Dual dispatch early defibrillation in out-of-hospital cardiac arrest in a mixed urban–rural population

doi:10.1016/j.resuscitation.2013.02.023

Resuscitation

Volume 84, Issue 9, September 2013, Pages 1197-1202

https://doi.org/10.1016/j.resuscitation.2013.02.023 Get rights and content

Abstract

Aims

The effects of a system based on minimally trained first responders (FR) dispatched simultaneously with the emergency medical services (EMS) of the local hospital in a mixed urban and rural area in Northwestern Switzerland were examined.

Methods and results

In this prospective study 500 voluntary fire fighters received a 4-h training in basic-life-support using automated-external-defibrillation (AED). FR and EMS were simultaneously dispatched in a two-tier rescue system. During the years 2001–2008, response times, resuscitation interventions and outcomes were monitored. 1334 emergencies were included. The FR reached the patients (mean age 60.4 ± 19 years; 65% male) within 6 ± 3 min after emergency calls compared to 12 ± 5 min by the EMS (p < 0.0001). Seventy-six percent of the 297 OHCAs occurred at home. Only 3 emergencies with resuscitation attempts occurred at the main railway station equipped with an on-site AED. FR were on the scene before arrival of the EMS in 1166 (87.4%) cases. Of these, the FR used AED in 611 patients for monitoring or defibrillation. CPR was initiated by the FR in 164 (68.9% of 238 resuscitated patients). 124 patients were defibrillated, of whom 93 (75.0%) were defibrillated first by the FR. Eighteen patients (of whom 13 were defibrillated by the FR) were discharged from hospital in good neurological condition.

Conclusions

Minimally trained fire fighters integrated in an EMS as FR contributed substantially to an increase of the survival rate of OHCAs in a mixed urban and rural area.

Introduction

Out of hospital cardiac arrest (OHCA) is a major cause of death in the Western world. This is also the case for Switzerland where sudden cardiac death still ranks as the single most important cause of death.¹

Early defibrillation is essential for survival. An automated external defibrillator (AED) allows lay rescuers to initiate treatment before emergency medical services (EMS) arrive at the scene. There are two ways of making AED available to cardiac arrest victims. First, AEDs are placed at specific locations where people gather such as shopping malls, hotels, sports facilities, airports, or public and office buildings (public access defibrillation). Second, EMS may dispatch first responders (FR) like fire fighters or police officers with an AED to the scene of cardiac arrest (FR, or two-tiered programmes (except ‘program’ in computers)). In both systems, the key for successful resuscitation is defibrillation within a few minutes after cardiac arrest. Placing the AED in public places and training lay persons as FR resulted in improved survival.2, 3, 4, 5, 6, 7, 8, 9, 10, 11 However, up to 80% of cardiac arrests occur at home.¹² Studies placing AED in the home of patients at risk of sudden cardiac death have shown that home AED has serious limitations.¹³ Because the distance between the OHCA and AED availability either in a public access setting or applied by lay FR integrated into the EMS is the most crucial factor for success, survival of OHCA is lower in areas with low population density and related to delay in EMS response.¹⁴

Dual dispatch early defibrillation in out-of-hospital cardiac arrest (OHCA) has proven to increase survival in predominantly metropolitan areas. We considered FR to be an equally appropriate system for the low density population mixed urban and rural area in Northwestern Switzerland and therefore conducted a prospective interventional study evaluating the impact of a FR system based on minimally trained fire fighters dispatched by the EMS simultaneously with the ambulance of the local hospital on survival of OHCAs.

Section snippets

Pre-intervention period

During the control period of the study, incidence, characteristics, and survival of OHCAs were monitored in the study area during 18 months in the years 1997 and 1998, when a one-tiered system with EMS only was in place.

Intervention period

Due to the geographical and demographic aspects of this area a two-tiered system of FR trained in basic life support (BLS) using AED seemed to be the most promising system to increase survival of OHCAs. Public access defibrillation (PAD) was considered beneficial only at the

Pre-intervention period

Based on the ambulance protocols, death certificates, obituaries and interviews with witnesses and family members, 90 cases of sudden death during a period of 18 months in 1997 and 1998 were found in the study area (60/100,000 inhabitants/years). Of these, 46 cases were identified as being most probably OHCAs. Mean age of victims was 66.2 years, 47% were male. The events were witnessed in 54.3% of cases. 69.7% occurred at home and 30.3% in public places. Bystanders’ CPR was applied in only 3

Discussion

The reasons that there were no survivors discharged from hospital resulting from 46 OHCAs during the 18 months of the pre-intervention period may have been that with the public awareness of the ‘need to call the EMS’ was poor and the availability of mobile phones was still minimal at that time. We therefore implemented a two-tier rescue system to respond to OHCAs in the mixed urban and rural setting of Olten, Switzerland. Local fire fighters were trained in BLS and the use of AED. In 1334

Conflict of interest statement

None declared.

Acknowledgements

We warmly thank our volunteer fire fighters who through their commitment helped to save numerous human lives. This study was funded by the Swiss Heart Foundation and by the Olten Heart Foundation.

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VTOL air ambulances dedicated to OHCA response may improve EMS response intervals, with substantial improvements in ALS response metrics.
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Emergency medical services (EMS) is a critical component high-quality health-care. Road traffic crashes are one of the major causes of death and injury around the world. In the Kingdom of Saudi Arabia (KSA), the road traffic crash death rate has reached 29 per 100,000 people, or 11.25% of total deaths in 2018. The Saudi Red Crescent Authority (SRCA) is responsible for providing EMS in KSA. However, its average response time to road traffic crashes (14 min) is slower than the international standard (8 min). In this study, we analyzed a total of 57,928 road traffic crash reports recorded in 2019 by the SRCA for all cities in the KSA. The effective planning of SRCA, which is highly dependent on historical data analysis, is critical for decreasing emergency response times and, thereby, rescue times. Thus, we aimed to analyze response and rescue time trends related to road traffic crashes to identify significant factors that would assist decision-makers in enhancing the responsiveness of EMS through rescheduling, relocating stations, managing resources (e.g., ambulances and staff), or strategies based on the factors identified as significant. Statistical tools were used to identify the significant factors that affect the SRCA’s performance in responding to road traffic crashes. The analysis results showed that the response and rescue times for road traffic crashes of the SRCA varied within as a result of different factors like geographical region, academic calendar, crash time, weather conditions, the severity of injuries sustained, and the number of injured people. The central regions have the longest average response and rescue times while the northern regions have the shortest ones. Response and rescue times were higher during daytime hours and holidays than during night hours and non-holiday periods. The results also indicated that EMS response and rescue times were significantly associated with mortality rate for road traffic crashes. As a result, by decreasing response and rescue times, the mortality rate for traffic accidents in the KSA could be decreased. Identifying and understanding significant factors that impact EMS response and rescue times can help decision-makers improve the performance of EMS, reduce response and rescue times, save people’s lives, and reduce governmental healthcare costs.
Firefighters as first-responders in out-of-hospital cardiac arrest – A retrospective study of a time-gain selective dispatch system in the Skåne Region, Sweden
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Of 3,245 eligible cases, 43% were DUAL-dispatches with first-responders first on scene (FR-first) in 72%. Despite a five-minute median reduction in response time in the FR-first group, no association with SIR was found (aOR 0.83, 95%CI 0.64–1.07) nor improved 30-day survival (aOR 1.03, 95%CI 0.72–1.47). A positive association between ROSC and the FR-first group (aOR 1.25, 95%CI 1.02–1.54) disappeared in the matched analysis (cOR 1.12, 95%CI 0.87–1.43). Time to first monitored rhythm was 7:06 minutes in the FR-first group versus 3:01 in the combined AMB-only/AMB-first groups.
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Further underscoring the role of fire/police as initial providers, both domestically and abroad, dual-dispatch systems have repeatedly shown to reduce the time to defibrillation and improve survival rates. 10,28–31 In each study, earlier response times were speculated to be the primary mechanism driving improved survival outcomes.10,28–31 Notably, each of these studies also included widespread access to AEDs and (for prospective studies) annual training.
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We completed a secondary data analysis of the MI-CARES registry from 2014 to 2019. We reported rates of CPR initiation and AED use by fire or police first responders. Multilevel modeling was utilized to evaluate the relationship between fire/police first responder-initiated interventions and outcomes of interest: ROSC upon emergency department arrival, survival to hospital discharge, and good neurologic outcome.
Our cohort included 25,067 OHCA incidents. We found fire or police first responders initiated CPR in 31.8% of OHCA events and AED use in 6.1% of OHCA events. Likelihood of sustained ROSC on ED arrival after CPR initiated by a fire/police first responder was not statistically different as compared to EMS initiated CPR (aOR 1.01, CI 0.93–1.11). However, fire/police first responder interventions were associated with significantly higher odds of survival to hospital discharge and survival with good neurologic outcome (aOR 1.25, 95% CI 1.08–1.45 and aOR 1.40, 95% CI 1.18–1.65, respectively). Similar associations were see when examining fire or police initiated AED use.
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In areas with limited access to emergency medical services (EMS), first responders such as firefighters, police and home health nurses around the world have been invited to perform first emergency care [1–5]. This has decreased the time interval between an emergency call to the Emergency Medical Communication Centre (EMCC) and the arrival of help on-site to the affected person, and survival from OHCA has increased [6–10]. In Sweden, there has been collaboration between EMS and municipal fire departments (FD) since the 1990 s, where firefighters perform first aid before the ambulance arrives in areas with a long response time.
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Retrospective descriptive and comparative design.
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^☆: A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2013.02.023.

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Clinical paperDual dispatch early defibrillation in out-of-hospital cardiac arrest in a mixed urban–rural population☆

Abstract

Aims

Methods and results

Conclusions

Introduction

Section snippets

Pre-intervention period

Intervention period

Pre-intervention period

Discussion

Conflict of interest statement

Acknowledgements

Resuscitation

Prehosp Emerg Care

Ann Emerg Med

Resuscitation

J Am Coll Cardiol

Resuscitation

Resuscitation

Resuscitation

J Am Coll Cardiol

What do we actually know about out-of-hospital cardiac arrest?

Rev Med Suisse

Tripling survival from sudden cardiac arrest via early defibrillation without traditional education in cardiopulmonary resuscitation

Circulation

Improving survival from sudden cardiac arrest: the role of the automated external defibrillator

JAMA

Impact of community-wide police car deployment of automated external defibrillators on survival from out-of-hospital cardiac arrest

Circulation

Clinical paper
Dual dispatch early defibrillation in out-of-hospital cardiac arrest in a mixed urban–rural population☆