1
|
Li N, Shen C, Yang X, Wang R, Gu LQ, Zhao W, Chu ZP. The Real Experience of Lay Responders Performing Cardiopulmonary Resuscitation: A Synthesis of Qualitative Evidence. Public Health Rev 2024; 45:1606650. [PMID: 38903868 PMCID: PMC11188311 DOI: 10.3389/phrs.2024.1606650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 05/24/2024] [Indexed: 06/22/2024] Open
Abstract
Objectives To synthesize qualitative evidence on the experience of lay responders performing cardiopulmonary resuscitation (CPR). Methods Qualitative evidence synthesis was performed using the Thomas and Harden method. The PubMed, Cochrane Library, Web of Science, OVID Medline, Embase, CINAHL, CNKI, and WanFang databases were systematically searched. The quality of the research was assessed by the Critical Assessment Skills Program Tool (CASP). Results A total of 5,610 studies were identified, and 9 studies were included in the analysis. Four analytical themes were generated: emotional ambivalence before CPR, psychological tolerance during CPR, perceived experience after CPR, and enhancing psychological resilience. Conclusion Lay responders face complicated psychological experience during CPR, which may be susceptible to psychological effects such as "loss aversion," "bystander effects" and "knowledge curse." In addition to the timely retraining of CPR, lay responders should be instructed to manage psychological distress and improve psychological resilience. More importantly, the psychological sequelae may be long-lasting, requiring ongoing psychological intervention and follow-up based on valuing transdisciplinarity across endeavours.
Collapse
Affiliation(s)
- Na Li
- Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chen Shen
- Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xin Yang
- Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Rao Wang
- Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lian Qi Gu
- Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wei Zhao
- Shanghai Mental Health Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhi Ping Chu
- Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| |
Collapse
|
2
|
Kragh AR, Gregers MT, Andelius L, Grabmayr AJ, Kollander L, Kjærulf VE, Kjølbye JS, Sheikh AP, Ersbøll AK, Folke F, Hansen CM. Volunteer Responder Interventions in Out-of-Hospital Cardiac Arrest in Urban, Suburban, and Rural Areas. J Am Heart Assoc 2024; 13:e032629. [PMID: 38348801 PMCID: PMC11010116 DOI: 10.1161/jaha.123.032629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/19/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Patients with out-of-hospital cardiac arrest (OHCA) in rural areas experience longer emergency response times and have lower survival rates compared with patients in urban areas. Volunteer responders might improve care and outcomes for patients with OHCA specifically in rural areas. Therefore, we investigated volunteer responder interventions based on the degree of urbanization. METHODS AND RESULTS We included 1310 OHCAs from 3 different regions in Denmark where volunteer responders had arrived at the OHCA location. The location was classified as urban, suburban, or rural according to the Eurostat Degree of Urbanization Tool. A logistic regression model was used to examine associations between the degree of urbanization and volunteer responder arrival before emergency medical services, cardiopulmonary resuscitation, or defibrillation. We found the odds for volunteer responder arrival before emergency medical services more than doubled in rural areas (odds ratio [OR], 2.60 [95% CI, 1.91-3.53]) and suburban areas (OR, 2.05 [95% CI, 1.56-2.69]) compared with urban areas. In OHCA cases where volunteer responders arrived first, odds for bystander cardiopulmonary resuscitation was tripled in rural areas (OR, 3.83 [95% CI, 1.64-8.93]) and doubled in suburban areas (OR, 2.27 [95% CI, 1.17-4.41]) compared with urban areas. Bystander defibrillation was more common in suburban areas (OR, 1.53 [95% CI, 1.02-2.31]), where almost 1 out of 4 patients received bystander defibrillation, compared with urban areas. CONCLUSIONS Volunteer responders are significantly more likely to arrive before emergency medical services in rural and suburban areas than in urban areas. Patients with OHCA received more cardiopulmonary resuscitation in rural and suburban areas and more defibrillation in suburban areas than in urban areas.
Collapse
Affiliation(s)
- Astrid Rolin Kragh
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
| | - Mads Tofte Gregers
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
| | - Linn Andelius
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
| | - Anne Juul Grabmayr
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
| | - Louise Kollander
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
| | - Victor Elnegaard Kjærulf
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
| | - Julie Samsøe Kjølbye
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
| | - Annam Pervez Sheikh
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
| | - Annette Kjær Ersbøll
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- National Institute of Public Health, University of Southern DenmarkCopenhagenDenmark
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
- Department of CardiologyHerlev Gentofte University HospitalCopenhagenDenmark
| | - Carolina Malta Hansen
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
- Department of CardiologyHerlev Gentofte University HospitalCopenhagenDenmark
- Department of CardiologyRigshospitalet, University of CopenhagenBallerupDenmark
| |
Collapse
|
3
|
Pommerenke C, Poloczek S, Breuer F, Wolff J, Dahmen J. Automated and app-based activation of first responders for prehospital cardiac arrest: an analysis of 16.500 activations of the KATRETTER system in Berlin. Scand J Trauma Resusc Emerg Med 2023; 31:105. [PMID: 38124125 PMCID: PMC10731739 DOI: 10.1186/s13049-023-01152-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Bystander CPR is one of the main independent factors contributing to better survival after out-of-hospital cardiac arrest. Simultaneously, the rate of bystander CPR in Germany is below the European average. First responder applications (apps) contribute to reducing the time period without CPR (no-flow time) until professional help can arrive on-scene. METHODS The KATRETTER app was introduced in Berlin as one of the first apps in Europe which do not require any medical qualifications to register as a first responder. The activation of volunteer first responders for suspected cardiac arrest cases through the Berlin Emergency Medical Services integrated control center was evaluated based on data collected between 16 Oct 2020 and 16 Oct 2022. Our descriptive analysis includes the number of registered first responders, number of activations, the number and percentages of accepted activations, as well as all reports where first responders arrived at the scene. RESULTS As of 15 Oct 2022, a total of 10,102 first responders were registered in the state of Berlin. During this specified period, there were 16.505 activations of the system for suspected out-of-hospital cardiac arrest. In 38.4% of the accepted cases, first responders documented patient contact, and in 34.6% of cases with patient contact, CPR was performed. Only 2% of registered first responders did not have any medical qualifications. CONCLUSIONS Smartphone-based first responder applications should not be understood as a means of alerting professional help, but rather like a digitally amplified "call for help" in the vicinity of an emergency location. A large number of first responders can be recruited within 24 months, without large-scale public relations work necessary. No qualifications were required to become a first responder, contributing to a low-threshold registration process with the effect of a more widespread distribution of the app and cost reduction during implementation.
Collapse
Affiliation(s)
- C Pommerenke
- Charité University Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - S Poloczek
- Chief Medical Director, Emergency Medical Services, Fire Department, Berlin, Germany
| | - F Breuer
- Emergency Medical Services Director, Rhine-Berg-District, Office for Fire Protection and Emergency Medical Service, Bergisch Gladbach, Germany
| | - J Wolff
- Department of Anesthesia, Intensive Care and Emergency Medicine, Military Hospital Berlin, Berlin, Germany
| | - J Dahmen
- Department of Medicine, Health Faculty, University Witten/Herdecke, Witten, Germany.
| |
Collapse
|
4
|
Siddiqui FJ, Fook-Chong S, Shahidah N, Tan CK, Poh JY, Ng WM, Quah D, Ng YY, Leong BSH, Ong MEH. Technology activated community first responders in Singapore: Real-world care delivery & outcome trends. Resusc Plus 2023; 16:100486. [PMID: 37859630 PMCID: PMC10582741 DOI: 10.1016/j.resplu.2023.100486] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Community first responders (CFRs) strengthen the Chain of Survival for out-of-hospital cardiac arrest (OHCA) care. Considerable efforts have been invested in Singapore's CFR program, during the years 2016-2020, by developing an app-based activation system called myResponder. This paper reports on national CFR response indicators to evaluate the real-world impact of these efforts. METHODS We matched data from the Singapore Civil Defence Force's CFR registry with the Pan Asian Resuscitation Outcomes Study (PAROS) registry data to calculate performance indicators. These included the number of CFRs receiving and accepting an issued alert per OHCA event. Also calculated were the fraction of OHCA events where CFRs received an issued alert, or accepted the alert, and arrived at the scene either before or after EMS. We also present trends of these indicators and compare the prevalence of these fractions between the CFR-attended and CFR-unattended OHCA events. RESULTS Of 6577 alerted OHCA events, 42.7% accepted an alert, 50% of these arrived at the scene and 71% of them arrived before EMS. Almost all CFR response indicators improved over time even for the pandemic year (2020). The fraction of OHCA events where >2 CFRs received an alert increased from 62% to 96%; the same figure for accepting an alert did not change much but >2 CFRs arriving at the scene increased from 0% to 7.5%. The fraction of OHCA events with an automated external defibrillator applied and defibrillation performed by CFR increased from 4.2% to 10.3% and 1.6% to 3%, respectively. Statistically significant differences were observed in these indicators when CFR-attended and CFR-unattended OHCA events were compared. CONCLUSION This real-world study shows that activating CFRs using mobile technology can improve community response to OHCA and are bearing fruit in Singapore at a national level. Some targets for improvement and future research are highlighted in this report.
Collapse
Affiliation(s)
| | | | - Nur Shahidah
- Pre-hospital & Emergency Research Centre, Duke-NUS Medical School, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Colin K Tan
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore
| | - Jinn Yang Poh
- Volunteer & Community Partnership Department, Singapore Civil Defence Force, Singapore
| | - Wei Ming Ng
- Emergency Medicine Department, Ng Teng Fong General Hospital, Singapore
| | - Dennis Quah
- Operations Department, Singapore Civil Defence Force, Singapore
| | - Yih Yng Ng
- Digital and Smart Health Office, Ng Teng Fong Centre for Healthcare Innovation, Tan Tock Seng Hospital, Singapore
- Department of Preventive and Population Medicine, Tan Tock Seng Hospital, Singapore
| | - Benjamin SH Leong
- Emergency Medicine Department, National University Hospital, Singapore
| | - Marcus EH Ong
- Health Services & Systems Research, Duke-NUS Medical School, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| |
Collapse
|
5
|
Khalemsky M, Khalemsky A, Lankenau S, Ataiants J, Roth A, Marcu G, Schwartz DG. Predictive Dispatch of Volunteer First Responders: Algorithm Development and Validation. JMIR Mhealth Uhealth 2023; 11:e41551. [PMID: 38015602 PMCID: PMC10716760 DOI: 10.2196/41551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 06/03/2023] [Accepted: 10/17/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Smartphone-based emergency response apps are increasingly being used to identify and dispatch volunteer first responders (VFRs) to medical emergencies to provide faster first aid, which is associated with better prognoses. Volunteers' availability and willingness to respond are uncertain, leading in recent studies to response rates of 17% to 47%. Dispatch algorithms that select volunteers based on their estimated time of arrival (ETA) without considering the likelihood of response may be suboptimal due to a large percentage of alerts wasted on VFRs with shorter ETA but a low likelihood of response, resulting in delays until a volunteer who will actually respond can be dispatched. OBJECTIVE This study aims to improve the decision-making process of human emergency medical services dispatchers and autonomous dispatch algorithms by presenting a novel approach for predicting whether a VFR will respond to or ignore a given alert. METHODS We developed and compared 4 analytical models to predict VFRs' response behaviors based on emergency event characteristics, volunteers' demographic data and previous experience, and condition-specific parameters. We tested these 4 models using 4 different algorithms applied on actual demographic and response data from a 12-month study of 112 VFRs who received 993 alerts to respond to 188 opioid overdose emergencies. Model 4 used an additional dynamically updated synthetic dichotomous variable, frequent responder, which reflects the responder's previous behavior. RESULTS The highest accuracy (260/329, 79.1%) of prediction that a VFR will ignore an alert was achieved by 2 models that used events data, VFRs' demographic data, and their previous response experience, with slightly better overall accuracy (248/329, 75.4%) for model 4, which used the frequent responder indicator. Another model that used events data and VFRs' previous experience but did not use demographic data provided a high-accuracy prediction (277/329, 84.2%) of ignored alerts but a low-accuracy prediction (153/329, 46.5%) of responded alerts. The accuracy of the model that used events data only was unacceptably low. The J48 decision tree algorithm provided the best accuracy. CONCLUSIONS VFR dispatch has evolved in the last decades, thanks to technological advances and a better understanding of VFR management. The dispatch of substitute responders is a common approach in VFR systems. Predicting the response behavior of candidate responders in advance of dispatch can allow any VFR system to choose the best possible response candidates based not only on ETA but also on the probability of actual response. The integration of the probability to respond into the dispatch algorithm constitutes a new generation of individual dispatch, making this one of the first studies to harness the power of predictive analytics for VFR dispatch. Our findings can help VFR network administrators in their continual efforts to improve the response times of their networks and to save lives.
Collapse
Affiliation(s)
- Michael Khalemsky
- Department of Management, Hadassah Academic College, Jerusalem, Israel
| | - Anna Khalemsky
- Department of Management, Hadassah Academic College, Jerusalem, Israel
| | - Stephen Lankenau
- School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Janna Ataiants
- School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Alexis Roth
- School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Gabriela Marcu
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - David G Schwartz
- The Graduate School of Business Administration, Bar-Ilan University, Ramat Gan, Israel
| |
Collapse
|
6
|
Hutton J, Puyat JH, Asamoah-Boaheng M, Sobolev B, Lingawi S, Khalili M, Kuo C, Shadgan B, Christenson J, Grunau B. The effect of recognition on survival after out-of-hospital cardiac arrest and implications for biosensor technologies. Resuscitation 2023; 190:109906. [PMID: 37453691 DOI: 10.1016/j.resuscitation.2023.109906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Biosensor technologies have been proposed as a solution to provide recognition and facilitate earlier responses to unwitnessed out-of-hospital cardiac arrest (OHCA) cases. We sought to estimate the effect of recognition on survival and modelled the potential incremental impact of increased recognition of unwitnessed cases on survival to hospital discharge, to demonstrate the potential benefit of biosensor technologies. METHODS We included cases from the British Columbia Cardiac Arrest Registry (2019-2020), which includes Emergency Medical Services (EMS)-assessed OHCAs. We excluded cases that would not have benefitted from early recognition (EMS-witnessed, terminal illness, or do-not-resuscitate). Using a mediation analysis, we estimated the relative benefits on survival of a witness recognizing vs. intervening in an OHCA; and estimated the expected additional number of survivors resulting from increasing recognition alone using a bootstrap logistic regression framework. RESULTS Of 13,655 EMS-assessed cases, 11,412 were included (6314 EMS-treated, 5098 EMS-untreated). Survival to hospital discharge was 191/8879 (2.2%) in unwitnessed cases and 429/2533 (17%) in bystander-witnessed cases. Of the total effect attributable to a bystander witness, recognition accounted for 84% (95% CI: 72, 86) of the benefit. If all previously unwitnessed cases had been bystander witnessed, we would expect 1198 additional survivors. If these cases had been recognized, but no interventions performed, we would expect 912 additional survivors. CONCLUSION Unwitnessed OHCA account for the majority of OHCAs, yet survival is dismal. Methods to improve recognition, such as with biosensor technologies, may lead to substantial improvements in overall survival.
Collapse
Affiliation(s)
- Jacob Hutton
- Faculty of Medicine, University of British Columbia, British Columbia, Canada; British Columbia Emergency Health Services, Canada; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, University of British Columbia, British Columbia, Canada.
| | - Joseph H Puyat
- British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, University of British Columbia, British Columbia, Canada; School of Population and Public Health, University of British Columbia, British Columbia, Canada
| | - Michael Asamoah-Boaheng
- Faculty of Medicine, University of British Columbia, British Columbia, Canada; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, University of British Columbia, British Columbia, Canada
| | - Boris Sobolev
- Faculty of Medicine, University of British Columbia, British Columbia, Canada; School of Population and Public Health, University of British Columbia, British Columbia, Canada
| | - Saud Lingawi
- Faculty of Medicine, University of British Columbia, British Columbia, Canada; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; School of Biomedical Engineering, University of British Columbia, British Columbia, Canada; International Collaboration on Repair Discoveries, British Columbia, Canada
| | - Mahsa Khalili
- School of Biomedical Engineering, University of British Columbia, British Columbia, Canada; International Collaboration on Repair Discoveries, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, University of British Columbia, British Columbia, Canada
| | - Calvin Kuo
- British Columbia Resuscitation Research Collaborative, British Columbia, Canada; School of Biomedical Engineering, University of British Columbia, British Columbia, Canada
| | - Babak Shadgan
- British Columbia Resuscitation Research Collaborative, British Columbia, Canada; School of Biomedical Engineering, University of British Columbia, British Columbia, Canada; Department of Orthopedic Surgery, University of British Columbia, British Columbia, Canada
| | - Jim Christenson
- Faculty of Medicine, University of British Columbia, British Columbia, Canada; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, University of British Columbia, British Columbia, Canada
| | - Brian Grunau
- Faculty of Medicine, University of British Columbia, British Columbia, Canada; British Columbia Emergency Health Services, Canada; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, University of British Columbia, British Columbia, Canada
| |
Collapse
|
7
|
Baldi E, D'Alto A, Benvenuti C, Caputo ML, Cresta R, Cianella R, Auricchio A. Perceived threats and challenges experienced by first responders during their mission for an out-of-hospital cardiac arrest. Resusc Plus 2023; 14:100403. [PMID: 37287957 PMCID: PMC10242624 DOI: 10.1016/j.resplu.2023.100403] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/04/2023] [Accepted: 05/16/2023] [Indexed: 06/09/2023] Open
Abstract
Aim No study has systematically captured the perceived threat, discomfort or issues experienced by First Responders (FRs). We aimed to report the FRs' experience during a mission for an out-of-hospital cardiac arrest (OHCA) in a ten-year span. Methods We collected all the 40-items questionnaires filled out by the FRs dispatched in Ticino Region (Switzerland) from 01/10/2010 to 31/12/2020. We compared results between FRs alerted by SMS or APP and between professional and citizen FRs. Results 3391 FRs filled the questionnaire. The OHCA information was considered complete more frequently by FRs alerted by APP (85.6% vs 76.8%, p < 0.001), but a challenge in reaching the location was more frequent (15.5% vs 11.4%, p < 0.001), mainly due to wrong GPS coordinate. The FRs initiated/participated in resuscitation in 64.6% and used an AED in 31.9% of OHCAs, without issue in 97.9%. FRs reported a very high-level of satisfaction (97%) in EMS collaboration, but one-third didn't have the possibility to debrief. Citizen FRs used AED more frequently than professional FRs (34.6% vs 30.7%, p < 0.01), but experienced more often difficulties in performing CPR (2.6% vs 1.2%, p = 0.02) and wore more in need to debrief (19.7% vs 13%, p < 0.01). Conclusions We provide a unique picture from the FRs' point of view during a real-life OHCA reporting high-level of satisfaction, great motivation but also the need of systematic debrief. We identified areas of improvements including geolocation accuracy, further training on AED use and support program dedicated to citizen FRs.
Collapse
Affiliation(s)
- Enrico Baldi
- Fondazione Ticino Cuore, Breganzona, Switzerland
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessia D'Alto
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | | | - Maria Luce Caputo
- Fondazione Ticino Cuore, Breganzona, Switzerland
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Ruggero Cresta
- Fondazione Ticino Cuore, Breganzona, Switzerland
- Federazione Cantonale Ticinese Servizi Autoambulanze, Lugano, Switzerland
| | - Roberto Cianella
- Federazione Cantonale Ticinese Servizi Autoambulanze, Lugano, Switzerland
| | - Angelo Auricchio
- Fondazione Ticino Cuore, Breganzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| |
Collapse
|
8
|
Starck SM, Jensen JJ, Sarkisian L, Schakow H, Andersen C, Henriksen FL. The association between the experience of lay responders and response interval to medical emergencies in a rural area: an observational study. BMC Emerg Med 2023; 23:46. [PMID: 37149579 PMCID: PMC10164305 DOI: 10.1186/s12873-023-00803-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 03/09/2023] [Indexed: 05/08/2023] Open
Abstract
AIM The aim of this retrospective observational study was to determine how response intervals correlated to the experience of the community first responders (CFRs) using data collected from the Danish Island of Langeland via a global positioning system (GPS)-based system. METHODS All medical emergency calls involving CFRs in the time period from 21st of April 2012 to 31st of December 2017 were included. Each emergency call activated 3 CFRs. Response intervals were calculated using the time from when the system alerted the CFRs to CFR time of arrival at the emergency site measured by GPS. CFRs response intervals were grouped depending on their level of experience according to ≤ 10, 11-24, 25-49, 50-99, ≥ 100 calls accepted and arrived on-site. RESULTS A total of 7273 CFR activations were included. Median response interval for the CFR arriving first on-site (n = 3004) was 4:05 min (IQR 2:42-6:01) and median response interval for the arrival of the CFR with an automated external defibrillator (n = 2594) was 5:46 min (IQR 3:59-8:05). Median response intervals were 5:53 min (3:43-8:29) for ≤ 10 calls (n = 1657), 5:39 min (3:49-8:01) for 11-24 calls (n = 1396), 5:45 min (3:49-8:00) for 25-49 calls (n = 1586), 5:07 min (3:38-7:26) for 50-99 calls (n = 1548) and 4:46 min (3:14-7:32) for ≥ 100 calls (n = 1086) (p < 0.001). There was a significant negative correlation between experience and response intervals (p < 0.001, Spearman's rho = -0.0914). CONCLUSION This study found an inverse correlation between CFR experience and response intervals, which could lead to increased survival after a time-critical incident.
Collapse
Affiliation(s)
- S M Starck
- Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark.
| | - J J Jensen
- Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark.
| | - L Sarkisian
- Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
| | - H Schakow
- Emergency Medical Services, Region of Southern Denmark, Damhaven 12, 7100, Vejle, Denmark
| | - C Andersen
- Department of Anaesthesiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
| | - F L Henriksen
- Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
| |
Collapse
|
9
|
Gregers MCT, Andelius L, Kjoelbye JS, Juul Grabmayr A, Jakobsen LK, Bo Christensen N, Kragh AR, Hansen CM, Lyngby RM, Væggemose U, Torp-Pedersen C, Ersbøll AK, Folke F. Association Between Number of Volunteer Responders and Interventions Before Ambulance Arrival for Cardiac Arrest. J Am Coll Cardiol 2023; 81:668-680. [PMID: 36792282 DOI: 10.1016/j.jacc.2022.11.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/03/2022] [Accepted: 11/08/2022] [Indexed: 02/16/2023]
Abstract
BACKGROUND Volunteer responder (VR) programs for activation of laypersons in out-of-hospital cardiac arrest (OHCA) have been deployed worldwide, but the optimal number of VRs to dispatch is unknown. OBJECTIVES The purpose of this study was to investigate the association between the number of VRs arriving before Emergency Medical Services (EMS) and the proportion of bystander cardiopulmonary resuscitation (CPR) and defibrillation. METHODS We included OHCAs not witnessed by EMS with VR activation from the Capital Region (September 2, 2017, to May 14, 2019) and the Central Region of Denmark (November 5, 2018, to December 31, 2019). We created 4 groups according to the number of VRs arriving before EMS: 0, 1, 2, and 3 or more. Using a logistic regression model adjusted for EMS response time, we examined associations between the number of VRs arriving before EMS and bystander CPR and defibrillation. RESULTS We included 906 OHCAs. The adjusted ORs for bystander CPR were 2.40 (95% CI: 1.42-4.05), 3.18 (95% CI: 1.39-7.26), and 2.70 (95% CI: 1.32-5.52) when 1, 2, or 3 or more VRs arrived before EMS (reference), respectively. The adjusted OR for bystander defibrillation increased when 1 (1.97 [95% CI: 1.12-3.52]), 2 (2.88 [95% CI: 1.48-5.58]), or 3 or more (3.85 [95% CI: 2.11-7.01]) VRs arrived before EMS (reference). The adjusted OR of bystander defibrillation increased to 1.95 (95% CI: 1.18-3.22) when ≥3 VRs arrived first compared with 1 VR arriving first (reference). CONCLUSIONS We found an association of increased bystander CPR and defibrillation when 1 or more VRs arrived before the EMS with a trend toward increased bystander defibrillation with increasing number of VRs arriving first.
Collapse
Affiliation(s)
- Mads Christian Tofte Gregers
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. https://twitter.com/mads_tofte
| | - Linn Andelius
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | - Julie Samsoee Kjoelbye
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Juul Grabmayr
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Louise Kollander Jakobsen
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nanna Bo Christensen
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Astrid Rolin Kragh
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Carolina Malta Hansen
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Meyer Lyngby
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | - Ulla Væggemose
- Department of Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital - North Zealand, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Fredrik Folke
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| |
Collapse
|
10
|
Berglund E, Hollenberg J, Jonsson M, Svensson L, Claesson A, Nord A, Nordberg P, Forsberg S, Rosenqvist M, Lundgren P, Högstedt Å, Riva G, Ringh M. Effect of Smartphone Dispatch of Volunteer Responders on Automated External Defibrillators and Out-of-Hospital Cardiac Arrests: The SAMBA Randomized Clinical Trial. JAMA Cardiol 2023; 8:81-88. [PMID: 36449309 PMCID: PMC9713680 DOI: 10.1001/jamacardio.2022.4362] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/20/2022] [Indexed: 12/03/2022]
Abstract
Importance Smartphone dispatch of volunteer responders to nearby out-of-hospital cardiac arrests (OHCAs) has emerged in several emergency medical services, but no randomized clinical trials have evaluated the effect on bystander use of automated external defibrillators (AEDs). Objective To evaluate if bystander AED use could be increased by smartphone-aided dispatch of lay volunteer responders with instructions to collect nearby AEDs compared with instructions to go directly to patients with OHCAs to start cardiopulmonary resuscitation (CPR). Design, Setting, and Participants This randomized clinical trial assessed a system for smartphone dispatch of volunteer responders to individuals experiencing OHCAs that was triggered at emergency dispatch centers in response to suspected OHCAs and randomized 1:1. The study was conducted in 2 main Swedish regions: Stockholm and Västra Götaland between December 2018 and January 2020. At study start, there were 3123 AEDs in Stockholm and 3195 in Västra Götaland and 24 493 volunteer responders in Stockholm and 19 117 in Västra Götaland. All OHCAs in which the volunteer responder system was activated by dispatchers were included. Excluded were patients with no OHCAs, those with OHCAs not treated by the emergency medical services, and those with OHCAs witnessed by the emergency medical services. Interventions Volunteer responders were alerted through the volunteer responder system smartphone application and received map-aided instructions to retrieve nearest available public AEDs on their way to the OHCAs. The control arm included volunteer responders who were instructed to go directly to the OHCAs to perform CPR. Main Outcomes and Measures Overall bystander AED attachment, including those attached by volunteer responders and lay volunteers who did not use the smartphone application. Results Volunteer responders were activated for 947 patients with OHCAs. Of those, 461 were randomized to the intervention group (median [IQR] age of patients, 73 [61-81] years; 295 male patients [65.3%]) and 486 were randomized to the control group (median [IQR] age of patients, 73 [63-82] years; 312 male patients [65.3%]). Primary outcome of AED attachment occurred in 61 patients (13.2%) in the intervention arm vs 46 patients (9.5%) in the control arm (difference, 3.8% [95% CI, -0.3% to 7.9%]; P = .08). The majority of AEDs were attached by lay volunteers who were not using the smartphone application (37 in intervention arm, 28 in control). There were no significant differences in secondary outcomes. Among the volunteer responders using the application, crossover was 11% and compliance to instructions was 31%. Volunteer responders attached 38% (41 of 107) of all AEDs and provided 45% (16 of 36) of all defibrillations and 43% (293 of 666) of all CPR. Conclusions and Relevance In this study, smartphone dispatch of volunteer responders to OHCAs to retrieve nearby AEDs vs instructions to directly perform CPR did not significantly increase volunteer AED use. High baseline AED attachement rate and crossover may explain why the difference was not significant. Trial Registration ClinicalTrials.gov Identifier: NCT02992873.
Collapse
Affiliation(s)
- Ellinor Berglund
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Jacob Hollenberg
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Martin Jonsson
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Leif Svensson
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Claesson
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Anette Nord
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Per Nordberg
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Sune Forsberg
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Mårten Rosenqvist
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Peter Lundgren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Prehospen–Centre for Prehospital Research, University of Borås, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Åsa Högstedt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Prehospen–Centre for Prehospital Research, University of Borås, Sweden
| | - Gabriel Riva
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Mattias Ringh
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
11
|
Andelius L, Malta Hansen C, Jonsson M, Gerds TA, Rajan S, Torp-Pedersen C, Claesson A, Lippert F, Tofte Gregers MC, Berglund E, Gislason GH, Køber L, Hollenberg J, Ringh M, Folke F. Smartphone-activated volunteer responders and bystander defibrillation for out-of-hospital cardiac arrest in private homes and public locations. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 12:87-95. [PMID: 36574433 PMCID: PMC9910568 DOI: 10.1093/ehjacc/zuac165] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/18/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
AIMS To investigate the association between the arrival of smartphone-activated volunteer responders before the Emergency Medical Services (EMS) and bystander defibrillation in out-of-hospital cardiac arrest (OHCA) at home and public locations. METHODS AND RESULTS This is a retrospective study (1 September 2017-14 May 2019) from the Stockholm Region of Sweden and the Capital Region of Denmark. We included 1271 OHCAs, of which 1029 (81.0%) occurred in private homes and 242 (19.0%) in public locations. The main outcome was bystander defibrillation. At least one volunteer responder arrived before EMS in 381 (37.0%) of OHCAs at home and 84 (34.7%) in public. More patients received bystander defibrillation when a volunteer responder arrived before EMS at home (15.5 vs. 2.2%, P < 0.001) and in public locations (32.1 vs. 19.6%, P = 0.030). Similar results were found among the 361 patients with an initial shockable heart rhythm (52.7 vs. 11.5%, P < 0.001 at home and 60.0 vs. 37.8%, P = 0.025 in public). The standardized probability of receiving bystander defibrillation increased with longer EMS response times in private homes. The 30-day survival was not significantly higher when volunteer responders arrived before EMS (9.2 vs. 7.7% in private homes, P = 0.41; and 40.5 vs. 35.4% in public locations, P = 0.44). CONCLUSION Bystander defibrillation was significantly more common in private homes and public locations when a volunteer responder arrived before the EMS. The standardized probability of bystander defibrillation increased with longer EMS response times in private homes. Our findings support the activation of volunteer responders and suggest that volunteer responders could increase bystander defibrillation, particularly in private homes.
Collapse
Affiliation(s)
| | - Carolina Malta Hansen
- Copenhagen University Hospital, Copenhagen Emergency Medical Services, Telegrafvej 5, opgang 2, 2750 Ballerup, Denmark,Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Martin Jonsson
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Jägargatan 20, 118 67 Stockholm, Sweden
| | - Thomas A Gerds
- The Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark,Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5,1014 Copenhagen, Denmark
| | - Shahzleen Rajan
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology and Clinical Research, Copenhagen University Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark,Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Andreas Claesson
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Jägargatan 20, 118 67 Stockholm, Sweden
| | - Freddy Lippert
- Copenhagen University Hospital, Copenhagen Emergency Medical Services, Telegrafvej 5, opgang 2, 2750 Ballerup, Denmark
| | - Mads Chr Tofte Gregers
- Copenhagen University Hospital, Copenhagen Emergency Medical Services, Telegrafvej 5, opgang 2, 2750 Ballerup, Denmark,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Ellinor Berglund
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Jägargatan 20, 118 67 Stockholm, Sweden
| | - Gunnar H Gislason
- The Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark,Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jacob Hollenberg
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Jägargatan 20, 118 67 Stockholm, Sweden
| | - Mattias Ringh
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Jägargatan 20, 118 67 Stockholm, Sweden
| | - Fredrik Folke
- Copenhagen University Hospital, Copenhagen Emergency Medical Services, Telegrafvej 5, opgang 2, 2750 Ballerup, Denmark,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark,Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| |
Collapse
|
12
|
Nielsen CG, Folke F, Andelius L, Hansen CM, Væggemose U, Christensen EF, Torp-Pedersen C, Ersbøll AK, Gregers MCT. Increased bystander intervention when volunteer responders attend out-of-hospital cardiac arrest. Front Cardiovasc Med 2022; 9:1030843. [DOI: 10.3389/fcvm.2022.1030843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
AimThe primary aim was to investigate the association between alarm acceptance compared to no-acceptance by volunteer responders, bystander intervention, and survival in out-of-hospital cardiac arrest.Materials and methodsThis retrospective observational study included all suspected out-of-hospital cardiac arrests (OHCAs) with activation of volunteer responders in the Capital Region of Denmark (1 November 2018 to 14 May 2019), the Central Denmark Region (1 November 2018 to 31 December 2020), and the Northern Denmark Region (14 February 2020 to 31 December 2020). All OHCAs unwitnessed by Emergency Medical Services (EMS) were analyzed on the basis on alarm acceptance and arrival before EMS. The primary outcomes were bystander cardio-pulmonary resuscitation (CPR), bystander defibrillation and secondary outcome was 30-day survival. A questionnaire sent to all volunteer responders was used with respect to their arrival status.ResultsWe identified 1,877 OHCAs with volunteer responder activation eligible for inclusion and 1,725 (91.9%) of these had at least one volunteer responder accepting the alarm (accepted). Of these, 1,355 (79%) reported arrival status whereof 883 (65%) arrived before EMS. When volunteer responders accepted the alarm and arrived before EMS, we found increased proportions and adjusted odds ratio for bystander CPR {94 vs. 83%, 4.31 [95% CI (2.43–7.67)] and bystander defibrillation [13 vs. 9%, 3.16 (1.60–6.25)]} compared to cases where no volunteer responders accepted the alarm.ConclusionWe observed a fourfold increased odds ratio for bystander CPR and a threefold increased odds ratio for bystander defibrillation when volunteer responders accepted the alarm and arrived before EMS.
Collapse
|
13
|
Rao G, Mago V, Lingras P, Savage DW. AEDNav: indoor navigation for locating automated external defibrillator. BMC Med Inform Decis Mak 2022; 22:159. [PMID: 35725395 PMCID: PMC9207858 DOI: 10.1186/s12911-022-01886-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 04/24/2022] [Indexed: 12/03/2022] Open
Abstract
Background In a sudden cardiac arrest, starting CPR and applying an AED immediately are the two highest resuscitation priorities. Many existing mobile applications have been developed to assist users in locating a nearby AED. However, these applications do not provide indoor navigation to the AED location. The time required to locate an AED inside a building due to a lack of indoor navigation systems will reduce the patient’s chance of survival. The existing indoor navigation solutions either require special hardware, a large dataset or a significant amount of initial work. These requirements make these systems not viable for implementation on a large-scale. Methods The proposed system collects Wi-Fi information from the existing devices and the path’s magnetic information using a smartphone to guide the user from a starting point to an AED. The information collected is processed using four techniques: turn detection method, Magnetic data pattern matching method, Wi-Fi fingerprinting method and Closest Wi-Fi location method to estimate user location. The user location estimations from all four techniques are further processed to determine the user’s location on the path, which is then used to guide the user to the AED location. Results The four techniques used in the proposed system Turn detection, Magnetic data pattern matching, Closest Wi-Fi location and Wi-Fi fingerprinting can individually achieve the accuracy of 80% with the error distance ± 9.4 m, ± 2.4 m, ± 4.6 m, and ± 4.6 m respectively. These four techniques, applied individually, may not always provide stable results. Combining these techniques results in a robust system with an overall accuracy of 80% with an error distance of ± 2.74 m. In comparison, the proposed system’s accuracy is higher than the existing systems that use Wi-Fi and magnetic data. Conclusion This research proposes a novel approach that requires no special hardware, large scale data or significant initial work to provide indoor navigation. The proposed system AEDNav can achieve an accuracy similar to the existing indoor navigation systems. Implementing this indoor navigation system could reduce the time to locate an AED and ultimately increase patient survival during sudden cardiac arrest.
Collapse
Affiliation(s)
- Gaurav Rao
- Department of Mathematics and Computing Science, Saint Mary's University, Halifax, NS, Canada.
| | - Vijay Mago
- Department of Computer Science, Lakehead University, Thunder Bay, ON, Canada
| | - Pawan Lingras
- Department of Mathematics and Computing Science, Saint Mary's University, Halifax, NS, Canada
| | - David W Savage
- Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| |
Collapse
|
14
|
Shekhar AC. Significant ethical considerations with cardiac arrest resuscitation by dispatched volunteer rescuers. Eur Heart J 2022; 43:2812-2813. [PMID: 35678571 DOI: 10.1093/eurheartj/ehac279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Aditya C Shekhar
- Center for Bioethics, Harvard Medical School, Boston, MA, USA
- Center for Resuscitation Science, Harvard University, Boston, MA, USA
| |
Collapse
|
15
|
Abstract
PURPOSE OF REVIEW Technology is being increasingly implemented in the fields of cardiac arrest and cardiopulmonary resuscitation. In this review, we describe how recent technological advances have been implemented in the chain of survival and their impact on outcomes after cardiac arrest. Breakthrough technologies that are likely to make an impact in the future are also presented. RECENT FINDINGS Technology is present in every link of the chain of survival, from prediction, prevention, and rapid recognition of cardiac arrest to early cardiopulmonary resuscitation and defibrillation. Mobile phone systems to notify citizen first responders of nearby out-of-hospital cardiac arrest have been implemented in numerous countries with improvement in bystanders' interventions and outcomes. Drones delivering automated external defibrillators and artificial intelligence to support the dispatcher in recognising cardiac arrest are already being used in real-life out-of-hospital cardiac arrest. Wearables, smart speakers, surveillance cameras, and artificial intelligence technologies are being developed and studied to prevent and recognize out-of-hospital and in-hospital cardiac arrest. SUMMARY This review highlights the importance of technology applied to every single step of the chain of survival to improve outcomes in cardiac arrest. Further research is needed to understand the best role of different technologies in the chain of survival and how these may ultimately improve outcomes.
Collapse
Affiliation(s)
- Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
| | - Lorenzo Gamberini
- Department of Anaesthesia and Intensive Care and EMS, Maggiore Hospital Bologna, Bologna, Italy
| | - Federico Semeraro
- Department of Anaesthesia and Intensive Care and EMS, Maggiore Hospital Bologna, Bologna, Italy
| |
Collapse
|
16
|
Scquizzato T, Belloni O, Semeraro F, Greif R, Metelmann C, Landoni G, Zangrillo A. Dispatching citizens as first responders to out-of-hospital cardiac arrests: a systematic review and meta-analysis. Eur J Emerg Med 2022; 29:163-172. [PMID: 35283448 DOI: 10.1097/mej.0000000000000915] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mobile phone technologies to alert citizen first responders to out-of-hospital cardiac arrests (OHCAs) were implemented in numerous countries. This systematic review and meta-analysis aim to investigate whether activating citizen first responders increases bystanders' interventions and improves outcomes. We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to 24 November 2021, for studies comparing citizen first responders' activation versus standard emergency response in the case of OHCA. The primary outcome was survival at hospital discharge or 30 days. Secondary outcomes were discharge with favourable neurological outcome, bystander-initiated cardiopulmonary resuscitation (CPR), and the use of automated external defibrillators (AEDs) before ambulance arrival. Evidence certainty was evaluated with GRADE. Our search strategy yielded 1215 articles. After screening, we included 10 studies for a total of 23 351 patients. OHCAs for which citizen first responders were activated had higher rates of survival at hospital discharge or 30 days compared with standard emergency response [nine studies; 903/9978 (9.1%) vs. 1104/13 247 (8.3%); odds ratio (OR), 1.45; 95% confidence interval (CI), 1.21-1.74; P < 0.001], return of spontaneous circulation [nine studies; 2575/9169 (28%) vs. 3445/12 607 (27%); OR, 1.40; 95% CI, 1.07-1.81; P = 0.01], bystander-initiated CPR [eight studies; 5876/9074 (65%) vs. 6384/11 970 (53%); OR, 1.75; 95% CI, 1.43-2.15; P < 0.001], and AED use [eight studies; 654/9132 (7.2%) vs. 624/14 848 (4.2%); OR, 1.82; 95% CI, 1.31-2.53; P < 0.001], but similar rates of neurological intact discharge [three studies; 316/2685 (12%) vs. 276/2972 (9.3%); OR, 1.37; 95% CI, 0.81-2.33; P = 0.24]. Alerting citizen first responders to OHCA patients is associated with higher rates of bystander-initiated CPR, use of AED before ambulance arrival, and survival at hospital discharge or 30 days.
Collapse
Affiliation(s)
- Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
| | - Olivia Belloni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
| | - Federico Semeraro
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Ospedale Maggiore, Bologna, Italy
| | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Camilla Metelmann
- Department of Anaesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
17
|
Högstedt A, Thuccani M, Carlström E, Claesson A, Bremer A, Ravn-Fischer A, Berglund E, Ringh M, Hollenberg J, Herlitz J, Rawshani A, Lundgren P. Characteristics and motivational factors for joining a lay responder system dispatch to out-of-hospital cardiac arrests. Scand J Trauma Resusc Emerg Med 2022; 30:22. [PMID: 35331311 PMCID: PMC8943963 DOI: 10.1186/s13049-022-01009-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background There has been in increase in the use of systems for organizing lay responders for suspected out-of-hospital cardiac arrests (OHCAs) dispatch using smartphone-based technology. The purpose is to increase survival rates; however, such systems are dependent on people’s commitment to becoming a lay responder. Knowledge about the characteristics of such volunteers and their motivational factors is lacking. Therefore, we explored characteristics and quantified the underlying motivational factors for joining a smartphone-based cardiopulmonary resuscitation (CPR) lay responder system. Methods In this descriptive cross-sectional study, 800 consecutively recruited lay responders in a smartphone-based mobile positioning first-responder system (SMS-lifesavers) were surveyed. Data on characteristics and motivational factors were collected, the latter through a modified version of the validated survey “Volunteer Motivation Inventory” (VMI). The statements in the VMI, ranked on a Likert scale (1–5), corresponded to(a) intrinsic (an inner belief of doing good for others) or (b) extrinsic (earning some kind of reward from the act) motivational factors. Results A total of 461 participants were included in the final analysis. Among respondents, 59% were women, 48% between 25 and 39 years of age, 37% worked within health care, and 66% had undergone post-secondary school. The most common way (44%) to learn about the lay responder system was from a CPR instructor. A majority (77%) had undergone CPR training at their workplace. In terms of motivation, where higher scores reflect greater importance to the participant, intrinsic factors scored highest, represented by the category values (mean 3.97) followed by extrinsic categories reciprocity (mean 3.88) and self-esteem (mean 3.22). Conclusion This study indicates that motivation to join a first responder system mainly depends on intrinsic factors, i.e. an inner belief of doing good, but there are also extrinsic factors, such as earning some kind of reward from the act, to consider. Focusing information campaigns on intrinsic factors may be the most important factor for successful recruitment. When implementing a smartphone-based lay responder system, CPR instructors, as a main information source to potential lay responders, as well as the workplace, are crucial for successful recruitment. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-022-01009-1.
Collapse
Affiliation(s)
- A Högstedt
- Prehospen - Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
| | - M Thuccani
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - E Carlström
- Institute of Healthcare Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,USN School of Business, University of South-Eastern Norway, Kongsberg, Norway
| | - A Claesson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - A Bremer
- Prehospen - Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.,Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - A Ravn-Fischer
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - E Berglund
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - M Ringh
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - J Hollenberg
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - J Herlitz
- Prehospen - Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - A Rawshani
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - P Lundgren
- Prehospen - Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
18
|
Gregers MCT, Andelius L, Malta Hansen C, Kragh AR, Torp‐Pedersen C, Christensen HC, Kjoelbye JS, Væggemose U, Frischknecht Christensen E, Folke F. Activation of Citizen Responders to Out‐of‐Hospital Cardiac Arrest During the COVID‐19 Outbreak in Denmark 2020. J Am Heart Assoc 2022; 11:e024140. [PMID: 35253455 PMCID: PMC9075288 DOI: 10.1161/jaha.121.024140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Little is known about how COVID‐19 influenced engagement of citizen responders dispatched to out‐of‐hospital cardiac arrest (OHCA) by a smartphone application. The objective was to describe and analyze the Danish Citizen Responder Program and bystander interventions (both citizen responders and nondispatched bystanders) during the first COVID‐19 lockdown in 2020. Methods and Results All OHCAs from January 1, 2020, to June 30, 2020, with citizen responder activation in 2 regions of Denmark were included. We compared citizen responder engagement for OHCA in the nonlockdown period (January 1, 2020, to March 10, 2020, and April 21, 2020, to June 30, 2020) with the lockdown period (March 11, 2020, to April 20, 2020). Data are displayed in the order lockdown versus nonlockdown period. Bystander cardiopulmonary resuscitation rates did not differ in the 2 periods (99% versus 92%; P=0.07). Bystander defibrillation (9% versus 14%; P=0.4) or return‐of‐spontaneous circulation (23% versus 23%; P=1.0) also did not differ. A similar amount of citizen responders accepted alarms during the lockdown (6 per alarm; interquartile range, 6) compared with the nonlockdown period (5 per alarm; interquartile range, 5) (P=0.05). More citizen responders reported performing chest‐compression‐only cardiopulmonary resuscitation during lockdown compared with nonlockdown (79% versus 59%; P=0.0029), whereas fewer performed standardized cardiopulmonary resuscitation, including ventilations (19% versus 38%; P=0.0061). Finally, during lockdown, more citizen responders reported being not psychologically affected by attending an OHCA compared with nonlockdown period (68% versus 56%; P<0.0001). Likewise, fewer reported being mildly affected during lockdown (26%) compared with nonlockdown (35%) (P=0.003). Conclusions The COVID‐19 lockdown in Denmark was not associated with decreased bystander‐initiated resuscitation in OHCAs attended by citizen responders.
Collapse
Affiliation(s)
- Mads Christian Tofte Gregers
- Copenhagen University Hospital–Copenhagen Emergency Medical Services Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Linn Andelius
- Copenhagen University Hospital–Copenhagen Emergency Medical Services Copenhagen Denmark
| | - Carolina Malta Hansen
- Copenhagen University Hospital–Copenhagen Emergency Medical Services Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
- Department of Cardiology Copenhagen University Hospital–Herlev and Gentofte Copenhagen Denmark
| | - Astrid Rolin Kragh
- Copenhagen University Hospital–Copenhagen Emergency Medical Services Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Christian Torp‐Pedersen
- Department of Cardiology Copenhagen University Hospital–North Zealand Copenhagen Denmark
- Department of Cardiology Aalborg University Hospital–Aalborg Aalborg Denmark
- Department of Public Health University of Copenhagen Denmark
| | - Helle Collatz Christensen
- Copenhagen University Hospital–Copenhagen Emergency Medical Services Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Julie Samsoee Kjoelbye
- Copenhagen University Hospital–Copenhagen Emergency Medical Services Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Ulla Væggemose
- Department of Research and Development Prehospital Emergency Medical ServicesCentral Denmark Region Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Erika Frischknecht Christensen
- Department of Emergency Medicine and Trauma Care Centre for Prehospital and Emergency ResearchAalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Hospital Aalborg Denmark
- Prehospital Emergency Services North Denmark Region Aalborg Denmark
| | - Fredrik Folke
- Copenhagen University Hospital–Copenhagen Emergency Medical Services Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
- Department of Cardiology Copenhagen University Hospital–Herlev and Gentofte Copenhagen Denmark
| |
Collapse
|
19
|
Brooks SC, Clegg GR, Bray J, Deakin CD, Perkins GD, Ringh M, Smith CM, Link MS, Merchant RM, Pezo-Morales J, Parr M, Morrison LJ, Wang TL, Koster RW, Ong MEH. Optimizing Outcomes After Out-of-Hospital Cardiac Arrest With Innovative Approaches to Public-Access Defibrillation: A Scientific Statement From the International Liaison Committee on Resuscitation. Circulation 2022; 145:e776-e801. [PMID: 35164535 DOI: 10.1161/cir.0000000000001013] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Out-of-hospital cardiac arrest is a global public health issue experienced by ≈3.8 million people annually. Only 8% to 12% survive to hospital discharge. Early defibrillation of shockable rhythms is associated with improved survival, but ensuring timely access to defibrillators has been a significant challenge. To date, the development of public-access defibrillation programs, involving the deployment of automated external defibrillators into the public space, has been the main strategy to address this challenge. Public-access defibrillator programs have been associated with improved outcomes for out-of-hospital cardiac arrest; however, the devices are used in <3% of episodes of out-of-hospital cardiac arrest. This scientific statement was commissioned by the International Liaison Committee on Resuscitation with 3 objectives: (1) identify known barriers to public-access defibrillator use and early defibrillation, (2) discuss established and novel strategies to address those barriers, and (3) identify high-priority knowledge gaps for future research to address. The writing group undertook systematic searches of the literature to inform this statement. Innovative strategies were identified that relate to enhanced public outreach, behavior change approaches, optimization of static public-access defibrillator deployment and housing, evolved automated external defibrillator technology and functionality, improved integration of public-access defibrillation with existing emergency dispatch protocols, and exploration of novel automated external defibrillator delivery vectors. We provide evidence- and consensus-based policy suggestions to enhance public-access defibrillation and guidance for future research in this area.
Collapse
|
20
|
Brooks SC, Clegg GR, Bray J, Deakin CD, Perkins GD, Ringh M, Smith CM, Link MS, Merchant RM, Pezo-Morales J, Parr M, Morrison LJ, Wang TL, Koster RW, Ong MEH. Optimizing outcomes after out-of-hospital cardiac arrest with innovative approaches to public-access defibrillation: A scientific statement from the International Liaison Committee on Resuscitation. Resuscitation 2022; 172:204-228. [PMID: 35181376 DOI: 10.1016/j.resuscitation.2021.11.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Out-of-hospital cardiac arrest is a global public health issue experienced by ≈3.8 million people annually. Only 8% to 12% survive to hospital discharge. Early defibrillation of shockable rhythms is associated with improved survival, but ensuring timely access to defibrillators has been a significant challenge. To date, the development of public-access defibrillation programs, involving the deployment of automated external defibrillators into the public space, has been the main strategy to address this challenge. Public-access defibrillator programs have been associated with improved outcomes for out-of-hospital cardiac arrest; however, the devices are used in <3% of episodes of out-of-hospital cardiac arrest. This scientific statement was commissioned by the International Liaison Committee on Resuscitation with 3 objectives: (1) identify known barriers to public-access defibrillator use and early defibrillation, (2) discuss established and novel strategies to address those barriers, and (3) identify high-priority knowledge gaps for future research to address. The writing group undertook systematic searches of the literature to inform this statement. Innovative strategies were identified that relate to enhanced public outreach, behavior change approaches, optimization of static public-access defibrillator deployment and housing, evolved automated external defibrillator technology and functionality, improved integration of public-access defibrillation with existing emergency dispatch protocols, and exploration of novel automated external defibrillator delivery vectors. We provide evidence- and consensus-based policy suggestions to enhance public-access defibrillation and guidance for future research in this area.
Collapse
|
21
|
Crabb DB, Elmelige YO, Gibson ZC, Ralston DC, Harrell C, Cohen SA, Fitzpatrick DE, Becker TK. Unrecognized cardiac arrests: A one-year review of audio from emergency medical dispatch calls. Am J Emerg Med 2022; 54:127-130. [DOI: 10.1016/j.ajem.2022.01.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 01/23/2022] [Accepted: 01/30/2022] [Indexed: 01/14/2023] Open
|
22
|
Affiliation(s)
- Remy Stieglis
- Department of Cardiology Amsterdam University Medical Center, Location AMC Amsterdam the Netherlands
| | - Rudolph W. Koster
- Department of Cardiology Amsterdam University Medical Center, Location AMC Amsterdam the Netherlands
| |
Collapse
|
23
|
Smith CM, Lall R, Fothergill RT, Spaight R, Perkins GD. The effect of the GoodSAM volunteer first-responder app on survival to hospital discharge following out-of-hospital cardiac arrest. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:20-31. [PMID: 35024801 PMCID: PMC8757292 DOI: 10.1093/ehjacc/zuab103] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/08/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022]
Abstract
AIMS Bystander cardiopulmonary resuscitation and defibrillation can double survival to hospital discharge in out-of-hospital cardiac arrest. Mobile phone applications, such as GoodSAM, alerting nearby volunteer first-responders about out-of-hospital cardiac arrest could potentially improve bystander cardiopulmonary resuscitation and defibrillation, leading to better patient outcomes. The aim of this study was to determine GoodSAM's effect on survival to hospital discharge following out-of-hospital cardiac arrest. METHODS AND RESULTS We collected data from the Out-of-Hospital Cardiac Arrest Outcomes Registry (University of Warwick, UK) submitted by the London Ambulance Service (1 April 2016 to 31 March 2017) and East Midlands Ambulance Service (1 January 2018 to 17 June 2018) and matched out-of-hospital cardiac arrests to GoodSAM alerts. We constructed logistic regression models to determine if there was an association between a GoodSAM first-responder accepting an alert and survival to hospital discharge, adjusting for location type, presenting rhythm, age, gender, ambulance service response time, cardiac arrest witnessed status, and bystander actions. Survival to hospital discharge was 9.6% (393/4196) in London and 7.2% (72/1001) in East Midlands. A GoodSAM first-responder accepted an alert for out-of-hospital cardiac arrest in 1.3% (53/4196) cases in London and 5.4% (51/1001) cases in East Midlands. When a responder accepted an alert, the adjusted odds ratio for survival to hospital discharge was 3.15 (95% CI: 1.19-8.36, P = 0.021) in London and 3.19 (95% CI: 1.17-8.73, P = 0.024) in East Midlands. CONCLUSION Alert acceptance was associated with improved survival in both ambulance services. Alert acceptance rates were low, and challenges remain to maximize the potential benefit of GoodSAM.
Collapse
Affiliation(s)
- Christopher M Smith
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - Rachael T Fothergill
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK.,Clinical Audit and Research Unit, London Ambulance Service NHS Trust, 8-20 Pocock Street, London SE1 8SD, UK
| | - Robert Spaight
- East Midlands Ambulance Service NHS Trust, 1 Horizon Place, Mellors Way, Nottingham NG8 6PY, UK
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| |
Collapse
|
24
|
Allan KS, O'Neil E, Currie MM, Lin S, Sapp JL, Dorian P. Responding to Cardiac Arrest in the Community in the Digital Age. Can J Cardiol 2021; 38:491-501. [PMID: 34954009 DOI: 10.1016/j.cjca.2021.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 01/25/2023] Open
Abstract
Sudden cardiac arrest (SCA) is a common event, affecting almost 400,000 individuals annually in North America. Initiation of cardiopulmonary resuscitation (CPR) and early defibrillation using an automated external defibrillator (AED) are critical for survival, yet many bystanders are reluctant to intervene. Digital technologies, including mobile devices, social media and crowdsourcing may help play a role to improve survival from SCA. In this article we review the current digital tools and strategies available to increase rates of bystander recognition of SCA, prompt immediate activation of Emergency Medical Services (EMS), initiate high quality CPR and to locate, retrieve and operate AEDs. Smartphones can help to both educate and connect bystanders with EMS dispatchers, through text messaging or video-calling, to encourage the initiation of CPR and retrieval of the closest AED. Wearable devices and household smartspeakers could play a future role in continuous vital signs monitoring in individuals at-risk of lethal arrhythmias and send an alert to either chosen contacts or EMS. Machine learning algorithms and mathematical modeling may aid EMS dispatchers with better recognition of SCA as well as policymakers with where to best place AEDs for optimal accessibility. There are challenges with the use of digital tech, including the need for government regulation and issues with data ownership, accessibility and interoperability. Future research will include smart cities, e-linkages, new technologies and using social media for mass education. Together or in combination, these emerging digital technologies may represent the next leap forward in SCA survival.
Collapse
Affiliation(s)
- Katherine S Allan
- Division of Cardiology, Unity Health Toronto - St. Michael's Hospital, Toronto, Ontario, Canada.
| | - Emma O'Neil
- Department of Emergency Medicine, Unity Health Toronto - St. Michael's Hospital, Toronto, Ontario, Canada
| | - Margaret M Currie
- Faculty of Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Steve Lin
- Department of Emergency Medicine, Unity Health Toronto - St. Michael's Hospital, Toronto, Ontario, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - John L Sapp
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Paul Dorian
- Division of Cardiology, Unity Health Toronto - St. Michael's Hospital, Toronto, Ontario, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
25
|
Smida T, Salerno J, Weiss L, Martin-Gill C, Salcido DD. PulsePoint dispatch associated patient characteristics and prehospital outcomes in a mid-sized metropolitan area. Resuscitation 2021; 170:36-43. [PMID: 34774964 DOI: 10.1016/j.resuscitation.2021.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mobile phone-based dispatch of volunteers to out-of-hospital cardiac arrests (OHCA) has been shown to increase the likelihood of early CPR and AED application. In the United States, limited characterization of patients encountered as a result of such systems exists. AIMS Examine prehospital case characteristics and outcomes from a multi-year deployment of PulsePoint Respond in Pittsburgh, Pennsylvania. METHODS PulsePoint event timing, location, and associated prehospital electronic health records (ePCRs) were obtained for EMS-encountered OHCA cases that did and did not generate PulsePoint alerts within the service area of Pittsburgh EMS from July 2016 to October 2020. ePCRs were reviewed and OHCA case characteristics were extracted according to the Utstein template. PulsePoint-associated OHCA and non-PulsePoint-associated OHCA were compared. RESULTS Of 840 total PulsePoint dispatches, 64 (7.6%) were for OHCA associated with a resuscitation attempt. Forty-one (64.1%) were witnessed, 38 (59.4%) received bystander CPR, and 13 (20.0%) of these patients had an AED applied prior to EMS arrival. Twenty-seven (39.7%) had an initial shockable rhythm, and 31 (48.4%) patients achieved ROSC in the field. In the city of Pittsburgh, there were 1229 total OHCA during the study period, with an estimated 29.6% occurring in public. When PulsePoint-associated and publicly occurring non-PulsePoint-associated OHCA were compared, baseline characteristics (age, sex, witnessed status) were similar, but PulsePoint-associated OHCA received more bystander CPR (p = 0.008). CONCLUSIONS A minority of PulsePoint dispatches in Pittsburgh were triggered by true OHCA. The majority of OHCA during the study period occurred within private residences where PulsePoint responders are not currently dispatched. PulsePoint dispatches were associated with prognostically favorable OHCA characteristics and increased bystander CPR performance.
Collapse
Affiliation(s)
- Tanner Smida
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; West Virginia University MD/PhD Program, United States.
| | - Jessica Salerno
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Leonard Weiss
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | | | - David D Salcido
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| |
Collapse
|
26
|
Berglund E, Olsson E, Jonsson M, Svensson L, Hollenberg J, Claesson A, Nordberg P, Lundgren P, Högstedt Å, Ringh M. Wellbeing, emotional response and stress among lay responders dispatched to suspected out-of-hospital cardiac arrests. Resuscitation 2021; 170:352-360. [PMID: 34774709 DOI: 10.1016/j.resuscitation.2021.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/07/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Systems for smartphone dispatch of lay responders to perform cardio-pulmonary resuscitation (CPR) and bring automated external defibrillators to out-of-hospital cardiac arrests (OHCAs) are advocated by recent international guidelines and emerging worldwide. OBJECTIVES This study aimed to investigate the emotional responses, posttraumatic stress reactions and levels of wellbeing among smartphone-alerted lay responders dispatched to suspected OHCAs. METHODS Lay responders were stratified by level of exposure: unexposed (Exp-0), tried to reach (Exp-1), and reached the suspected OHCA (Exp-2). Participants rated their emotional responses online, at 90 minutes and at 4-6 weeks after an incident. Level of emotional response was measured in two dimensions of core affect: "alertness" - from deactivation to activation, and "pleasantness" - from unpleasant to pleasant. At 4-6 weeks, WHO wellbeing index and level of posttraumatic stress (PTSD) were also rated. RESULTS Altogether, 915 (28%) unexposed and 1471 (64%) exposed responders completed the survey. Alertness was elevated in the exposed groups: Exp-0: 6.7 vs. Exp-1: 7.3 and Exp-2: 7.5, (p < 0.001) and pleasantness was highest in the unexposed group: 6.5, vs. Exp-1: 6.3, and Exp-2: 6.1, (p < 0.001). Mean scores for PTSD at follow-up was below clinical cut-off, Exp-0: 9.9, Exp-1: 8.9 and Exp-2: 8.8 (p = 0.065). Wellbeing index showed no differences, Exp-0: 78.0, Exp-1: 78.5 and Exp-2: 79.9 (p = 0.596). CONCLUSION Smartphone dispatched lay responders rated the experience as high-energy and mainly positive. No harm to the lay responders was seen. The exposed groups had low posttraumatic stress scores and high-level general wellbeing at follow-up.
Collapse
Affiliation(s)
- Ellinor Berglund
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden.
| | - Erik Olsson
- Department of Women's and Children's Health, Clinical Psychology in Healthcare, Uppsala University, Sweden
| | - Martin Jonsson
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Leif Svensson
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Jacob Hollenberg
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Claesson
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Per Nordberg
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Peter Lundgren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Prehospen - Centre for Prehospital Research, University of Borås, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Åsa Högstedt
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden
| | - Mattias Ringh
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
27
|
Haskins B, Nehme Z, Dicker B, Wilson MH, Ray M, Bernard S, Cameron P, Smith K. A binational survey of smartphone activated volunteer responders for out-of-hospital cardiac arrest: Availability, interventions, and post-traumatic stress. Resuscitation 2021; 169:67-75. [PMID: 34710547 DOI: 10.1016/j.resuscitation.2021.10.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Responder smartphone apps use global positioning data to enable emergency medical services to alert volunteer responders of nearby potential out-of-hospital cardiac arrests (OHCA). AIM To assess volunteer availability, interventions provided and frequency of probable post traumatic stress disorder (PTSD) experienced by responders receiving a smartphone alert. METHODS A web-based survey was emailed to alerted responders at week-two post-alert and a PTSD screening survey at week-six, in Victoria, Australia (1/08/2019-8/11/2020), and in New Zealand (18/02/2020-28/10/2020). RESULTS We received 1,985 responses to the week-two survey and 1,443 responses to the week-six survey. Of the 1,985 responders, 1,744 (87.9%) had completed cardiopulmonary resuscitation (CPR) training in the last twelve months, and 1,514 (76.3%) had performed CPR at least once. The alert was seen by 1,501 (75.6%) responders, 749 (37.7%) accepted the alert, 538 (27.1%) arrived on scene, and 283 (14.3%) provided care to the patient. In the multivariable analysis, CPR training within twelve months was associated with increased odds of responders accepting alerts (AOR 1.41, 95%CI: 1.02-1.96; p=0.040). Responders who had performed CPR before, were more than twice as likely to provide patient care compared to responders who had not (AOR 2.54, 95%CI: 1.56-4.12; p<0.001). One responder screened positive for probable PTSD. CONCLUSION Acceptance rates in Australia and New Zealand were consistent with other smartphone apps. Responder recruitment should be targeted at those with medical backgrounds who have prior CPR experience, as they are more likely to provide care. The very low risk of PTSD is reassuring information when recruiting volunteers.
Collapse
Affiliation(s)
- Brian Haskins
- NHMRC Centre of Research Excellence in Pre-hospital Emergency Care Australia and NZ (PEC-ANZ), Monash University, St Kilda, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia.
| | - Ziad Nehme
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia; Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Bridget Dicker
- St John, Auckland, New Zealand; Auckland University of Technology, Auckland, New Zealand
| | - Mark H Wilson
- Imperial College Biomedical Research Centre, St Mary's Hospital, London W2 1NY, UK
| | - Michael Ray
- Ambulance Victoria, Melbourne, Victoria, Australia
| | - Stephen Bernard
- Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia; Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia; The Alfred Hospital, Prahran, Victoria, Australia
| | - Peter Cameron
- NHMRC Centre of Research Excellence in Pre-hospital Emergency Care Australia and NZ (PEC-ANZ), Monash University, St Kilda, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia; The Alfred Hospital, Prahran, Victoria, Australia
| | - Karen Smith
- NHMRC Centre of Research Excellence in Pre-hospital Emergency Care Australia and NZ (PEC-ANZ), Monash University, St Kilda, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia; Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| |
Collapse
|
28
|
Stoesser CE, Boutilier JJ, Sun CLF, Brooks SC, Cheskes S, Dainty KN, Feldman M, Ko DT, Lin S, Morrison LJ, Scales DC, Chan TCY. Moderating effects of out-of-hospital cardiac arrest characteristics on the association between EMS response time and survival. Resuscitation 2021; 169:31-38. [PMID: 34678334 DOI: 10.1016/j.resuscitation.2021.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/06/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although several Utstein variables are known to independently improve survival, how they moderate the effect of emergency medical service (EMS) response times on survival is unknown. OBJECTIVES To quantify how public location, witnessed status, bystander CPR, and bystander AED shock individually and jointly moderate the effect of EMS response time delays on OHCA survival. METHODS This retrospective cohort study was a secondary analysis of the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest database (December 2005 to June 2015). We included all adult, non-traumatic, non-EMS witnessed, and EMS-treated OHCAs from eleven sites across the US and Canada. We trained a logistic regression model with standard Utstein control variables and interaction terms between EMS response time and the four aforementioned OHCA characteristics. RESULTS 102,216 patients were included. Three of the four characteristics - witnessed OHCAs (OR = 0.962), bystander CPR (OR = 0.968) and public location (OR = 0.980) - increased the negative effect of a one-minute delay on the odds of survival. In contrast, a bystander AED shock decreased the negative effect of a one-minute response time delay on the odds of survival (OR = 1.064). The magnitude of the effect of a one-minute delay in EMS response time on the odds of survival ranged from 1.3% to 9.8% (average: 5.3%), depending on the underlying OHCA characteristics. CONCLUSIONS Delays in EMS response time had the largest reduction in survival odds for OHCAs that did not receive a bystander AED shock but were witnessed, occurred in public, and/or received bystander CPR. A bystander AED shock appears to be protective against a delay in EMS response time.
Collapse
Affiliation(s)
- Clara E Stoesser
- Departmentof Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Justin J Boutilier
- Departmentof Industrial and Systems Engineering, University of Wisconsin - Madison, Madison, WI, USA.
| | - Christopher L F Sun
- SloanSchool of Management, Massachusetts Institute of Technology, Cambridge, MA, USA; HealthcareSystems Engineering, Massachusetts General Hospital, Boston, MA, USA
| | - Steven C Brooks
- LiKa Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Departmentsof Emergency Medicine and Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Sheldon Cheskes
- LiKa Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Departmentof Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada; SunnybrookCenter for Prehospital Medicine, Toronto, ON, Canada
| | - Katie N Dainty
- Instituteof Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada; NorthYork General Hospital, Toronto, ON, Canada
| | - Michael Feldman
- SunnybrookCenter for Prehospital Medicine, Toronto, ON, Canada
| | - Dennis T Ko
- Instituteof Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada; Institutefor Clinical Evaluation Sciences, Toronto, ON, Canada; SchulichHeart Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Departmentof Medicine, University of Toronto, Toronto, ON, Canada
| | - Steve Lin
- LiKa Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Instituteof Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada; Departmentof Medicine, University of Toronto, Toronto, ON, Canada
| | - Laurie J Morrison
- LiKa Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Departmentof Medicine, University of Toronto, Toronto, ON, Canada
| | - Damon C Scales
- LiKa Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Instituteof Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada; Institutefor Clinical Evaluation Sciences, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Timothy C Y Chan
- Departmentof Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada; LiKa Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| |
Collapse
|
29
|
Kragh AR, Andelius L, Gregers MT, Kjølbye JS, Jørgensen AJ, Christensen AK, Zinckernagel L, Torp-Pedersen C, Folke F, Hansen CM. Immediate psychological impact on citizen responders dispatched through a mobile application to out-of-hospital cardiac arrests. Resusc Plus 2021; 7:100155. [PMID: 34430949 PMCID: PMC8371246 DOI: 10.1016/j.resplu.2021.100155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/30/2021] [Accepted: 07/14/2021] [Indexed: 11/30/2022] Open
Abstract
Background Activating citizen responders may increase survival after out-of-hospital cardiac arrest (OHCA) but could induce significant psychological impact on the citizen responders. We examined psychological impact among citizen responders within the first days following resuscitation attempt. Methods and Results A mobile phone application to activate citizen responders to perform cardiopulmonary resuscitation (CPR) was implemented in the Capital Region of Denmark. All dispatched citizen responders (September 2017 to May 2019) received a survey 90 minutes after an alarm, including self-rating of perceived psychological impact on a scale of 1–4. Of 5,395 included citizen responders, most (88.6%) completed the survey within 24 hours. The majority reported no psychological impact (68.6%), whereas 24.7%, 5.5% and 1.2% reported low, moderate, or severe impact, respectively. Severe impact was more commonly reported in the following groups: No CPR training (3.8% vs 1.2%, p = 0.02), age < 30 years (2.0% vs 0.9%, p < 0.001), female sex (1.8% vs 0.7%, p < 0.001), provided CPR (2.7% vs 1.0%, p < 0.001), and arrived prior to the emergency medical services (EMS) (2.8% vs 0.7%, p < 0.001) compared to no to moderate impact. Chi square test, Mann-Whitney U test, Fischer’s exact test and a logistic regression model were used to assess differences in psychological impact across groups. Conclusion Very few citizen responders reported severe psychological impact. Lack of prior CPR training, younger age, female sex, performing CPR and arrival prior to the EMS were associated with greater psychological impact. Though very few citizen responders reported severe impact, the possibility of professional debriefing should be considered in citizen responder programs.
Collapse
Affiliation(s)
- Astrid Rolin Kragh
- Copenhagen Emergency Medical Services, University of Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Linn Andelius
- Copenhagen Emergency Medical Services, University of Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mads Tofte Gregers
- Copenhagen Emergency Medical Services, University of Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Julie Samsøe Kjølbye
- Copenhagen Emergency Medical Services, University of Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Juul Jørgensen
- Copenhagen Emergency Medical Services, University of Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Line Zinckernagel
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Denmark.,Department of Cardiology, North Zealand Hospital, Denmark
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, University of Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Herlev Gentofte University Hospital, Copenhagen, Denmark
| | - Carolina Malta Hansen
- Copenhagen Emergency Medical Services, University of Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Herlev Gentofte University Hospital, Copenhagen, Denmark
| |
Collapse
|
30
|
Lancaster G, Herrmann JW. Computer simulation of the effectiveness of novel cardiac arrest response systems. Resusc Plus 2021; 7:100153. [PMID: 34382026 PMCID: PMC8340301 DOI: 10.1016/j.resplu.2021.100153] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 06/23/2021] [Accepted: 07/06/2021] [Indexed: 01/14/2023] Open
Abstract
Aims To use a computer simulation model to predict the response time and survival impact of a sample of novel cardiac arrest response systems, such as those that use cellphone apps to dispatch citizen mobile responders and those that use drones to deliver an AED to the cardiac arrest location. Methods We developed a model which applies a Monte Carlo approach to simulate the response time and predicted survival for cardiac arrest events within a specific region. We used the model to compare the performance of 4 different novel response systems, along with simulated EMS performance, in Bellevue, Washington. We estimated the 10 year cost for each system, which was utilized together with the system performance predictions in a cost-benefit analysis. Results The best performing systems in the simulation were a mobile responder system capable of providing both CPR and defibrillation, similar to the PulsePoint verified responder program, as well as a drone AED delivery system with bystander application. Both systems showed an incremental improvement in survival of 10% over the simulated EMS survival. The systems that provided the best cost-benefit ratio were the mobile responder system providing only CPR (PulsePoint Respond) and drone systems with bystander application. Conclusions Our simulation results suggest that these novel response systems have the potential to substantially improve survival at an efficient cost.
Collapse
Affiliation(s)
- Greg Lancaster
- Philips Healthcare, 22100 Bothell Everett Hwy, Bothell, WA 98021, United States
| | - Jeffrey W Herrmann
- University of Maryland, Department of Mechanical Engineering, College Park, MD 20742, United States
| |
Collapse
|
31
|
White AE, Ho AFW, Shahidah N, Asyikin N, Liew LX, Pek PP, Kua JPH, Chia MYC, Ng YY, Arulanandam S, Leong SHB, Ong MEH. An essential review of Singapore's response to out-of-hospital cardiac arrests: improvements over a ten-year period. Singapore Med J 2021; 62:438-443. [PMID: 35001113 PMCID: PMC8804483 DOI: 10.11622/smedj.2021114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Care for patients who experience out-of-hospital cardiac arrest (OHCA) has rapidly evolved in the past decade. Increased sophistication of care in the community, emergency medical services (EMS) and hospital setting is associated with improved patient-centred outcomes. Notably, Utstein survival doubled from 11.6% to 23.1% between 2011 and 2016. These achievements involved collaboration between policymakers, clinicians and researchers, and were made possible by a strategic interplay of policy, research and implementation. We review the development and current state of OHCA in Singapore using primary population-based data from the Pan-Asian Resuscitation Outcomes Study and an unstructured search of research databases. We discuss the roles of important milestones in policy, community, dispatch, EMS and hospital interventions. Finally, we relate these interventions to relevant processes and outcomes, such as the relationship between the strategic implementation of bystander cardiopulmonary resuscitation and placement of automated external defibrillator with return of spontaneous circulation, survival to discharge and survival with favourable neurological outcomes.
Collapse
Affiliation(s)
- Alexander E White
- Unit for Prehospital Emergency Care, Singapore General Hospital, Singapore
- Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore
| | - Andrew FW Ho
- Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Nurul Asyikin
- Unit for Prehospital Emergency Care, Singapore General Hospital, Singapore
| | - Le Xuan Liew
- Unit for Prehospital Emergency Care, Singapore General Hospital, Singapore
| | - Pin Pin Pek
- Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Jade PH Kua
- Emergency Department, Woodlands Health Campus, Singapore
| | | | - Yih Yng Ng
- Emergency Department, Tan Tock Seng Hospital, Singapore
- Home Team Medical Services Division, Ministry of Home Affairs, Singapore
| | - Shalini Arulanandam
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore
| | | | - Marcus EH Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| |
Collapse
|
32
|
Ries ES, Kragh AR, Dammeyer J, Folke F, Andelius L, Malta Hansen C. Association of Psychological Distress, Contextual Factors, and Individual Differences Among Citizen Responders. J Am Heart Assoc 2021; 10:e020378. [PMID: 34212765 PMCID: PMC8403282 DOI: 10.1161/jaha.120.020378] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Little is known about the psychological risks of dispatched citizen responders who have participated in resuscitation attempts. Methods and Results A cross‐sectional survey study was performed with 102 citizen responders who participated in a resuscitation attempt from July 23, 2018, to August 22, 2018, in the Capital Region of Denmark. Psychological distress, defined as symptoms of posttraumatic stress disorder, was assessed 3 weeks after the resuscitation attempt and measured with the Impact of Event Scale‐Revised. Perceived stress was measured with the Perceived Stress Scale. Individual differences were assessed as the personality traits of agreeableness, conscientiousness, extraversion, neuroticism, and openness to experience with the Big Five Inventory, general self‐efficacy, and coping mechanisms (Brief Coping Orientation to Problems Experienced Inventory). Associations between continuous variables were examined with the Pearson correlation. The associations between psychological distress levels and contextual factors and individual differences were analyzed in multivariable linear regression models to determine factors independently associated with psychological distress levels. The mean overall posttraumatic stress disorder score was 0.65 of 12; the mean perceived stress score was 7.61 of 40. The most common coping mechanisms were acceptance and emotional support. Low perceived stress was significantly associated with high general self‐efficacy, and high perceived stress was significantly associated with high scores on neuroticism and openness to experience. Non–healthcare professionals were less likely to report symptoms of posttraumatic stress disorder. Conclusions Citizen responders who participated in resuscitation reported low levels of psychological distress. Individual differences were significantly associated with levels of psychological distress and should be considered when engaging citizen responders in resuscitation.
Collapse
Affiliation(s)
| | | | | | - Fredrik Folke
- Copenhagen Emergency Medical Services University of Copenhagen Denmark.,Department of Cardiology Herlev Gentofte University Hospital Copenhagen Denmark
| | - Linn Andelius
- Copenhagen Emergency Medical Services University of Copenhagen Denmark
| | - Carolina Malta Hansen
- Copenhagen Emergency Medical Services University of Copenhagen Denmark.,Department of Cardiology Herlev Gentofte University Hospital Copenhagen Denmark
| |
Collapse
|
33
|
Mentzelopoulos SD, Couper K, Van de Voorde P, Druwé P, Blom M, Perkins GD, Lulic I, Djakow J, Raffay V, Lilja G, Bossaert L. [Ethics of resuscitation and end of life decisions]. Notf Rett Med 2021; 24:720-749. [PMID: 34093076 PMCID: PMC8170633 DOI: 10.1007/s10049-021-00888-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/14/2022]
Abstract
These European Resuscitation Council Ethics guidelines provide evidence-based recommendations for the ethical, routine practice of resuscitation and end-of-life care of adults and children. The guideline primarily focus on major ethical practice interventions (i.e. advance directives, advance care planning, and shared decision making), decision making regarding resuscitation, education, and research. These areas are tightly related to the application of the principles of bioethics in the practice of resuscitation and end-of-life care.
Collapse
Affiliation(s)
- Spyros D. Mentzelopoulos
- Evaggelismos Allgemeines Krankenhaus, Abteilung für Intensivmedizin, Medizinische Fakultät der Nationalen und Kapodistrischen Universität Athen, 45–47 Ipsilandou Street, 10675 Athen, Griechenland
| | - Keith Couper
- Universitätskliniken Birmingham NHS Foundation Trust, UK Critical Care Unit, Birmingham, Großbritannien
- Medizinische Fakultät Warwick, Universität Warwick, Coventry, Großbritannien
| | - Patrick Van de Voorde
- Universitätsklinikum und Universität Gent, Gent, Belgien
- staatliches Gesundheitsministerium, Brüssel, Belgien
| | - Patrick Druwé
- Abteilung für Intensivmedizin, Universitätsklinikum Gent, Gent, Belgien
| | - Marieke Blom
- Medizinisches Zentrum der Universität Amsterdam, Amsterdam, Niederlande
| | - Gavin D. Perkins
- Medizinische Fakultät Warwick, Universität Warwick, Coventry, Großbritannien
| | | | - Jana Djakow
- Intensivstation für Kinder, NH Hospital, Hořovice, Tschechien
- Abteilung für Kinderanästhesiologie und Intensivmedizin, Universitätsklinikum und Medizinische Fakultät der Masaryk-Universität, Brno, Tschechien
| | - Violetta Raffay
- School of Medicine, Europäische Universität Zypern, Nikosia, Zypern
- Serbischer Wiederbelebungsrat, Novi Sad, Serbien
| | - Gisela Lilja
- Universitätsklinikum Skane, Abteilung für klinische Wissenschaften Lund, Neurologie, Universität Lund, Lund, Schweden
| | | |
Collapse
|
34
|
Barry T, Headon M, Quinn M, Egan M, Masterson S, Deasy C, Bury G. General practice and cardiac arrest community first response in Ireland. Resusc Plus 2021; 6:100127. [PMID: 34223384 PMCID: PMC8244493 DOI: 10.1016/j.resplu.2021.100127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/21/2022] Open
Abstract
Background In Ireland, the MERIT 3 scheme enables doctors to volunteer as cardiac arrest community first responders and receive text message alerts from emergency medical services (EMS) to facilitate early care. Aim To establish the sustainability, systems and clinical outcomes of a novel, general practice based, cardiac arrest first response initiative over a four-year period. Methods Data on alerts, responses, incidents and outcomes were gathered prospectively using EMS control data, incident data reported by responders and corroborative data from the national Out-of-Hospital Cardiac Arrest Registry. Results Over the period 2016–2019, 196 doctors joined MERIT 3 and 163 (83.2%) were alerted on one or more occasions; 61.3% of those alerted responded to at least one alert. Volunteer doctors attended 300 patients of which 184 (61.3%) had suffered OHCA and had a resuscitation attempt. Responders arrived to OHCA before EMS on 75 occasions (40.8%), initiated chest compressions on seven occasions (3.8%), and brought the first defibrillator on 42 occasions (22.8%). Information on the first monitored rhythm was available for 149/184 (81.0%) patients and was shockable in 30/149 (20.1%); in 9/30 cases, shocks were administered by responders. The overall survival rate was 11.0% (national survival rate 7.3%). Doctors also provided advanced life support and were closely involved in decision making on ceasing resuscitation. Conclusion The MERIT 3 initiative in Ireland has been sustained over a four-year period and has demonstrated the ability of volunteer doctors to provide early care for OHCA patients as well as more complex interventions including end-of-life care. Further development of this strategy is warranted.
Collapse
Affiliation(s)
- Tomas Barry
- School of Medicine, University College Dublin, Ireland
- Corresponding author.
| | - Mary Headon
- Centre for Emergency Medical Science, University College Dublin, Ireland
| | | | - Mairead Egan
- Centre for Emergency Medical Science, University College Dublin, Ireland
| | - Siobhan Masterson
- Clinical Strategy and Evaluation, National Ambulance Service, Health Service Executive, Ireland
| | | | - Gerard Bury
- School of Medicine, University College Dublin, Ireland
| |
Collapse
|
35
|
Morgenstern J, Heitz C, Bond C, Milne WK. Hot Off the Press: Mobile Smartphone Technology Is Associated With Out-of-hospital Cardiac Arrest Survival Improvement. Acad Emerg Med 2021; 28:589-592. [PMID: 33187028 DOI: 10.1111/acem.14172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Corey Heitz
- the Virginia Tech Carilion School of Medicine Roanoke VAUSA
| | - Chris Bond
- the University of Calgary Calgary Alberta Canada
| | | |
Collapse
|
36
|
Ataiants J, Reed MK, Schwartz DG, Roth A, Marcu G, Lankenau SE. Decision-making by laypersons equipped with an emergency response smartphone app for opioid overdose. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103250. [PMID: 33887699 DOI: 10.1016/j.drugpo.2021.103250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/19/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Targeted naloxone distribution to potential lay responders increases the timeliness of overdose response and reduces mortality. Little is known, however, about the patterns of decision-making among overdose lay responders. This study explored heuristic decision-making among laypersons equipped with an emergency response smartphone app. METHODS UnityPhilly, a smartphone app that connects lay responders equipped with naloxone to overdose victims, was piloted in Philadelphia from March 2019 to February 2020. Participants used the app to signal overdose alerts to peer app users and emergency medical services, or respond to alerts by arriving at overdose emergency sites. This study utilised in-depth interviews, background information, and app use data from a sample of 18 participants with varying histories of opioid use and levels of app use activity. RESULTS The sample included 8 people who used opioids non-medically in the past 30 days and 10 people reporting no opioid misuse. Three prevailing, not mutually exclusive, heuristics were identified. The heuristic of unconditional signalling ("Always signal for help or backup") was used by 7 people who valued external assistance and used the app as a replacement for a 911 call; this group had the highest number of signalled alerts and on-scene appearances. Nine people, who expressed confidence in their ability to address an overdose themselves, followed a heuristic of conditional signalling ("Rescue, but only signal if necessary"); these participants had the highest frequency of prior naloxone administrations. Eleven participants used the heuristic of conditional responding ("Assess if I can make a difference"), addressing an alert if they carried naloxone, were nearby, or received a signal before dark hours. CONCLUSION The deployment of specific heuristics was influenced by prior naloxone use and situational factors. Success of overdose prevention interventions assisted by digital technologies may depend on the involvement of people with diverse overdose rescue backgrounds.
Collapse
Affiliation(s)
- Janna Ataiants
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA 19104, USA.
| | - Megan K Reed
- Department of Emergency Medicine, Thomas Jefferson University, 1025 Walnut St, College Bldg, Suite 706, Philadelphia, PA 19107, USA
| | - David G Schwartz
- Information Systems Division, Graduate School of Business, Bar-Ilan University, Ramat-Gan, 5290002, Israel
| | - Alexis Roth
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA 19104, USA
| | - Gabriela Marcu
- School of Information, University of Michigan, Ann Arbor, 105 S. State Street, Ann Arbor, MI 48109, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA 19104, USA
| |
Collapse
|
37
|
Mentzelopoulos SD, Couper K, Voorde PVD, Druwé P, Blom M, Perkins GD, Lulic I, Djakow J, Raffay V, Lilja G, Bossaert L. European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions. Resuscitation 2021; 161:408-432. [PMID: 33773832 DOI: 10.1016/j.resuscitation.2021.02.017] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
These European Resuscitation Council Ethics guidelines provide evidence-based recommendations for the ethical, routine practice of resuscitation and end-of-life care of adults and children. The guideline primarily focus on major ethical practice interventions (i.e. advance directives, advance care planning, and shared decision making), decision making regarding resuscitation, education, and research. These areas are tightly related to the application of the principles of bioethics in the practice of resuscitation and end-of-life care.
Collapse
Affiliation(s)
| | - Keith Couper
- UK Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - Patrick Van de Voorde
- University Hospital and University Ghent, Belgium; Federal Department Health, Belgium
| | - Patrick Druwé
- Ghent University Hospital, Department of Intensive Care Medicine, Ghent, Belgium
| | - Marieke Blom
- Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Gavin D Perkins
- UK Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Jana Djakow
- Paediatric Intensive Care Unit, NH Hospital, Hořovice, Czech Republic; Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital and Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Violetta Raffay
- European University Cyprus, School of Medicine, Nicosia, Cyprus; Serbian Resuscitation Council, Novi Sad, Serbia
| | - Gisela Lilja
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden
| | | |
Collapse
|
38
|
Smartphone Activation of Citizen Responders to Facilitate Defibrillation in Out-of-Hospital Cardiac Arrest. J Am Coll Cardiol 2021; 76:43-53. [PMID: 32616162 DOI: 10.1016/j.jacc.2020.04.073] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/13/2020] [Accepted: 04/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Dispatching citizen responders through a smartphone application (app) holds the potential to increase bystander cardiopulmonary resuscitation (CPR) and defibrillation in out-of-hospital cardiac arrest (OHCA). OBJECTIVES This study investigated arrival at the OHCA location of app-dispatched citizen responders before the Emergency Medical Services (EMS) and the association with bystander CPR and bystander defibrillation. METHODS Suspected OHCAs with alerted citizen responders from September 1, 2017, to August 31, 2018, were included. Citizen responders located 1.8 km (1.1 miles) from the OHCA were dispatched to start CPR or retrieve an automated external defibrillator. OHCAs where at least 1 citizen responder arrived before EMS were compared with OHCAs where EMS arrived first. In both groups, random bystanders could be present before the arrival of citizen responders and the EMS. Primary outcomes were bystander CPR and bystander defibrillation, which included CPR and defibrillation by citizen responders and random bystanders. RESULTS Citizen responders were alerted in 819 suspected OHCAs, of which 438 (53.5%) were confirmed cardiac arrests eligible for inclusion. At least 1 citizen responder arrived before EMS in 42.0% (n = 184) of all included OHCAs. When citizen responders arrived before EMS, the odds for bystander CPR increased (odds ratio: 1.76; 95% confidence interval: 1.07 to 2.91; p = 0.027) and the odds for bystander defibrillation more than tripled (odds ratio: 3.73; 95% confidence interval: 2.04 to 6.84; p < 0.001) compared with OHCAs in which citizen responders arrived after EMS. CONCLUSIONS Arrival of app-dispatched citizen responders before EMS was associated with increased odds for bystander CPR and a more than 3-fold increase in odds for bystander defibrillation. (The HeartRunner Trial; NCT03835403).
Collapse
|
39
|
Rao G, Choudhury S, Lingras P, Savage D, Mago V. SURF: identifying and allocating resources during Out-of-Hospital Cardiac Arrest. BMC Med Inform Decis Mak 2020; 20:313. [PMID: 33380330 PMCID: PMC7772910 DOI: 10.1186/s12911-020-01334-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 11/16/2020] [Indexed: 11/20/2022] Open
Abstract
Background When an Out-of-Hospital Cardiac Arrest (OHCA) incident is reported to emergency services, the 911 agent dispatches Emergency Medical Services to the location and activates responder network system (RNS), if the option is available. The RNS notifies all the registered users in the vicinity of the cardiac arrest patient by sending alerts to their mobile devices, which contains the location of the emergency. The main objective of this research is to find the best match between the user who could support the OHCA patient. Methods For performing matching among the user and the AEDs, we used Bipartite Matching and Integer Linear Programming. However, these approaches take a longer processing time; therefore, a new method Preprocessed Integer Linear Programming is proposed that solves the problem faster than the other two techniques. Results The average processing time for the experimentation data was 1850 s using Bipartite matching, 32 s using the Integer Linear Programming and 2 s when using the Preprocessed Integer Linear Programming method. The proposed algorithm performs matching among users and AEDs faster than the existing matching algorithm and thus allowing it to be used in the real world. Conclusion: This research proposes an efficient algorithm that will allow matching of users with AED in real-time during cardiac emergency. Implementation of this system can help in reducing the time to resuscitate the patient.
Collapse
Affiliation(s)
- Gaurav Rao
- Department of Mathematics and Computing Science, Saint Mary's University, Halifax, CA, USA
| | - Salimur Choudhury
- Department of Computer Science, Lakehead University, Thunder Bay, CA, USA
| | - Pawan Lingras
- Department of Mathematics and Computing Science, Saint Mary's University, Halifax, CA, USA
| | - David Savage
- Northern Ontario School of Medicine, Thunder Bay, CA, USA
| | - Vijay Mago
- Department of Computer Science, Lakehead University, Thunder Bay, CA, USA.
| |
Collapse
|
40
|
Valeriano A, Van Heer S, de Champlain F, C Brooks S. Crowdsourcing to save lives: A scoping review of bystander alert technologies for out-of-hospital cardiac arrest. Resuscitation 2020; 158:94-121. [PMID: 33188832 DOI: 10.1016/j.resuscitation.2020.10.035] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 11/30/2022]
Abstract
AIM Out-of-hospital cardiac arrest (OHCA) constitutes a significant global health burden, with a survival rate of only 10-12%. Mobile phone technologies have been developed that crowdsource citizen volunteers to nearby OHCAs in order to initiate resuscitation prior to ambulance arrival. We performed a scoping review to map the available literature on these crowdsourcing technologies and compared their technical specifications. METHODS A search strategy was developed for five online databases. Two reviewers independently assessed all articles for inclusion and extracted relevant study information. Subsequently, we performed a supplementary internet search and consulted experts to identify all available bystander alert technologies and their specifications. RESULTS We included 65 articles examining bystander alerting technologies from more than 15 countries. We also identified 25 unique technologies, of which 18 were described in the included literature. Technologies were text message-based systems (n = 3) or mobile phone applications (n = 22). Most (21/25) used global positioning systems to direct bystanders to victims and nearby AEDs. Response radii for alerts varied widely from 200 m to 10 km. Some technologies incorporated advanced features such as video-conferencing with ambulance dispatch and detailed alert settings. Not all systems required volunteers to have training in cardiopulmonary resuscitation. Only ten studies assessed impact on clinical outcomes. Key barriers discussed included false positive alerts, legal liability, and potential psychological impact on volunteers. CONCLUSION Our review provides a comprehensive overview of crowdsourcing technologies for bystander intervention in out-of-hospital cardiac arrest. Future work should focus on clinical outcomes and methods of addressing barriers to implementation.
Collapse
Affiliation(s)
| | - Shyan Van Heer
- School of Medicine, Queen's University, Kingston, Canada
| | | | - Steven C Brooks
- Department of Emergency Medicine, Queen's University, Kingston, Canada.
| |
Collapse
|
41
|
Out-of-hospital cardiac arrest: comparing organised groups to individual first responders. Eur J Anaesthesiol 2020; 38:1096-1104. [DOI: 10.1097/eja.0000000000001335] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
42
|
Integration of novel monitoring devices with machine learning technology for scalable cardiovascular management. Nat Rev Cardiol 2020; 18:75-91. [PMID: 33037325 PMCID: PMC7545156 DOI: 10.1038/s41569-020-00445-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 01/19/2023]
Abstract
Ambulatory monitoring is increasingly important for cardiovascular care but is often limited by the unpredictability of cardiovascular events, the intermittent nature of ambulatory monitors and the variable clinical significance of recorded data in patients. Technological advances in computing have led to the introduction of novel physiological biosignals that can increase the frequency at which abnormalities in cardiovascular parameters can be detected, making expert-level, automated diagnosis a reality. However, use of these biosignals for diagnosis also raises numerous concerns related to accuracy and actionability within clinical guidelines, in addition to medico-legal and ethical issues. Analytical methods such as machine learning can potentially increase the accuracy and improve the actionability of device-based diagnoses. Coupled with interoperability of data to widen access to all stakeholders, seamless connectivity (an internet of things) and maintenance of anonymity, this approach could ultimately facilitate near-real-time diagnosis and therapy. These tools are increasingly recognized by regulatory agencies and professional medical societies, but several technical and ethical issues remain. In this Review, we describe the current state of cardiovascular monitoring along the continuum from biosignal acquisition to the identification of novel biosensors and the development of analytical techniques and ultimately to regulatory and ethical issues. Furthermore, we outline new paradigms for cardiovascular monitoring. Advances in cardiovascular monitoring technologies have resulted in an influx of consumer-targeted wearable sensors that have the potential to detect numerous heart conditions. In this Review, Krittanawong and colleagues describe processes involved in biosignal acquisition and analysis of cardiovascular monitors, as well as their associated ethical, regulatory and legal challenges. Advances in the use of cardiovascular monitoring technologies, such as the development of novel portable sensors and machine learning algorithms that can provide near-real-time diagnosis, have the potential to provide personalized care. Wearable sensor technologies can detect numerous biosignals, such as cardiac output, blood-pressure levels and heart rhythm, and can integrate multiple modalities. The use of novel biosignals for diagnosis raises concerns regarding accuracy and actionability within clinical guidelines, in addition to medical, legal and ethical issues. Machine learning-based interpretation of biosensor data can facilitate rapid evaluation of the haemodynamic consequences of heart failure or arrhythmias, but is limited by the presence of noise and training data that might not be representative of the real-world clinical setting. The use of data derived from cardiovascular monitoring devices is associated with numerous challenges, such as data security, accessibility and ownership, in addition to other ethical and regulatory concerns.
Collapse
|
43
|
Derkenne C, Jost D, Roquet F, Dardel P, Kedzierewicz R, Mignon A, Travers S, Frattini B, Prieux L, Rozenberg E, Demaison X, Gaudet J, Charry F, Stibbe O, Briche F, Lemoine F, Lesaffre X, Maurin O, Gauyat E, Faraon E, Lemoine S, Prunet B. Mobile Smartphone Technology Is Associated With Out-of-hospital Cardiac Arrest Survival Improvement: The First Year "Greater Paris Fire Brigade" Experience. Acad Emerg Med 2020; 27:951-962. [PMID: 32445436 DOI: 10.1111/acem.13987] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/25/2020] [Accepted: 03/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) remains associated with very high mortality. Accelerating the initiation of efficient cardiopulmonary resuscitation (CPR) is widely perceived as key to improving outcomes. The main goal was to determine whether identification and activation of nearby first responders through a smartphone application named Staying Alive (SA) can improve survival following OHCA in a large urban area (Paris). METHODS We conducted a nonrandomized cohort study of all adults with OHCA managed by the Greater Paris Fire Brigade during 2018, irrespective of mobile application usage. We compared survival data in cases where SA did or did not lead to the activation of nearby first responders. During dispatch, calls for OHCA were managed with or without SA. The intervention group included all cases where nearby first responders were successfully identified by SA and actively contributed to CPR. The control group included all other cases. We compared survival at hospital discharge between the intervention and control groups. We analyzed patient data, CPR metrics, and first responders' characteristics. RESULTS Approximately 4,107 OHCA cases were recorded in 2018. Among those, 320 patients were in the control group, whereas 46 patients, in the intervention group, received first responder-initiated CPR. After adjustment for confounders, survival at hospital discharge was significantly improved for patients in the intervention group (35% vs. 16%, adjusted odds ratio = 5.9, 95% confidence interval = 2.1 to 16.5, p < 0.001). All CPR metrics were improved in the intervention group. CONCLUSIONS We report that mobile smartphone technology was associated with OHCA survival through accelerated initiation of efficient CPR by first responders in a large urban area.
Collapse
Affiliation(s)
- Clément Derkenne
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - Daniel Jost
- From the Emergency Medical Department Paris Fire Brigade Paris France
- the Sudden Death Expertise Center Hôpital Pompidou Paris France
| | - Florian Roquet
- the Critical Care Department Hôpital Pompidou Paris France
- INSERM 1153 Unit Hôpital St Louis Paris France
| | - Paul Dardel
- Staying Alive Responder Endowment Fund Boulogne Billancourt France
| | | | - Alexandre Mignon
- Université Paris Descartes Paris France
- Hôpital Cochin 24 Assistance Publique–Hôpitaux de Paris Paris France
| | - Stéphane Travers
- From the Emergency Medical Department Paris Fire Brigade Paris France
- and the French Military Health Service Val de Grâce Military Academy Paris France
| | - Benoit Frattini
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - Laurent Prieux
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | | | - Xavier Demaison
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - John Gaudet
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - Félicité Charry
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - Olivier Stibbe
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - Frédérique Briche
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - Frédéric Lemoine
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - Xavier Lesaffre
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - Olga Maurin
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - Eric Gauyat
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - Eric Faraon
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - Sabine Lemoine
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - Bertrand Prunet
- From the Emergency Medical Department Paris Fire Brigade Paris France
- and the French Military Health Service Val de Grâce Military Academy Paris France
| |
Collapse
|
44
|
Abstract
Cardiac electrical stimulation is a rarely used but required skill for pediatric emergency physicians. Children who are in cardiac arrest or who demonstrate evidence of hypoperfusion because of cardiac reasons require rapid diagnosis and intervention to minimize patient morbidity and mortality. Both hospital- and community-based personnel must have sufficient access to, and knowledge of, appropriate equipment to provide potentially lifesaving defibrillation, cardioversion, or cardiac pacing. In this review, we will discuss the primary clinical indications for cardioelectrical stimulation in pediatric patients, including the use of automated external defibrillators, internal defibrillators, and pacemakers. We discuss the types of devices that are currently available, emergency management of internal defibrillation and pacemaker devices, and the role of advocacy in improving delivery of emergency cardiovascular care of pediatric patients in the community.
Collapse
|
45
|
Blewer AL, Ho AFW, Shahidah N, White AE, Pek PP, Ng YY, Mao DR, Tiah L, Chia MYC, Leong BSH, Cheah SO, Tham LP, Kua JPH, Arulanandam S, Østbye T, Bosworth HB, Ong MEH. Impact of bystander-focused public health interventions on cardiopulmonary resuscitation and survival: a cohort study. LANCET PUBLIC HEALTH 2020; 5:e428-e436. [DOI: 10.1016/s2468-2667(20)30140-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 03/27/2020] [Accepted: 06/05/2020] [Indexed: 12/26/2022]
|
46
|
Schwartz DG, Ataiants J, Roth A, Marcu G, Yahav I, Cocchiaro B, Khalemsky M, Lankenau S. Layperson reversal of opioid overdose supported by smartphone alert: A prospective observational cohort study. EClinicalMedicine 2020; 25:100474. [PMID: 32954238 PMCID: PMC7486335 DOI: 10.1016/j.eclinm.2020.100474] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Rapid naloxone administration is crucial in reversing an opioid overdose. We investigated whether equipping community members, including people who use opioids (PWUO), with a smartphone application enabling them to signal and respond to suspected overdose would support naloxone administration in advance of Emrgency Medical Services (EMS). METHODS This observational cohort study of opioid overdose intervention used a dedicated smartphone app, UnityPhilly, activated by volunteers witnessing an overdose to signal other nearby volunteers in Philadelphia (March 2019 - February 2020). Alerted volunteers chose to respond, or declined to respond, or ignored/missed the alert. Witnessing volunteer was connected to 9-1-1 through a semi-automated telephone call. The primary outcome was layperson-initiated overdose reversal before EMS arrival, and a secondary outcome was hospital transfer. This study is registered with ClinicalTrials.gov, NCT03305497. FINDINGS 112 volunteers, including 57 PWUO and 55 community members, signaled 291 suspected opioid overdose alerts. 89 (30⸱6%) were false alarms. For 202 true alerts, the rate of layperson initiated naloxone use was 36⸱6% (74/202 cases). Most naloxone-use cases occurred in the street (58⸱11% (43/74)) and some in home settings (22⸱98% (17/74)). The first naloxone dose was provided by a nearby volunteer responding to the alert in 29⸱73% (22/74) of cases and by the signaling volunteer in 70⸱27% (52/74) of cases. Successful reversal was reported in 95⸱9% (71/74) of cases. Layperson intervention preceded EMS by 5 min or more in 59⸱5% of cases. Recovery without hospital transport was reported in 52⸱7% (39/74) of cases. INTERPRETATION Our findings support the benefits of equipping community members, potentially witnessing suspected opioid overdose, with naloxone and an emergency response community smartphone app, alerting EMS and nearby laypersons to provide additional naloxone. FUNDING Funding provided by NIH through NIDA, grant number: 5R34DA044758.
Collapse
Affiliation(s)
- David G. Schwartz
- Information Systems Division, Graduate School of Business, Bar-Ilan University, Ramat-Gan, Israel
- Corresponding author.
| | - Janna Ataiants
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Alexis Roth
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Gabriela Marcu
- School of Information, University of Michigan, Ann Arbor, MI, USA
| | - Inbal Yahav
- Coller School of Management, Tel-Aviv University, Tel-Aviv, Israel
| | - Benjamin Cocchiaro
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Khalemsky
- Information Systems Division, Graduate School of Business, Bar-Ilan University, Ramat-Gan, Israel
| | - Stephen Lankenau
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| |
Collapse
|
47
|
Ming Ng W, De Souza CR, Pek PP, Shahidah N, Ng YY, Arulanandam S, White AE, Leong BSH, Ong MEH. myResponder Smartphone Application to Crowdsource Basic Life Support for Out-of-Hospital Cardiac Arrest: The Singapore Experience. PREHOSP EMERG CARE 2020; 25:388-396. [PMID: 32497484 DOI: 10.1080/10903127.2020.1777233] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The Singapore myResponder is a novel smartphone application developed by the Singapore Civil Defence Force (SCDF) that notifies volunteer first responders of a suspected out-of-hospital cardiac arrest (OHCA) case and locations of Automated External Defibrillators (AED) in the vicinity so that they can assist with resuscitation. We aimed to examine the performance of this application, challenges encountered, and future directions. Methods: We analyzed data from the myResponder app since its launch from April 2015 to July 2019. The number of installations, registered community first responders, suspected OHCA cases, notifications sent by the app, percentage of responders who accepted activation and arrived at scene were reviewed. A subgroup of taxi driving responders (within a 1.5-kilometer response radius) carrying an AED under a subsequent pilot program was also analyzed. Results: By July 2019, 46,689 responders were registered in the myResponder app. There were a total of 19,189 cases created for suspected OHCA, with a median of 358 cases per month (IQR 330-430), in which 10,073 responders accepted activation from myResponder and 4,955 arrived on-scene. A total of 135,599 notifications were sent for these cases, with a median of 7.1 notifications per case (IQR 4.3-8.7). In 2019, the percentages of responders who accepted notification and arrived on scene were 45.8% and 24.1%, respectively. 43% (1110/2581) of responders arrived before EMS crew. Conclusion: The myResponder mobile application is a feasible smart technology solution to improve community response to OHCA, and to increase bystander CPR and AED use. Future directions include increasing the number of active responders, improving response rates, app performance, and better data capture for quality improvement.
Collapse
|
48
|
Chugh SS, Jui J, Salvucci A. Pivotal Role in the Community Response to Cardiac Arrest: The Smart Bystander. J Am Coll Cardiol 2020; 76:54-56. [PMID: 32616163 PMCID: PMC7324100 DOI: 10.1016/j.jacc.2020.05.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 01/11/2023]
Affiliation(s)
- Sumeet S Chugh
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California.
| | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon
| | - Angelo Salvucci
- Ventura County Emergency Medical Services, Ventura, California
| |
Collapse
|
49
|
Improving response to out-of-hospital cardiac arrest: The verified responder program pilot. Resuscitation 2020; 154:1-6. [PMID: 32580006 DOI: 10.1016/j.resuscitation.2020.06.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 06/03/2020] [Accepted: 06/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Survival following out-of-hospital cardiac arrest (OHCA) decreases as the interval from collapse to CPR and defibrillation increases. Innovative approaches are needed to reduce response intervals, especially for private locations. METHODS We undertook the Verified Responder Program in 5 United States communities during 2018, whereby off-duty EMS professionals volunteered and were equipped with automated external defibrillators (AEDs). Volunteers were alerted using a geospatial smartphone application (PulsePoint) and could respond to nearby private and public suspected OHCA. The study evaluated the frequency of Verified Responder notification, response, scene arrival, and initial care prior to EMS arrival. OHCA surveillance used the CARES registry. RESULTS Of the 651 OHCA events (475 private, 176 public), Verified Responders were notified in 7.4% (n = 49). Among the 475 in a private location, volunteers were alerted in 8% (n = 38), responded in 2.7% (n = 13), arrived on scene in 2.3% (n = 11), and provided initial care in 1.7% (n = 8). Among the 176 in a public location, volunteers were alerted in 6.3% (n = 11), responded in 2.3% (n = 4), arrived on-scene in 2.3% (n = 4), and provided initial care in 2.3% (n = 4). Over 96% surveyed had positive impression of the program and intended to continue participation. No responder reported any adverse event. CONCLUSIONS In this initial US-based experience of a smartphone program for suspected OHCA in private and public locations, Verified Responders reported a positive experience, though were only involved in a small fraction of OHCA. Studies should determine how this type of program could be enhanced to involve more OHCA events.
Collapse
|
50
|
McBride R, Ski CF, Thompson DR, Quinn T, Wilson MH. Championing survival: connecting the unknown network of responders to address out-of-hospital cardiac arrest. Scand J Trauma Resusc Emerg Med 2020; 28:49. [PMID: 32493504 PMCID: PMC7271506 DOI: 10.1186/s13049-020-00748-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/27/2020] [Indexed: 12/18/2022] Open
Abstract
Early intervention for out-of-hospital cardiac arrest (OHCA) presents a challenge for Emergency Medical Services (EMS) across Europe. Strategies designed to address this include education and training initiatives for citizens and building CPR skills capacity and awareness amongst health care professionals. However, there is a need to improve access to volunteer first responders who can commence CPR and defibrillate before the arrival of EMS. In the UK, initiatives such GoodSAM have integrated crowdsourcing technology with ambulance services to allow them autonomy in alerting responders to OHCAs which is parallel to an EMS dispatch. These services are building capacity to improve the initial 'call for help' and time to commence CPR and defibrillation if indicated. The next step is to identify and implement appropriate methods for public engagement, involvement and eventual networking of resources with statutory bodies such as local EMS. As crowdsourcing volunteer responders is at an early stage, there is a need to determine whether crowdsourcing is associated with patient outcomes, what its impact is on those responding to OHCA, whether it facilitates or impedes current services, and whether it is a safe and cost effective way to involve citizens to intervene in the community during cardiac arrest or other medical emergencies? Addressing such issues is likely to provide further insight into the role and effectiveness of new technologies and their potential impact on the wider community.
Collapse
Affiliation(s)
- Ronan McBride
- Ronan McBride, Anaesthetics, Theatres and Intensive Care Services, Southern Health and Social Care Trust, Portadown, UK
| | - Chantal F Ski
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Rd, Belfast, UK.
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Rd, Belfast, UK
| | - Tom Quinn
- Emergency, Cardiovascular and Critical Care Research Group, Kingston University London and St George's, London, UK
| | - Mark H Wilson
- Department of Neurosurgery, Imperial College London, London, UK
| |
Collapse
|