The geographical approach of extracting weak areas provides two major suggestions. The first is that public service is limited in terms of rapid response under maximum settings and when expressed as numerical information. The second is that mutual aid is indeed an essential component of AED deployment within 5 min in weak areas due to latency in the response of public emergency services. The study illustrates that although the maximum coverage rate is high at 65% in Osaka and minimum at 22% in Okayama, there is no valuable for the comparison. Each city is given specific areas and limited budget per year. For example, the larger population, the more the fire stations, where the areas covered by public emergency services depend on the number of fire stations. In addition, the covered area is dependent on population density. If a fire station is set in the center of a densely populated city, then the covered areas experience better emergency services. Conversely, coverage of decentralized populations, such as rural areas, is difficult.
One of solutions for rapid response first aid is for emergency teams to standby in weak areas in anticipation of emergency calls. Large fire stations reserve extra emergency vehicles that specifically respond to medical calls for cardiac arrest. If surplus emergency vehicles in fire stations can afford to standby in other areas, then coverage area may be improved. Unfortunately, however, standing by on streets or large parking areas in Japan is prohibited due to opposition from residents.15 Evidently, emergency services are required to respond to other emergency calls even if they are in other areas or are returning from hospitals.
Other solutions are constructing an emergency response system with mutual aid, especially in the case of a sudden cardiac arrest, which can happen to anyone at any time. Therefore, protecting yourself, your family, and neighbors in the area is a natural tendency. However, such areas and facilities come in many forms, such as residential, public utility and leisure areas; offices; and warehouses. Thus, attention should be given to the development of emergency systems in weak areas due to nature of each area and facility. For example, a stadium is obliged to protect its consumers. Out of this area, this obligation is null.
Moreover, the most of individuals may be accustomed to mutual aid within their environment. Iwami16 reports that “cardiac arrests in public or in the work place had a higher chance of being found in ventricular fibrillation and survival than those at private residences.” In other words, the place to occur is under a person’s observation. The notion suggests that formulating an emergency response system with mutual aid that can be utilized in public or the work place is a viable option. Consequently, office workers are commendable as first aid responders for coworkers and customers.
However, approximately 70% of cases of cardiac arrests occur in private residences.17 In this case, a rapid response system with mutual aids is required as soon as possible. Compared with the public or work place setting, cardiac arrest that occurs in residential areas may lead to cognitive loss among first responders. In fact, actions may be delayed until first responders are notified about the symptoms of cardiac arrest. Even when cardiac arrest occurs near someone inside the house, other family members rely on emergency services. Therefore, the expected implementation of this solution is particularly low in weak areas. As such, the solution continues to be efficient communication through text messages and mobile phone applications.18,19 In addition, the 2020 care system guideline of the American Heart Association 2020 recommends that “notification of lay rescuers via mobile phone apps results in improved bystander response times, higher bystander CPR rates, shorter time to defibrillation, and higher rates of survival after hospital discharge.”20
Moreover, according to Kurn,21 a local neighborhood volunteer can improve response time to a simulated cardiac arrest. The more rapid the response to the scene, the more the chance of survival for patients undergoing cardiac arrest.22–25 In fact, the Kashiwa city fire department initiates a rapid response system for first responders through a mobile application.26 Especially, the application is used for particular conditions, such as arrhythmia, VF, or pulseless ventricular tachycardia, because it can be treated with AED not only by healthcare providers but also by lay persons. However, the lay persons should be trained as first responders to obtain average-quality CPR.27 Alternative, once a response system with mutual aid is established, then it can lead to potential improvement in weak areas in terms of recognition and response time for first aid.28
The study does not intend to arouse unnecessary public anxiety, but to geographically identify areas that require a strategy for rapid response. From the point of view of residents, they should geographically understand their areas and the necessity for mutual aids in the occurrence of cardiac arrest in their areas. Conversely, from the point of view of the public, cities should focus on inclusive strategies in terms of the number of first aid classes, which should be offered as frequently as possible. Moreover, cities should appeal for the appropriation of public funds for emergency care services to their residents. According to Weisfeldt,29 “The incremental value of resuscitation strategies, such as the ready availability of an AED, may be related to the place where the arrest occurs.”
Lastly, each city should prioritize their areas with a geographic strategy to improve hospital discharge rates by formulating a rapid response system with mutual aid that is open to all residents. Moreover, the study suggests that calculating the population coverage rate is useful for evaluating public response and mutual aid as one of the numerous objectives for equal rights. In the future, the population coverage rate could become a standard evaluation for rapid response systems across cities.