*Thread on #FirstResponders for OHCA*
In the last decade, numerous systems like @pulsepoint @GoodSamApp @SAUVLife @HartslagNu were developed to alert laypersons.
In this review, we provide an overview of published technologies and analyze their impact on pts outcomes.
#FOAMed
In the last decade, numerous systems like @pulsepoint @GoodSamApp @SAUVLife @HartslagNu were developed to alert laypersons.
In this review, we provide an overview of published technologies and analyze their impact on pts outcomes.
#FOAMed
How does a citizens first responder system work?
Citizens willing to help in case of OHCA can voluntarily register in a first responder network.
When an OHCA occurs, the nearest ones are alerted simultaneously with #EMS dispatch to increase CPR rates before ambulance arrival.
Citizens willing to help in case of OHCA can voluntarily register in a first responder network.
When an OHCA occurs, the nearest ones are alerted simultaneously with #EMS dispatch to increase CPR rates before ambulance arrival.
Our systematic review found 12 different systems (7 apps, 5 text message systems).
Activation radius varied from 150 m to 5 km. Also activation criteria, training required, technology used, and active time varied between systems and are summarized below 👇
Activation radius varied from 150 m to 5 km. Also activation criteria, training required, technology used, and active time varied between systems and are summarized below 👇
Text messages or smartphone apps?
Compared with text messages, an app allowed 70% of first responders to arrive before EMS with a reduction of the arrival time (3.5 vs 5.6 min) and increase survival to discharge from 17% to 28% in an observational study.
doi.org/10.1016/j.resu…
Compared with text messages, an app allowed 70% of first responders to arrive before EMS with a reduction of the arrival time (3.5 vs 5.6 min) and increase survival to discharge from 17% to 28% in an observational study.
doi.org/10.1016/j.resu…
We found 3 strategies to dispatch FRs:
- Prioritizing CPR
- Closest FR collects AED & others go to OHCA
- 2 go to OHCA and 1 collect AED
First one shortened time to CPR. Arrival before EMS was 58-69%, 59-100%, and 90-99% respectively. No study compared the different strategies.
- Prioritizing CPR
- Closest FR collects AED & others go to OHCA
- 2 go to OHCA and 1 collect AED
First one shortened time to CPR. Arrival before EMS was 58-69%, 59-100%, and 90-99% respectively. No study compared the different strategies.
First responders accepted to intervene in median 29% of alerts and reached the scene after 4.6 minutes for performing CPR. Arrival before EMS occurred in median 47% of cases, performed CPR in 24%, and attached an AED in 9% (35% found a shockable rhythm).
Meta-analysis showed that FRs activation increased layperson-#CPR rates and survival to hospital discharge or at 30 days.
Unfortunately, ROSC was not improved. Only one before-and-after study showed better neurological outcome after FR implementation.
Unfortunately, ROSC was not improved. Only one before-and-after study showed better neurological outcome after FR implementation.
We believe that first responders implementation requires a multidisciplinary approach (doctors, engineers, ...). We proposed that the chosen strategy develops the technology that works to improve outcomes. Results achieved are used to improve strategy and technology.
Efficiency of FR systems can be mainly negatively affected by technical factors such as notifications, location accuracy, inadequate activation radius, insufficient FR density, changes and updates to smartphones systems.
How to increase first responders density?
- Advertising campaigns in newspapers, websites, and social media and inviting citizens after CPR courses.
- Involving laypeople working in the streets (taxi, food-riders,...) and in public places with an AED.
- Advertising campaigns in newspapers, websites, and social media and inviting citizens after CPR courses.
- Involving laypeople working in the streets (taxi, food-riders,...) and in public places with an AED.
In the future?
- 5G will allow high-quality & latency-free video with AR, drone-delivered AEDs, more precise geolocation
- 2 RCTs: SAMBA trial is randomizing FRs to reach the OHCA directly vs after collecting AED, HeartRunner trial is randomizing FRs activation vs only EMS.
- 5G will allow high-quality & latency-free video with AR, drone-delivered AEDs, more precise geolocation
- 2 RCTs: SAMBA trial is randomizing FRs to reach the OHCA directly vs after collecting AED, HeartRunner trial is randomizing FRs activation vs only EMS.
If you want to get deeper on the topic, read the full systematic review published on Resuscitation.
➡️ bit.ly/ReviewOHCAFirs…
Others interesting article on the topic by @fsemeraro1973 and @Ilcor_org @ERC_resus colleagues:
- doi.org/10.1186/s13049…
- doi.org/10.1016/j.resu…
➡️ bit.ly/ReviewOHCAFirs…
Others interesting article on the topic by @fsemeraro1973 and @Ilcor_org @ERC_resus colleagues:
- doi.org/10.1186/s13049…
- doi.org/10.1016/j.resu…
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