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Open Access Open Badges Original research

Developing an analytical tool for evaluating EMS system design changes and their impact on cardiac arrest outcomes: combining geographic information systems with register data on survival rates

Björn Sund

Author Affiliations

Swedish Civil Contingencies Agency (MSB), Karlstad, Sweden

Department of Economics and Statistics, Karlstad Business School, Karlstad University, Karlstad, Sweden

Swedish Business School, Örebro University, Örebro, Sweden

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2013, 21:8  doi:10.1186/1757-7241-21-8

Published: 15 February 2013



Out-of-hospital cardiac arrest (OHCA) is a frequent and acute medical condition that requires immediate care. We estimate survival rates from OHCA in the area of Stockholm, through developing an analytical tool for evaluating Emergency Medical Services (EMS) system design changes. The study also is an attempt to validate the proposed model used to generate the outcome measures for the study.

Methods and results

This was done by combining a geographic information systems (GIS) simulation of driving times with register data on survival rates. The emergency resources comprised ambulance alone and ambulance plus fire services. The simulation model predicted a baseline survival rate of 3.9 per cent, and reducing the ambulance response time by one minute increased survival to 4.6 per cent. Adding the fire services as first responders (dual dispatch) increased survival to 6.2 per cent from the baseline level. The model predictions were validated using empirical data.


We have presented an analytical tool that easily can be generalized to other regions or countries. The model can be used to predict outcomes of cardiac arrest prior to investment in EMS design changes that affect the alarm process, e.g. (1) static changes such as trimming the emergency call handling time or (2) dynamic changes such as location of emergency resources or which resources should carry a defibrillator.

Out-of-hospital cardiac arrest; Defibrillation; Response time; Survival rate; Geographic information systems; Fire services