Identification of priority areas for public-access automated external defibrillators (AEDs) in metropolitan areas: A case study in Hangzhou, China

Out-of-hospital cardiac arrest (OHCA) is a major health concern in China. The use of automated external defibrillators (AEDs) has received great attention from Chinese public healthcare departments as a useful intervention to address OHCA, and there is a growing need to place AEDs throughout the urban built environment. However, due to the lack of a publicly available, geocoded dataset of historical OHCA cases, there is not a coherent approach for identifying priority areas for AEDs placement in this country. This study attempts to fill this gap by examining the spatial disparity of OHCA risk in Hangzhou, China, and then proposing a Geographic Information Systems(GIS) based model that incorporates the urban land cover, vulnerable groups, and transportation accessibility to identify priority areas at the hexagon level for future AEDs placement. Results show that: (1) the hexagons with the highest level of OHCA risk (ranked Group 1) are accounting for 9.87%–16.71% and are spatially dispersed. (2) A large high-risk cluster was identified in the western region of the Qiantang district. (3) Nearly one-fifth of the new AEDs are recommended to install in Phase I, more than 60% in Phase II, and the remainder in Phase III. (4) Xiaoshan district requires the most AEDs, while Linping district requires the fewest. Ultimately, these results guide future placement of the AED facilities in the cities, particularly those with no geocoded OHCA historical data.