Characterization of non-cardiac arrest PulsePoint activations in public and private settings

BACKGROUND

Geospatial smartphone application alert systems are used in some communities to crowdsource community response for out-of-hospital cardiac arrest (OHCA). Although the clinical focus of this strategy is OHCA, dispatch identification of OHCA is imperfect so that activation may occur for the non-arrest patient. The frequency and clinical profile of such non-arrest patients has not been well-investigated.

METHODS

We undertook a prospective 3-year cohort investigation of patients for whom a smartphone geospatial application was activated for suspected OHCA in four United States communities (total population ~1 million). The current investigation evaluates those patients with an activation for suspected OHCA who did not experience cardiac arrest. The volunteer response cohort included off-duty, volunteer public safety personnel (verified responders) notified regardless of location (public or private) and laypersons notified to public locations. The study linked the smartphone application information with the EMS records to report the frequency, condition type, and EMS treatment for these non-arrest patients.

RESULTS

Of 1779 calls where volunteers were activated, 756 had suffered OHCA, resulting in 1023 non-arrest patients for study evaluation. The most common EMS assessments were syncope (15.9%, n=163), altered mental status (15.5%, n=159), seizure (14.3%, n=146), overdose (13.0%, n=133), and choking (10.5%, n=107). The assessment distribution was similar for private and public locations. Overall, the most common EMS interventions included placement of an intravenous line (43.1%, n=441), 12-Lead ECG(27.9%, n=285), naloxone treatment (9.8%, n=100), airway or ventilation assistance (8.7%, n=89), and oxygen administration (6.6%, n=68).

CONCLUSIONS

More than half of patients activated for suspected OHCA had conditions other than cardiac arrest. A subset of these conditions may benefit from earlier care that could be provided by both layperson and public safety volunteers if they were appropriately trained and equipped.

In the shadow of El Chichon: an overview of the medical impact of the 28 March to 4 April 1982 eruptions of the Mexican volcano

On 28 March 1982, El Chichon, a volcanic peak located in southern Mexico, began an eruptive phase of activity. Four major eruptions occurred within the next eight days, culminating in a cataclysmic eruption on 4 April. When the dust had settled, an estimated 200 million tons of ash blanketed more than 200 square kilometers of southern Mexico and neighboring Central American countries. Forty thousand villagers were left homeless and several thousand people may have lost their lives. Fifty thousand head of cattle were destroyed outright with many more succumbing to lack of water and pasture. Millions of hectares of crops were destroyed (Figure 1).