42 By Peter Prescott MS, Brett Todd MD, Robert Swor DO, Department of Emergency Medicine, William Beaumont University Hospital Cardiac Arrest Care on United States Golf Courses - Up to Par Yet? Golf is a very popular sport in the United States, with an estimated greater than 500 million rounds played in 2024. Golf courses are not an uncommon location for out-of-hospital cardiac arrest (OHCA), with one study identifying golf courses as the fifth most common public location for OHCA. Although the Professional Golfers’ Association of America recommends that automated external defibrillators (AEDs) be available at golf facilities, data on the response to cardiac arrests occurring on golf courses—including CPR administration, AED utilization, and associated outcomes—remain limited. In this study, we linked CARES records with a national commercial database of golf courses to explore OHCA incidence, rates of bystander CPR and AED use, and their association with survival outcomes after golf course OHCA. We identified OHCAs in CARES occurring in recreational settings between 2020 and 2023. Because CARES data does not identify golf courses as a unique location, the addresses of recreational arrests were geospatially linked to a national commercial database of golf courses using ArcGIS®. A 400-meter radius from the address listed in CARES was selected through author consensus to account for the large physical footprint of golf courses and variability in location addresses. We identified 476 OHCA cases occurring on golf courses during the study period, with an estimated incidence of 3.8% of golf courses in CARES-participating states (N = 12,615) having at least one OHCA. OHCA patients were overwhelmingly male (435, 94.5%), and their mean age was 64.6 years (SD 15.5). Bystander CPR was performed in 73.7% of cases, while bystander AED application occurred in 24.6%. Although EMS response data is missing in almost 20% of cases, response times data reflect delays in the provision of EMS care (median, IQR) 10.8 min (8.1, 14.1). Our data suggest that cardiac arrest events are often rapidly recognized and early CPR is initiated, likely because golf is typically a group activity. We observed overall survival to hospital discharge of 30.5%, substantially higher than the national average of 10.5% reported for OHCAs across all settings in 2024. Furthermore, among patients with witnessed arrest, a shockable initial rhythm, and AED application (Utstein characteristics), survival approached 64%. Remarkably, of all survivors (N = 145), 141 (97.2%) were discharged with a good neurologic outcome (CPC 1 or 2). Our data indicate that golf course OHCAs are not rare events. CPR provision is frequent, and AED utilization is relatively high, although substantial room for improvement remains. Interpretation of AED utilization is limited by the available data, which capture only whether a device was applied and when emergency medical services arrived; we cannot determine whether AEDs were available at a given location but not used. AED deployment on golf courses presents significant logistical challenges due to the wide area in which an arrest can occur, limiting the likelihood of timely implementation during cardiac arrest events. Location-specific guidelines for responding to these events are needed, with particular attention to elements of emergency response systems that are course-specific (communication to local staff, 911 activation, device placement, methods to support tiered response, staff training and continuing education, instructions for patrons, etc.). Although many states mandate AED availability in indoor recreational facilities, these requirements typically do not extend to outdoor recreational settings such as golf courses. Expanding legislation to include these environments may yield meaningful public health benefits.
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