Effects of fire-fighters as first responders in out-of-hospital cardiac arrest: A study of a selective dispatch system in Skåne County, Sweden

Objectives: Dual dispatch early defibrillation in out-of-hospital cardiac arrest (OHCA) victims provided by firefighters in addition to Emergency medical services (EMS) has proven to increase rate of return of spontaneous circulation (ROSC) and thus survival in the metropolitan or suburban areas whereas the data in rural areas are scarce. Methods: This was a retrospective observational cohort study of EMS resuscitated OHCA victims in regions with dual dispatch of volunteer firefighters as first responders (intervention group). Historical group was based on all OHCAs occurring in these regions before the implementation of first responders (EMS response only). Multivariate logistic regression with following variables: intervention, age, gender, witnessed status, bystander cardiopulmonary resuscitation (CPR), first rhythm and etiology were used to control for confounding factors affecting ROSC. Results: A total of 312 OHCAs were included in the study (historical group, n = 115 and intervention group, n = 197). Median time to arrival of first help shortened significantly for all patients, patients with ROSC and patients with Cerebral Performance Category 1/2 (CPC 1/2) in intervention vs historical group (8 vs 12 min, p < 0.001; 7.5 vs 11 min, p = 0.002; 7 vs 10 min, p = 0.011; respectively). The proportion of patients with ROSC, 30-day survival and CPC 1/2 at hospital discharge remained unchanged in intervention vs historical group (21% vs 23%, p = 0.808; 7% vs 6%, p = 0.914; 6% vs 3%, p = 0.442; respectively). The logistic regression model of adjustment confirms the absence of improvement in the ROSC rate after the implementation of first responders. Conclusions: Introduction of a dual dispatch of local first responders in addition to EMS in cases of OHCA significantly shortened response times. However, reduced response times were not associated with better survival outcomes.

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Out of Hospital Cardiac Arrest Management by First Responders: Retrospective Review of a Fire Fighter First Responder Program

Australasian Journal of Paramedicine ◽

10.33151/ajp.11.5.59 ◽

2014 ◽

Vol 11 (5) ◽

Cited By ~ 1

Author(s):

Christian Winship ◽

Malcolm Boyle ◽

Brett Williams

Keyword(s):

Cardiac Arrest ◽

Response Times ◽

Significant Rise ◽

First Responder ◽

Median Response ◽

Fire Fighters ◽

Shockable Rhythm ◽

Medical Response ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

IntroductionOver 9,500 people die annually in Australia from sudden cardiac arrest, with strong evidence suggesting early high quality CPR and early counter shock being paramount for improving survival from cardiac arrest. It has also been shown that first responder programs have been able to reduce response times and increase survival rates for out-of-hospital cardiac arrest. The objective of this study was to examine data from the first seven years of an Australian out-of-hospital cardiac arrest first responder program where fire fighters provided basic life support.MethodsThis study was a retrospective cohort study of all cardiac arrests attended by the Metropolitan Fire and Emergency Services Board (MFESB) as part of the Emergency Medical Response program over a seven-year period in Melbourne, Victoria, Australia.ResultsThe MFESB attended 4,450 cardiac arrests. The majority of patients presented in asystole 669 (63.7%) with just 243 (23.1%) presenting in a shockable rhythm. The majority of patients in cardiac arrest were males (64.2%) and the mean age of the patients was 67.5 years. The MFESB median response time during the study period was 5.7 minutes (IQR 2.25 minutes), range of 0.15 minutes to 31.7 minutes, which remained stable over the seven years. Patients spent a median time of 4.6 minutes (0.02 seconds to 36.5 minutes) in the care of fire fighters prior to the arrival of EMS. The rhythm on handover to paramedics was asystole in 787 (75.1%) cases with no shockable rhythms. One in three (31.3%) patients received bystander CPR, with a significant rise in the rate of bystander CPR occurring over the last two years.ConclusionThis study demonstrated acceptable response times to cardiac arrests and a low bystander CPR rate prior to arrival of the MFESB. The incidence of a shockable rhythm on arrival of the MFESB was low with the main rhythm being asystole. The main rhythm on handover to paramedics was asystole with non-shockable rhythms. Further research is required to determine the effect on patient outcomes.

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Survival of people with out-of-hospital cardiac arrest is not improved by equipping first responders with an automated external defibrillator

Evidence-based Healthcare ◽

10.1016/j.ehbc.2004.03.012 ◽

2004 ◽

Vol 8 (3) ◽

pp. 139-141 ◽

Cited By ~ 1

Author(s):

Judith Finn ◽

Ian Jacobs

Keyword(s):

Cardiac Arrest ◽

First Responders ◽

Automated External Defibrillator ◽

Hospital Cardiac Arrest ◽

External Defibrillator

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Dispatchers Gut Feeling plus Medical Priority Dispatch System reduced Dispatch Centre Times in Cases of Out of Hospital Cardiac Arrest Pre-alert - a Prospective, Cluster Randomized Trial

Resuscitation ◽

10.1016/j.resuscitation.2012.08.058 ◽

2012 ◽

Vol 83 ◽

pp. e23

Author(s):

Christoph Weiser ◽

Raphael van Tulder ◽

Mathias Stöckl ◽

Harald Herkner ◽

Christof C. Chwojka ◽

...

Keyword(s):

Cardiac Arrest ◽

Randomized Trial ◽

Cluster Randomized Trial ◽

Dispatch Centre ◽

Dispatch System ◽

Cluster Randomized ◽

Hospital Cardiac Arrest

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Experiences among firefighters and police officers of responding to out-of-hospital cardiac arrest in a dual dispatch programme in Sweden: an interview study

BMJ Open ◽

10.1136/bmjopen-2019-030895 ◽

2019 ◽

Vol 9 (11) ◽

pp. e030895

Author(s):

Ingela Hasselqvist-Ax ◽

Per Nordberg ◽

Leif Svensson ◽

Jacob Hollenberg ◽

Eva Joelsson-Alm

Keyword(s):

Cardiac Arrest ◽

Police Officers ◽

Critical Incident ◽

First Responders ◽

Interview Study ◽

Main Task ◽

Emotional Process ◽

Qualitative Interview Study ◽

Consecutive Time ◽

Hospital Cardiac Arrest

ObjectivesThe objective of this study was to explore firefighters’ and police officers’ experiences of responding to out-of-hospital cardiac arrest (OHCA) in a dual dispatch programme.DesignA qualitative interview study with semi-structured, open-ended questions where critical incident technique (CIT) was used to collect recalled cardiac arrest situations from the participants’ narratives. The interviews where transcribed verbatim and analysed with inductive content analysis.SettingThe County of Stockholm, Sweden.ParticipantsPolice officers (n=10) and firefighters (n=12) participating in a dual dispatch programme with emergency medical services in case of suspected OHCA of cardiac or non-cardiac origin.ResultsAnalysis of 60 critical incidents was performed resulting in three consecutive time sequences (preparedness, managing the scene and the aftermath) with related categories, where first responders described the complexity of the cardiac arrest situation. Detailed information about the case and the location was crucial for the preparedness, and information deficits created stress, frustration and incorrect perceptions about the victim. The technical challenges of performing cardiopulmonary resuscitation and managing the airway was prominent and the need of regular team training and education in first aid was highlighted.ConclusionsParticipating in dual dispatch in case of suspected OHCA was described as a complex technical and emotional process by first responders. Providing case discussions and opportunities to give, and receive feedback about the case is a main task for the leadership in the organisations to diminish stress among personnel and to improve future OHCA missions.

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Survival of people with out-of-hospital cardiac arrest is not improved by equipping first responders with an automated external defibrillator*1

Evidence-based Healthcare ◽

10.1016/s1462-9410(04)00047-6 ◽

2004 ◽

Vol 8 (3) ◽

pp. 139-141

Author(s):

J FINN

Keyword(s):

Cardiac Arrest ◽

First Responders ◽

Automated External Defibrillator ◽

Hospital Cardiac Arrest ◽

External Defibrillator

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