The number of out of hospital cardiac arrest (OHCAs) that occur in Sweden every year is really high and there are very few survivors. When a cardiac arrest happens the heart loses its original rhythm and to find it again the heart needs to be shocked within minutes. There is on going research to see what can be done to improve the survival rate. Publicly accessible defibrillators are one thing that is being implemented. Another solution being considered right now is the possibility of delivering a defibrillator by a drone, especially to places that are difficult to be reached by the ambulance. A test flight with this kind of drone will take place in Stockholm, Sweden in June 2015 and the purpose of this thesis was to analyze where the most suitable place would be to start the drone from for a test flight. The area studied was Stockholm County and the data used contained Out of Hospital Cardiac arrest occurrences between the years of 2006 and 2013 including the time it took for the ambulance to arrive at the scene. The analysis was done with Multi Criteria Evaluation. Multi Criteria Evaluation is a power spatial analysis tool that considers multiple criteria in decision-making environments. With Multi Criteria Evaluation suitable places can be found by adding different data and weighing them according to their importance. In this study a raster with interpolated values was produced from ambulance arrival times and this was weighed against a raster created from the density of previous OHCA cases. Results showed that the best place for a drone like this would be the city center since that is where most OHCAs occur but also the northern parts of the archipelago because of the time it takes for the ambulance to get there.

Cardiac arrest is the leading cause of death in the United States. By reviewing and analyzing the successes and failures of resuscitation efforts, it has been possible to identify critical components which have come to be known as the “Chain of Survival:” Early Recognition, Early CPR, Early Defibrillation, Early ALS, and Early Post Resuscitative Care. A failure in any one of the five links will result in a failed resuscitation. Early Recognition is the beginning of the resuscitation effort and includes a number of related components. Witnessed cardiac arrests, those that are seen or heard to occur, have a significantly higher chance of survival than those which are unwitnessed. Properly identifying agonal gasps: irregular, forceful, reflexive breaths which can occur during cardiac arrest, is key to recognition of arrest and activation of the emergency response system. Emergency dispatchers trained to recognize cardiac arrest, as well as to initiate Early CPR via telephonic instruction, have been identified as key personnel in the resuscitation effort. Once professional rescuers have been dispatched, response delays due to distance and traffic can be costly. The use of new technologies like GPS and traffic signal preemption (as well as the use of Police, Fire and EMS in conjunction) has been shown to make it possible to get qualified persons to the scene of a cardiac arrest more safely and more quickly. Once on scene, early, high quality CPR has been shown to dramatically improve survival. After just 8 minutes without assistance, a victim of cardiac arrest has a near zero percent chance of survival. CPR of high quality has been shown to help maintain survivability until more definitive care can be obtained. Early Defibrillation is another key component to survival in many cardiac arrests. While CPR can sustain organ function briefly, cardiac arrest is rarely reversed without defibrillation. Increasingly widespread prevalence of public automated external defibrillators (AEDs) has made Early Defibrillation easier. Furthermore, increased use of AEDs by lay and professional rescuers has called into question the value of more traditional, higher risk interventions like intubation and medication administration. Early ALS interventions have been a staple of resuscitation for decades, but there is little data to support the use of these interventions during cardiac arrest. Early Post-Resuscitative Care, however, has been shown to be an area where invasive ALS interventions can and do make a difference in improved survival. By looking at the body of research for links in the Chain of Survival, opportunities for improvement of resuscitation were identified. Persons who spend significant time around an individual at high risk for heart disease should be educated on possible precipitating symptoms of a myocardial infarct or other early signs of potential cardiac arrest. Persons likely to encounter a cardiac arrest should likewise be trained not only in how to recognize cardiac arrest (through the combination of unresponsiveness and abnormal breathing) but also to initiate basic care via compressions-only CPR. Emergency dispatchers should be increasingly trained to recognize cardiac arrest, as well how to effectively provide dispatcher assisted CPR. The focus of these efforts should be high quality CPR and the early deployment of defibrillation. The use of AEDs by bystanders should be encouraged whenever possible. The emphasis on CPR and use of an AED should be paramount, with invasive ALS interventions eschewed for the simpler and more effective therapies. Once ROSC has been obtained, the use of ALS interventions in unstable patients has been shown not only to prevent death due to transient hemodynamic instability, but also to improve the likelihood of survival with little to no neurological deficit. By embracing the chain of survival, and identifying the critical areas in need of research and improvement, it is possible to provide recommendations that may lead to improved survival from cardiac arrest.

When an out of hospital cardiac arrest (OHCA) occurs, time is of the utmost importance. For every minute that the arrest goes untreated, the chance of survival decreases rapidly. The most common treatment, that is also the most known, is Cardiopulmonary Resuscitation (CPR). Thanks to new technology, the defibrillator is no longer a tool only available to hospital personnel but to anyone who knows where they are located. The objective of this thesis is partly to visualize OHCA occurrences as well as visualize the differences in OHCA occurrences between locations and years. The thesis will analyze where the optimal locations of AEDs are based on a number of variables such as location and year, which is referred to as risk analysis. The analysis was performed by using daytime and nighttime population data from Statistics Sweden (SCB) in combination with heart disease statistics from the national patient register of Socialstyrelsen as well as socio-economic data from SCB. Along with that data, AED locations at the end of 2013 and OHCA data from 2006 up until 2013 was used in visualizations and risk analysis. In order to determine the final optimal placement through the risk analysis, a Geographical Information System (GIS) tool named Multi-Criteria Evaluation (MCE) was used. This tool enabled the weighting of the different parameters against each other, which was integral for the final result. In order to visualize differences, e.g. between two years, a raster was created which consisted of a density difference between the two years. This analysis method shows the spots where there is a majority of either case, e.g. if one area had a larger number of OHCA cases one year compared to previous year. Simple plots were included to show an overview of the problem e.g. where OHCA occurred between the years 2006 and 2013. The results implied that the recommended locations of AEDs while using daytime population data were located in commercial areas. Recommended AEDs from using the nighttime population data was located differently but was located as well as clusters in residential areas. A large source of error in the analysis was the prior heart disease data. The chosen method, an assignment of a percentage chance of heart disease per age group, is a rough and inexact approximation of the actual heart disease statistics. Had there been data about exactly where patients with prior heart disease live and work, the results would most likely be even better. / När ett hjärtstopp utanför sjukhus (OHCA) inträffar, är tiden av yttersta vikt. För varje minut som hjärtstoppet går obehandlat minskar snabbt chansen för överlevnad. Den vanligaste behandlingen, som även är den mest kända, är hjärt- och lungräddning. Tack vare ny teknik är defibrillatorn inte längre ett verktyg som endast är tillgänglig för sjukvårdspersonal utan för alla som vet var de finns. Syftet med denna uppsats är att delvis visualisera förekomsten av OHCA men även att åskådliggöra skillnaderna mellan platser och år. I studien analyseras även, baserat på ett antal variabler, var de optimala platserna för Automatiska Externa Defibrillatorer (AED) är. Denna del av analysen är benämnd som riskanalys. Analysen genomfördes med hjälp av att använda dag- och nattidsbefolkningsdata från Statistiska Centralbyrån (SCB) i kombination med hjärtsjuksdomsstatistik från Socialstyrelsens nationella patientsregister och även socioekonomiska data från SCB. Dessa data, samt AED data från slutet av 2013 och OHCA data daterat från 2006 till 2013 användes både till visualiseringen och till riskanalysen. För att bestämma de slutgiltiga optimala platserna genom riskanalysen användes ett Geografiskt Information System (GIS) verktyg som heter multikriterieanalys (MCE). Detta verktyg gör det möjligt att vikta de olika parametrarna mot varandra, vilket var väsentligt för det slutgiltiga resultatet. För att kunna visualisera skillnader, till exempel mellan två år, skapades ett raster som bestod av en densitetskillnad mellan de två åren. Denna analysmetod kunde sedan visualisera var det finns en majoritet av det ena fallet, till exempel om ett område hade fler hjärtstopp ett år jämfört med tidigare år. Enklare kartor användes för att ge en översikt, till exempel var OHCA har skett mellan åren 2006 och 2013. Resultatet tyder på att de rekommenderade platserna för AED då dagtidsbefolkningsdata användes hamnade i områden med många arbetsplatser. De optimala platserna för AED med nattidsbefolkningsdata var annorlunda utplacerade men hamnade även dem i kluster i befolkningstäta områden med mycket bostäder. En av de större felkällorna i analysen tros vara hjärtsjuksdomsstatistiken. Den metod som användes var att extrahera ålder- och könsgrupper från ett patientregister vilket är en grov och inexakt approximation av den faktiska hjärtsjuksdomsstatistiken. Hade tillgång till data om var befolkning med hjärtsjukdomar faktiskt bor och arbetar funnits, kunde resultatet blivit mer pålitligt.

The Analysis of Ilan¡¦s Out-of-Hospital Cardiac Arrest (OHCA) Patients Abstract The study uses Ilan¡¦s out-of-hospital cardiac arrest (OHCA) patients as the research object to understand the variable backgrounds of OHCA patients how they are affected by first aid factors between the period of pre-hospital and post-hospital admission. The study also discusses whether there is a correlation between first aid factors and first aid prognosis among those OHCA patients during pre-hospital and post-hospital admission periods. The study is retrospective and based on the Utstein style format. It collects 284 out-of-hospital cardiac arrest (OHCA) patient cases with trauma and non-trauma (282 effective samples) in an example of a regional teaching hospital in Ilan from 2007 to 2009. It uses descriptive statistics, independent sample t test, and Chi-Square test as the statistical analysis to obtain the following conclusions: 1. There are 282 effective sample patients in the study. There are 57 patients ( 20.2 %) who were return of spontaneous circulation (ROSC) after cardiac arrest approximately 14.77 minutes on average. There are 33 patients (11.7 % ) who survived to be hospitalized for 15.36 days on average, and there are 6 patients ( 2.1 % ) who were discharged from the hospital. 2. Internal medicine disease is the major causative factor of out-of-hospital cardiac arrest. Among those internal medicine disease cases, the history showed hypertension, diabetes mellitus, and heart diseases are the main causes of out-of-hospital cardiac arrest. Patients who are older than 65 years old are the main age groups, accounting for 67.7% of these cases. 3. The pre-hospital admission factors which affect the prognosis after the Emergency Department (ED) are the place of the accident, whether there are witnesses, scene process time , total reaction time , whether automatic external defibrillation was used, and whether people at the scene used CPR. 4. The post-hospital admission factors which affect the prognosis after the ED are initial cardiac rhythm, body temperature, pupil size , dose of epinephrine, whether defibrillation was used, the time of applying emergency first-aid, and medical expense. 5. The percentages of return of spontaneous circulation and survival rates in the study are lower than those of past studies of Taipei City and National Taiwan University Hospital. The possible factors are probably related to differences between rural and urban areas in the quality of emergency medical service systems (EMSS), and healthcare training. 6. From now on, in addition to improving the first-aid continuous monitoring system, we should also enhance EMT related training, and actively educate people to understand and learn CPR, so that comprehensive first-aid systems are available everywhere to effectively increase the success rate of first-aid. Keywords¡GOut-of-hospital cardiac arrest (OHCA), Cardiopulmonary resuscitation

Out-of-hospital cardiac arrest (OHCA) has become a leading cause of death in Sweden, while the useful tool external defibrillator (AED), which enables the heart to restart to beat, is not fully used. Prior studies have worked out various solutions to promote the use of AEDs. However, those studies only delved into the situation in certain areas but barely fit the conditions in Sweden. In addition, few of the studies explored the cause of low use of AEDs from the perspective of users. This work investigated the drawbacks in the current situation in Sweden and users’ thoughts towards using AEDs. As a result, this thesis presented a persuasive design, a group of embedded functions in Google Maps. The main effects of the design are: 1. Endowing bystanders with knowledge of where AEDs are located and how to manage the device 2. Facilitating the process of seeking and retrieving the devices and creating a channel for bystanders to sought help. The prototype was further evaluated through Heuristic Evaluation. The study results showed the design successfully made a persuasive impact on bystanders to change their attitudes by offering instruction for them to seek and control AEDs. The design also remedied deficiencies in the current situation of using AEDs in Sweden. Lastly, the study concluded persuasive design can play a role to facilitate the use of AEDs, thus improving the survival rate of OHCAs.

Bakgrund: Årligen drabbas cirka 5000 personer i Sverige av ett hjärtstopp utanför sjukhus. Tidig start av hjärt- och lungräddning är en förutsättning för ökad överlevnad vid ett hjärtstopp, samtidigt visar forskning på att ambulansens framkörningstid har ökat. I väntan på ambulans har sms-livräddare implementerats för att påbörja livräddande åtgärder. I dagsläget finns få studier gjorda på sms-livräddares erfarenheter och insatser vid accepterat hjärtstoppslarm, för att synliggöra hinder och eventuella fysiska och psykiska påfrestningar som de kan möta. Vid ett hjärtstopp arbetar ambulanssjuksköterskan och sms-livräddare tillsammans i team, detta gör det viktigt för ambulanssjuksköterskan att ha en ökad förståelse för sms-livräddares erfarenheter.  Syfte: Studiens syfte var att beskriva sms-livräddares erfarenheter och insatser i samband med ett accepterat hjärtstoppslarm. Metod: En blandad metod enkätstudie med en explorativ sekventiell design användes. Materialet utgick från 1231 enkäter som samlats in av Heartrunner Sweden. Materialet analyserades i tre faser. Resultat: Resultatet visade på att sms-livräddare möttes av flera hinder som medförde att deras insatser försvårades eller uteblev. Resultatet resulterade i fyra kategorier: Erfarenheter av utlarmning, Hjärtstartare, Samverkan i team och emotionella reaktioner. Sms-livräddare upplevde många känslor i samband med larmet som visade på ett eventuellt behov av debriefing. Slutsats: Trots negativa erfarenheter var 99,9% av sms-livräddarna motiverade att fortsätta sina insatser i framtiden. Resultatet tyder på att sms-livräddare hade en viktig roll i samverkan med ambulans och räddningstjänst. Sms-livräddare kunde behöva mer bekräftelse för deras insatser och stöttning för eventuella känslor som kunde uppkomma vid larm om misstänkt hjärtstopp utanför sjukhus. / Background: Every year, approximately 5000 people in Sweden suffer an out-of-hospital cardiac arrest. Early start of cardiopulmonary resuscitation is a prerequisite for increased survival in a cardiac arrest, while research shows that ambulance arrival time has increased. While waiting for an ambulance, mobile-phone dispatch of laypersons has been implemented to initiate life-saving measures. At present, few studies have been conducted on the experiences and interventions of mobile-phone dispatch of laypersons in the event of an accepted cardiac arrest alarm, in order to highlight obstacles and any physical and psychological stresses that they may face. In a cardiac arrest, the ambulance nurse and mobile-phone dispatch of laypersons work together in teams, this makes it important for the ambulance nurse to have an increased understanding of mobile-phone dispatch of laypersons ' experiences. Aim: The aim of the study was to describe mobile-phone dispatch of laypersons experiences and interventions in connection with an accepted cardiac arrest alarm. Method: A mixed method survey study with an explorative sequential design was used. The material was based on 1231 questionnaires collected by Heartrunner Sweden. The material was analysed in three phases. Results: The results showed that mobile-phone dispatch of laypersons were faced with several obstacles that made their interventions difficult or absent. The study resulted in four categories: Experience in emergency response, defibrillators, teamwork and emotional reactions. Mobile-phone dispatch of laypersons experienced many emotions in connection with the alarm, indicating a possible need for debriefing. Conclusion: Despite negative experiences, 99.9% of mobile-phone dispatch of laypersons were motivated to continue their interventions in the future. The result suggests that mobile-phone dispatch of laypersons had an important role in collaboration with ambulance and rescue services. Mobile-phone dispatch of laypersons could benefit from more acknowledgement of their interventions and support for any emotions that may arise when a suspected cardiac arrest is reported outside a hospital.

Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2018-07-13T12:02:18Z No. of bitstreams: 1 DAVID_PONCIANO_DE_SENA.pdf: 7136289 bytes, checksum: 63e5ded0ad929d80daf354b846f5dd28 (MD5) / Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2018-07-18T12:59:17Z (GMT) No. of bitstreams: 1 DAVID_PONCIANO_DE_SENA.pdf: 7136289 bytes, checksum: 63e5ded0ad929d80daf354b846f5dd28 (MD5) / Made available in DSpace on 2018-07-18T13:04:40Z (GMT). No. of bitstreams: 1 DAVID_PONCIANO_DE_SENA.pdf: 7136289 bytes, checksum: 63e5ded0ad929d80daf354b846f5dd28 (MD5) Previous issue date: 2018-04-12 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Aim of the Study: The purpose of this study was to develop and validate a serious game for mobile platforms comparing with a video-assisted self-learning method to assist in the teaching and learning process of cardiopulmonary resuscitation (CPR) maneuvers. In a traditional training, CPR is based on learning by doing using a simulated model with the assistance of an instructor. However, this model presents an overall higher cost and less accessibility, provoking the need for cheaper and more accessible alternative methods. Methods: Forty-five volunteer first-year medical students completed a written multiple choice and practical pretest about CPR maneuvers skills and were randomly allocated into two groups. During a period of 20 minutes, the video self-learning group with 22 students was exposed to a video-based training about CPR, while the video game group with 23 students used a serious game simulating a cardiac arrest scenario where the student should perform virtual CPR to keep playing the game. Each group then performed, a written multiple choice score and practical post-test on a CPR training model while being evaluated by three blinded emergency doctors based on 2015 AHA-BLS (American Heart Association - Basic Life Support) protocol. Both groups were also evaluated about how long they kept interested on each self-learning system. Results: The video group had superior performance as confirmed by a written multiple choice score 7.56+-0.21 against 6.51+-0,21 for a video game (p=0. 001) and practical scores 9.67+-0.21 against 8.40+-0,21 for a video game (p<0. 001). The video game group stayed longer using the method as confirmed by 18.57+- 0,66 minutes for video game group and 7.41+-0,43 for the video group (p<0. 001), demonstrating greater interest in the video game method. Conclusions: The group that used a video game as a self-training method in a short period of exposure had a lower performance than the video group in both the theoretical and practical tests regarding cardiorespiratory resuscitation. However, there was a clear preference for students to use games rather than videos as a form of self-training. / Objetivo do estudo: O objetivo deste estudo foi desenvolver e validar um jogo s?rio para plataformas m?veis em compara??o com um m?todo de autoaprendizagem assistido por v?deo para auxiliar no processo de ensino e aprendizagem das manobras de ressuscita??o cardiopulmonar (RCP). Em um treinamento tradicional, a RCP ? baseada no aprendizado pela pr?tica, utilizando um modelo simulado com a ajuda de um instrutor. No entanto, este modelo apresenta um custo global mais elevado e de menor acessibilidade, despertando a necessidade de m?todos alternativos mais baratos e pratic?veis. M?todos: Quarenta e cinco volunt?rios, estudantes de medicina do primeiro ano, completaram um pr?-teste de m?ltipla escolha escrito e um pr?-teste pr?tico sobre RCP e foram alocados aleatoriamente em dois grupos. Durante um per?odo de 20 minutos, o grupo de autoaprendizagem v?deo, composto por 22 alunos, foi exposto a um v?deo de treinamento sobre a RCP, enquanto o grupo videogame, composto por 23 estudantes, utilizou um jogo s?rio, simulando um cen?rio de parada card?aca, onde o aluno deveria executar uma RCP virtual para continuar jogando. Ao t?rmino do treinamento, cada grupo foi submetido a um p?s-teste escrito de m?ltipla escolha e um p?s-teste pr?tico em um modelo de treinamento de RCP, sendo avaliados de forma cegada, por tr?s m?dicos com experi?ncia em atendimento de emerg?ncia, com base no protocolo 2015 AHA-BLS (American Heart Association - Basic Life Support). Ambos os grupos tamb?m foram avaliados quanto a quantidade de tempo que eles permaneciam interessados em cada sistema de autoaprendizagem. Resultados: O grupo v?deo apresentou desempenho superior confirmado por uma maior pontua??o no teste escrito de m?ltipla escolha, 7.56 + -0.21 contra 6.51 + -0,21 para videogame (p = 0. 001) e pontua??o no teste de avalia??o pr?tica 9,67 + -0,21 contra 8,40 + -0,21 para videogame (p <0. 001). O grupo videogame permaneceu mais tempo utilizando o m?todo, 18,57 + - 0,66 minutos para o grupo videogame e 7,41 + -0,43 para o grupo v?deo (p <0. 001), demonstrando maior interesse no m?todo do videogame. Conclus?es: O grupo que usou o jogo s?rio (grupo videogame) como um m?todo de autotreinamento em um curto per?odo de exposi??o teve um desempenho pior do que o grupo v?deo nos testes te?ricos e pr?ticos em rela??o ? ressuscita??o cardiopulmonar. No entanto, houve uma clara prefer?ncia por parte dos alunos em utilizar jogos em rela??o aos v?deos como forma de autotreinamento.

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Bakgrund Vid ett prehospitalt hjärtstopp krävs utöver hjärt- och lungräddning med bröstkompressioner och defibrillering med hjärtstartare, även avancerad luftvägshantering för att skapa en fri luftväg vilket ambulanssjuksköterskan ansvarar för. Det finns en mängd olika luftvägshjälpmedel som ambulanssjuksköterskan kan använda sig av. För en del sjuksköterskor inom ambulanssjukvården kan en viss osäkerhet kring användningen av luftvägshjälpmedel finnas då de kan sakna rätt kompetens, utbildning eller ej fått tillräcklig träning i användandet för att utföra det på ett patientsäkert sätt.   Syfte Syftet med denna studie var att jämföra prehospitala luftvägshjälpmedel vid hjärtstopp utanför sjukhus i förhållande till överlevnad.   Metod Studien är en litteraturöversikt med kvantitativ ansats. Studien genomfördes genom en systematisk sökning av vetenskapliga artiklar vilka har jämfört olika luftvägshjälpmedel vid prehospitala hjärtstopp. Databaser som PubMed och CINAHL har främst använts. De utvalda artiklarna har kvalitetsgranskat.   Resultat Två huvudfynd framkom där mask- och blåsa var korrelerad till högre prevalens av överlevnad och där endotracheal intubering var korrelerad till högre prevalens att uppnå återkomst av spontan cirkulation.   Slutsats Av de inkluderade artiklarna visar resultatet på att mask- och blåsa är bästa alternativet för överlevnad och att endotracheal intubering är bästa alternativet för att uppnå återkomst av spontan cirkulation under ett prehospitalt hjärtstopp. Dock bör slutsatsen tas med försiktighet då resultaten kan skilja sig och bero på en mängd olika faktorer som skiljer sig åt i de olika studierna. / Background In addition to cardiac and pulmonary rescue with chest compressions and defibrillation with defibrillator, pre-hospital cardiac arrest also requires advanced airway management to create a clear airway for which the ambulance nurse is responsible. There are a variety of respiratory aids that the ambulance nurse can use. For some nurses in ambulance care, there may be some uncertainty about the use of respiratory aids as they may lack the right skills, education or have not received sufficient training in the use of it to perform it in a patient-safe manner.   Aim The purpose of this study was to compare prehospital airway aids in cardiac arrest outside of hospital in relation to survival.   Method The study is a literature review with a quantitative approach. The study was conducted through a systematic search of scientific articles comparing different respiratory aids at prehospital cardiac arrest. Databases such as PubMed and CINAHL have mainly been used. The selected articles have been quality checked.   Results Two main findings emerged where bag valve mask was correlated to higher prevalence to survival and where endotracheal intubation was correlated to higher prevalence to achieve return of spontaneous circulation.    Conclusion Of the included articles, the results indicate that bag valve mask is the best option for survival and that endotracheal intubation is the best option for achieving return of spontaneous circulation during a prehospital cardiac arrest. However, the conclusion should be taken with caution as the results may differ and depend on a variety of factors that differ in the different studies.