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