, Nord A, et al. Automated external defibrillators delivered by drones to patients with suspected out-of-hospital cardiac arrest. Eur Heart J 2021;articles in advance:1–10.

        • Weisfeldt M.L.
        • Sitlani C.M.
        • Ornato J.P.
        • et al.
        Survival after application of automatic external defibrillators before arrival of the emergency medical system. Evaluation in the resuscitation outcomes consortium population of 21 million.
        J Am Coll Cardiol. 2010; 55: 1713-1720
      2. Government of British Columbia. Data Catalogue n.d. (accessed March 1, 2021).

      3. Perkins GD, Jacobs IG, Nadkarni VM, et al. Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: A Statement for Healthcare Professionals From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Circulation 2015;132:1286–300.

        • Grunau B.
        • Kawano T.
        • Dick W.
        • et al.
        Trends in care processes and survival following prehospital resuscitation improvement initiatives for out-of-hospital cardiac arrest in British Columbia, 2006–2016.
        Resuscitation. 2018; 125: 118-125
      4. Statistics Canada. Population Centre and Rural Area Classification 2016 2017. (accessed December 6, 2021).

        • Sedig K.
        • Seaton M.B.
        • Drennan I.R.
        • Cheskes S.
        • Dainty K.N.
        “Drones are a great idea! What is an AED?” novel insights from a qualitative study on public perception of using drones to deliver automatic external defibrillators.
        Resuscitation Plus. 2020; 4100033
        • Zègre-Hemsey J.K.
        • Grewe M.E.
        • Johnson A.M.
        • et al.
        Delivery of automated external defibrillators via drones in simulated cardiac arrest: users’ experiences and the human-drone interaction.
        Resuscitation. 2020; 157: 83-88
        • Starks M.A.
        • Blewer A.L.
        • Sharpe E.
        • et al.
        Bystander performance during simulated drone delivery of an AED for mock out-of-hospital cardiac arrest.
        J Am Coll Cardiol. 2020; 75: 303
        • Ragin D.F.
        • Holohan J.A.
        • Ricci E.M.
        • Grant C.
        • Richardson L.D.
        Shocking a community into action: a social marketing approach to cardiac arrests.
        J Health Soc Pol. 2005; 20: 49-70
        • Nielsen A.M.
        • Isbye D.L.
        • Lippert F.K.
        • Rasmussen L.S.
        Can mass education and a television campaign change the attitudes towards cardiopulmonary resuscitation in a rural community?.
        Scand J Trauma Resuscitation Emerg Med. 2013; 21