Health geomatics framework to evaluate cardiac arrests in Lombardy - new tools for decision making

Development of a Health Geomatics
analysis framework to evaluate cardiac
arrests in Lombardy.
New information for decision-making
POLITECNICO DI MILANO
Marelli G1, Munoz C2, Brambilla P3, Sesana G3, Pagliosa A3,
Brovelli M 2, Caiani EG 1
1Eletronics, Information and Biomedical Eng. Dpt., Politecnico di Milano, Milan, Italy
2Environmental and Civil Eng., Politecnico di Milano, Milan, Italy
3Azienda Regionale Emergenza Urgenza (AREU), Milan, Italy

Introduction: Cardiac Arrest (CA)
Cardiac Arrest (CA) represents
a global major health problem:
in Italy, one over 1000
inhabitants loses his/her life
every year.
temporary
malfunction of
the cardiac
electric
conduction
system
arrhythmias VF CA
Car accidents: 0.06/1000
AIDS : 0.02/1000
enrico.caiani@polimi.it

Introduction: Cardiac Arrest (CA)
Consequences can be very
serious, as after 5-6
minutes brain cells, if not
opportunely oxigenated,
start dying.
Outcome from out-of-hospital CA (OHCA) remains poor: only
10.8% of adult patients with non-traumatic cardiac arrest who
have received resuscitative efforts from emergency medical
services (EMS) survive to hospital discharge [AHA Guidelines
Update 2015]

Introduction: Chain of Survival
Start immediately the actions prescribed in the Chain of
Survival.

Introduction: Cardiac Defibrillation
A proper distribution of AED on the territory is essential for
possible lay rescuers to access it when witnessing a CA, thus
increasing survival rate.

Aims of the work
• to analyze by health
geomatics techniques
the 2015 CA and
AED database
relevant to the
Lombardy Region in
Italy
• to retrospectively
focus on CA events
distribution and AED
coverage of the city
of Milan
We hypothesized that
approaches based on
health geomatics
applied to CA could
provide useful
information about the
distribution of events
and the definition of
strategies for
relocating
emergency
resources on a
specific territory.

Methods:Health Geomatics
Health Geomatics: gathering, storing, processing, and
delivering geographic information related to health through a
Geographical Information System
Location can influence
health (Hyppocrates, III b.c.)
John Snow

Methods: Cardiac Arrests in Lombardy in 2015
Fields in the database:
• Age and sex of the patient
• Geolocalization and date/time of the call
• Arrival time of the emergency medical services
• PCR: yes/no
• Result of PCR
• Utilized AED: yes/no
• Result of the emergency care
Geographical
information converted
into the WGS 84 -
UTM 32 Nord
coordinate reference
system

Methods: Open Access data relevant to Lombardy
Resident population
data for all towns in
Lombardy at 31/12/15,
divided by sex and age
Position of 6212 AED
in Lombardy
Cartography of towns,
provinces and
healthcare districts
(Aziende Sanitarie
Locali, ASL)
Open streets and
intersections

Methods: Merging and summarizing information
Chosing the proper subdivision of the territory for data merging:
1530 Towns
8 actual healthcare
discricts (ATS)
15 old healthcare
districts (ASL)

Results: Mapping CA in Lombardy
CA at home CA outside
At
home
87%
Out
13%
10686 CA events

Results: Mapping AED in Lombardy
ASL Code ASL Name # AED POPULATION
100*
DAE/POPULATION
(%)
1 Bergamo 806 1108298 0.073
2 Brescia 951 1163407 0.082
3 Como 426 599654 0.071
4 Cremona 168 360444 0.047
5 Lecco 202 339254 0.060
6 Lodi 148 236756 0.063
7 Mantova 252 412868 0.061
8 Milano 642 1615775 0.040
9 Milano 1 559 952855 0.059
10 Milano 2 341 632536 0.054
11 Monza e della Brianza 557 866076 0.064
12 Pavia 393 547926 0.072
13 Sondrio 117 181712 0.064
14 Varese 437 890090 0.049
15 Vallecamonica-Sebino 125 100698 0.124
Non-uniform distribution in
respect to the number of
residents, with a minimum of
4‰ (ASL 8) to a maximum of
10 ‰ (ASL 15).
Further analysis on
CA events distribution
and AED potential
coverage using
isochrones

Methods: Isochrones computation
Isochrones are temporal lines drawn on a map
connecting points that can be reached at the same
time from the same starting point.
RADIAL
REALISTIC:
real path on existing roads

Methods: Isochrones computation
DAE position
Closest road intersection
Network analysis: Milan’s
streets were considered as a
graph, formed by edges (the
streets), and nodes (their
intersection), with AED
position approximated by the
closest node.
15 Weight for each
edge: distance
PostgreSQL (http://www.postgresql.org) with pgRouting (http://pgrouting.org/)
and PostGIS https://postgis.net) extensions were used.
Realistic isochrones centered in each AED position, using as
parameter the distance that can be traveled in a roundtrip of 6
minutes, at three different walk speeds: 1.5 m/s (270 m), 2 m/s
(360 m) and 3 m/s (540 m).

Results: Milan territory covered by AED
3 m/s speed
realistic isochrones
Territory covered:
1.5 m/s  3.9%
2 m/s  7.1%
3 m/s  14.2%
4005 CAs events:
3556 at home, 449 outside
Median time of arrival:
9 min (7;12).
AED used in 1.5% cases
Not used: 45.8%
Unknown: 52.7%
Retrospective graphical analysis:
• 57% of CAs at home and 53% of CAs
outside potentially covered by one AED
within 540 m
• AED effectively used by laymen in
0.7% and 2% of cases only, respectively.

Limitations
• In isochrones computation:
- complete accuracy of the Milan road network topology
not guaranteed, as open data
- approximation of AED position with the closest node
- only ground level considered
• In available information:
- Missing data on AED utilization in >50% of CA events
- Missing data on >1 laymen presence at CA location
- AED inaccessible in certain hours not considered

Conclusions
Combined with the retrospective analysis of the effective
use of AED in CAs in Milan city in 2015, it showed that
AEDs were very rarely used by laymen, while waiting for
ambulance arrival, besides their potential availability.
Health geomatics approaches represent an additional tool
to assess the incidence of a disease on a specific territory,
and to evaluate the distribution of resources, useful for
designing spatial optimization strategies.
New strategies are needed to improve AEDs coverage of
the territory, citizen’s awareness about AEDs location and
how to use them, and active tools to alert possible nearby
rescuers.

Join us!
Acknowledgements
European Union H2020-TWINN-2015 (project
“Linking excellence in biomedical knowledge and
computational intelligence research for
personalized management of Cardio Vascular
Disease within Personalized Health Care”).

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