ORIGINAL RESEARCH Implications for public access defibrillation placement by non-traumatic out-of-hospital cardiac arrest occurrence in Singapore Nur Diana ZAKARIA, 1 Marcus Eng Hock ONG, 2,3 Han Nee GAN, 4 David FOO, 5 Nausheen DOCTOR, 2 Benjamin Sieu-Hon LEONG, 6 E Shaun GOH, 7 Yih Yng NG, 8 Lai Peng THAM, 9 Rabind CHARLES, 10 Nur SHAHIDAH, 2 Papia SULTANA 11 and Venkataraman ANANTHARAMAN 2 for the PAROS study group 1 Yong Loo Lin School of Medicine, National University Health System, Singapore, 2 Department of Emergency Medicine, Singapore General Hospital, Singapore, 3 Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, 4 Accident and Emergency Department, Changi General Hospital, Singapore, 5 Department of Cardiology, Tan Tock Seng Hospital, Singapore, 6 Emergency Medicine Department, National University Hospital, Singapore, 7 Department of Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore, 8 Medical Department, Singapore Civil Defence Force, Singapore, 9 Children’s Emergency, KK Women’s and Children’s Hospital, Singapore, 10 Emergency Medicine Department, Alexandra Hospital, Singapore, and 11 Department of Statistics, University of Rajshahi, Bangladesh Abstract Introduction: The American Heart As- sociation recommends automated ex- ternal defibrillator placement in public areas with a high probability (>1) of out-of-hospital cardiac arrest (OHCA) occurring in 5 years. We aimed to de- termine the incidence rate of OHCA for different location categories in Singapore. Methods: Cardiac arrest incidence was obtained from a national registry. De- nominators for the actual number of sites per location category were ob- tained from public accessible sources, government officers and purchased sta- tistics. Analysis was performed and ex- pressed in terms of the corresponding 95% confidence interval (CI). Results: From 1 October 2001 to 14 October 2004, 2254 non-trauma OHCA cases were included. Mean age for arrests was 62.2 years, with 67.5% men. The location category with the highest incidence of cardiac arrests per site per 5 years was Port/Airport/ Immigration Checkpoints (5.24 CI [3.66–7.20]). Top individual site with high average incidence of cardiac arrests per 5 years was Changi Airport (25.0 CI [16.18–36.90]). Seventy- one per cent of arrests occurred in resi- dential areas. The postal sector with the highest average incidence per 100 000 population was Bedok Res- ervoir (54.89), whereas that with the highest population density was Bukit Merah/Alexandra with 348.14 popu- lation per 100 km 2 . Conclusion: In this study, we found the categories and individual sites that clearly fulfilled the American Heart As- sociation criteria of at least 1 OHCA per site per 5 years. This study pro- vides a model of how cardiac arrest registry data can be used to guide local health policy on automated external defibrillator deployment. Key words: cardiopulmonary re- suscitation, emergency medical service, Geographic Information Systems, public access defibrillation, resuscitation. Introduction Out-of-hospital cardiac arrest (OHCA) is a global health problem. 1 In Correspondence: Associate Professor Marcus Eng Hock Ong, c/o Department of Emer- gency Medicine, Singapore General Hospital, Outram Road, Singapore 169608. Email: marcus.ong.e.h@sgh.com.sg Nur Diana Zakaria, MBBS (Singapore), Medical Officer; Marcus Eng Hock Ong, MBBS (Singapore), MPH, Senior Consultant; Han Nee Gan, MBBS (Singapore), MMed (Emer- gency Medicine), MRCS (A&E), Consultant; David Foo, MBBS (Melbourne), MRCP (UK), FAMS (Cardiology), FACC, Senior Consultant; Nausheen Doctor, MBBS (Sin- gapore), MMed (Emergency Medicine), MRCSEd, Consultant; Benjamin Sieu-Hon Leong, MBBS (Singapore), MRCSEd, MMed (Emergency Medicine), Senior Consultant; E Shaun Goh, MBBS (Melbourne), MRCSEd, Consultant; Yih Yng Ng, MBBS (Singapore), MRCSEd, Chief Medical Officer; Lai Peng Tham, MBBS (Singapore), MMed (Paedi- atrics), Senior Consultant; Rabind Charles, MBBS (Singapore), FRCSEd, Senior Con- sultant; Nur Shahidah, BA (Psych with Business), Research Coordinator; Papia Sultana, PhD, Biostatistician; Venkataraman Anantharaman, MBBS (Singapore), MRCP, FRCSEd (A&E), Senior Consultant. Accepted 7 November 2013 Key findings • Categories that fulfilled the AHA criteria of at least 1 OHCA per site per 5 years were Ports, Airports and Immigration Checkpoints. • PAD programme at these sites would be the most cost-effective in saving lives. • These findings will be useful to advise AED placement in Singa- pore and serves as a model to guide local health policy on AED deployment. Emergency Medicine Australasia (2014) 26, 229–236 doi: 10.1111/1742-6723.12174 © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine