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Geographic mapping strategies advance cardiac-arrest intervention in Denver, paving the way for officials to focus resources on where they could save more lives

Standing in the parking lot of your local grocery store, you see a person collapse in sudden cardiac arrest.

Do you rush to the victim to perform CPR? Are you even trained to intervene?

 and  contend that where you live will significantly affect your reaction.

Root, an assistant professor of geography at the University of Colorado Boulder, and Sasson, associate professor of emergency medicine at the CU School of Medicine and the Colorado School of Public Health, recently identified areas in Denver where the population is at higher risk of death from cardiac arrest partly because bystanders don’t intervene.

“In some of our Denver neighborhoods, not a single person has had bystander CPR performed, while literally across the street 40 percent of cardiac arrest victims have had CPR,” Sasson explains.

Receiving bystander CPR can double or triple a victim’s chance of survival, according to the American Heart Association. But if you’re the victim, you have a better chance of receiving CPR from a bystander in Denver’s Capitol Hill neighborhood than in Five Points.

The aim of the study, which was published in December in the journal , was to isolate these areas for outreach, and put public-health resources in the hands of the community.

Using a composite of specially selected geographic identification methods, the researchers cross-referenced out-of-hospital cardiac arrest (OHCA) rates with frequency of bystander CPR, for Denver’s 142 census tracts. The research team was led by Ariann F. Nassel of the University of Alabama and included Kevin McVaney and Christopher Colwell of the CU Department of Emergency Medicine in Denver and Jason S. Haukoos of the CU Emergency Medicine Department and the Colorado School of Public Health.

OHCA is a critical distinction, indicating that a victim’s heart has stopped in a non-clinical place such as a home or shopping area—rather than a hospital or nursing home, where intervention is readily available.

We are now able to focus our resources in the neighborhoods in which we can have the greatest impact. Where you drop should not determine whether or not you will survive.

As the first study in this topic to use the combination of analytical tools, it could help officials maximize limited public-health resources.

“The idea is that targeted interventions are more cost effective and easier to implement than covering the whole city of Denver,” Root says.

Consistent with prior research, the study re-established that high-poverty areas tend to have both risk factors: high incidence of out-of-hospital cardiac arrest and little or no bystander CPR.

While Root stresses that theories about why are untested, she says scholarly literature on neighborhoods and health show people are often unwilling to engage in behaviors if they are fearful for their own well-being.

“They may be fearful of touching people, and especially giving CPR,” she says, adding that people fear both crime and disease. “From the limited literature on this topic, it certainly seems like a possible reason.”

But researchers have found another major determinant is simply the community’s lack of access to resources and training.

“In Boulder, you would go sign up and pay for a CPR program,” Root explains. “That doesn’t happen in some of these high-poverty areas. “People aren’t willing to pay, and the programs may not exist.”

To address training shortfalls, CU faculty are already working on the ground to increase the odds of survival in OHCA, using community-based intervention strategies enhanced by the geographic research.

“I think this is a really good example of how good social science, and geography specifically, can and should play a leading role in public-health research,” Root says.

She adds that research is only as useful as its applications, and when it comes to cardiac arrest, applying the science is critical.

“I am more interested in policy implications of research,” Root says. “I would like to see the research translated into effective programming.”

Launching effective programs involves engaging influencers—community leaders who can encourage and facilitate CPR training classes in social gathering places such as churches, recreation centers and even barbershops.

The American Heart Association (AHA) has jumped on board with the targeted community outreach effort, thanks to Root and Sasson’s work.

“Ultimately, with the work we have done here in Colorado, we are going to try to shift the paradigm of CPR training completely,” says Sasson, who also serves as the AHA’s National Director of Community Markets and Programs for CPR and First Aid.

The AHA has created a national program to organize CPR training in the highest-risk areas instead using a blanket approach.

“We are now able to focus our resources in the neighborhoods in which we can have the greatest impact,” Sasson says. “Where you drop should not determine whether or not you will survive.”

Also collaborating on the research were the following: Ariann F. Nassel of the University of Birmingham; Jason S. Haukoos, Kevin McVaney and Christopher Colwell of the Department of Emergency Medicine at CU in Aurora; James Robinson of the Denver Health and Hospital Authority; Brian Eigel of the American Heart Association; and David J. Magid of Kaiser Permanente.

Meagan Taylor is a CU-alumna and local freelancer who is certified in CPR/AED and First Aid by the American Red Cross.