Coffee shops, ATMs provide best out-of-hospital cardiac arrest coverage in Toronto

Coffee shops and bank automated teller machines (ATMs) offered the best out-of-hospital cardiac arrest coverage in Toronto from 2007 to 2015, according to a retrospective, population-based cohort study.

Lead researcher Christopher L.F. Sun, BASc, of the University of Toronto, and colleagues published their results online in Circulation on March 20. The study was funded by a Zoll Foundation grant.

Although the use of automated external defibrillators (AEDs) has been shown to increase survival following out-of-hospital cardiac arrest, the researchers noted that bystander AED use remained low. They added that out-of-hospital cardiac arrests were associated with a less than 10 percent survival rate and approximately 400,000 deaths in North America each year.

For this analysis, the researchers evaluated a cardiac arrest database and identified all nontraumatic, out-of-hospital cardiac arrests that occurred in public locations in Toronto from January 2007 through December 2015. They also obtained data on all registered AEDs in Toronto as of March 2015 and converted the geographical data for the location of each out-of-hospital cardiac arrest episode to the Universal Transverse Mercator format.

Of the 27,650 nontraumatic out-of-hospital cardiac arrests that occurred from 2007 to 2015 in Toronto, 2,654 occurred in a public setting, including 506 in the downtown area. They identified 41 businesses and municipal locations and calculated the total number of their facilities.

The researchers considered assumed coverage as the total number of out-of-hospital cardiac arrests that occurred within 100 meters of their facilities. They defined actual coverage as the total number of out-of-hospital cardiac arrests that occurred within 100 meters of their facilities and when the respective facility was open on the basis of its hours of operations. They also defined coverage loss as assumed 24/7 coverage minus actual coverage divided by assumed 24/7 coverage and defined coverage efficiency as the actual coverage divided by the number of facilities.

The top-ranked businesses were Tim Hortons (act
al coverage of 286), Royal Bank of Canada ATMs (actual coverage of 243) and Subway restaurants (actual coverage of 228). Eight of the top 10 locations were coffee shops (Tim Hortons, Starbucks and Second Cup) and ATMs of the five major Canadian banks (Royal Bank of Canada, Bank of Nova Scotia, Canadian Imperial Bank of Commerce, Toronto-Dominion Bank and Bank of Montreal). Those same eight locations ranked in the top 10 of actual coverage in the downtown area, although they were in a different order.

The researchers also found that the top-ranked businesses in coverage efficiency were 7-Eleven (coverage efficiency of 1.92), Burger King (coverage efficiency of 1.73) and Second Cup (coverage efficiency of 1.39). Meanwhile, the businesses with the largest coverage loss were Wendy’s (coverage loss of 78.6 percent), UPS Stores (coverage loss of 67.7 percent) and Scotiabank branches (coverage loss of 62.9 percent).

In the downtown area, the top-ranked businesses by actual coverage were Starbucks (actual coverage of 110), Tim Hortons (actual coverage of 97) and Royal Bank of Canada ATMs (actual coverage of 94). The top-ranked businesses by coverage efficiency were Burger King (coverage efficiency of 4.25), 7-Eleven (coverage efficiency of 3.50) and Pizza Nova (coverage efficiency of 3.17), while the largest coverage losses occurred at religious schools (coverage loss of 100 percent), public schools (coverage loss of 77.8 percent) and private schools (coverage loss of 71.4 percent).

The researchers cited a few limitations of the study, including that they only collected the hours of operation once and that the hours may fluctuate during the year. They also assumed each of the facilities were present every year, which might not have been the case. In addition, they only included franchises with at least 20 locations in Toronto. Further, they noted that the results might not be generalizable to other cities and that public out-of-hospital cardiac arrests only make up a minority of out-of-hospital cardiac arrests.

“Health organizations and policy makers focused on developing public-access defibrillator programs can use our rankings to identify businesses and municipal locations to develop partnerships for automated external defibrillator deployment and public-access defibrillator programs,” the researchers wrote. “These private-public partnerships with businesses and municipal locations may provide benefits such as financial support and increased automated external defibrillator awareness and accessibility and reduce the barriers to automated external defibrillator deployment and distribution.”