Development of a health geomatics analysis framework to evaluate cardiac arrests in Lombardy: New information for decision-making

Cardiac arrest (CA) is an unpredictable event whose deleterious consequences can be minimized only by an immediate medical intervention in the first six minutes from the event, including cardiac defibrillation with automated external defibrillator (AED). Knowledge of AED distribution on a specific territory is functional to potentially provide immediate assistance while waiting for ambulance arrival. Our aim was to apply a health geomatic framework to map CAs occurred in Lombardy region in Italy along the year 2015, and known AED locations to retrospectively obtain new information that could be used to optimize AED placement over the considered territory. Results showed 10686 CAs and 6212 AED in all Lombardy region, with CA incidence in the range 0.7-1.27% and AED availability in the range 0.4-1.24% of inhabitants in the 15 healthcare districts in which Lombardy was divided. For the city of Milan, connected points reached within the same time (i.e., isochrones) were created starting from the position of each known AED and considering the distance traveled in a 6 min roundtrip at different walk speeds, showing 14% of potential territory coverage. A retrospective analysis of the 4005 CAs occurred in 2015 in the city of Milan showed that, despite an AED was within a 3-min range of a CA in 55% of the cases, only in less than 2% an AED was utilized. Health geomatics approaches provide new ways to look at existing information that could be used in decision-making processes to guide resources distribution on the Lombardy territory, while improving CA emergency care.