Effectiveness of the Dual Dispatch to Cardiac Arrest Policy in Houston, Texas

Abstract

Context: Houston policy is to dual dispatch medically trained firefighters, in addition to emergency medical services (EMS) units to out-of-hospital cardiac arrest (OHCA) cases. While believed to improve public health outcomes, no research exists supporting the policy that when firefighters respond before a better-equipped EMS unit, they increase the probability of survival. Objective: To inform EMS policy decisions regarding the effectiveness of dual dispatch by determining the impact of medically trained firefighter dispatch on return of spontaneous circulation (ROSC), a measure of survivability, in OHCA 911 calls while controlling for the subsequent arrival of an EMS unit. Design: This retrospective study uses logistic regression to determine the association between ROSC and response time for fire apparatus first responders controlling for arrival of the EMS unit. Setting: Out-of-hospital cardiac arrest cases in Houston between May 2008 and April 2013 when dual dispatch was used. Participants: A total of 6961 OHCA cases with the complete data needed for the analysis. Main Outcome Measures: Logistic regression of the dependence of OHCA survival using the indicator ROSC, as related to the fire first responder response times controlling for subsequent arrival of the EMS. Results: Fire apparatus arrived first in 46.7% of cases, a median value of 1.5 minutes before an EMS unit. Controlling for subsequent arrival time of EMS has no effect on ROSC achieved by the fire first responder. If the firefighters had not responded, the resulting 1.5-minute increase in response time equates to a decrease in probability of attaining ROSC of 20.1% for cases regardless of presenting heart rhythm and a 47.7% decrease for ventricular fibrillation cases in which bystander cardiopulmonary resuscitation was initiated. Conclusions: The firefighter first responder not only improved response time but also greatly increased survivability independent of the arrival time of the better-equipped EMS unit, validating the public health benefit of the dual dispatch policy in Houston.

Improving community-based first response to out of hospital cardiac arrest (FirstCPR): protocol for a cluster randomised controlled trial

“…Some of these have focused on improving CPR training and others on the quality of CPR technique 34–36. Other successful strategies to increase bystander CPR rates include dispatch of lay and/or professional voluntary responders by emergency services and use of apps to activate trained citizens and off-duty paramedics and doctors 42–46. In Australia, such initiatives are underway in some states but have not been adopted in NSW so far 47–50…”

The number and level of first-contact emergency medical services crew and clinical outcomes in out-of-hospital cardiac arrest with dual dispatch response

“…10,11 Dispatching multiple vehicles to a scene is associated with shorter EMS response time, which is the elapsed time interval between EMS activation and ambulance scene arrival, and a better prognosis. [11][12][13] Additionally, early defibrillation and a higher defibrillation rate are the other positive effects of multiple vehicle dispatch on clinical outcomes. [14][15][16] DDR has been shown to increase the number of on-scene EMS personnel, leading to better quality CPR and application of advanced procedures that improve survival outcomes.…”

Serving the community while balancing multiple responsibilities – experiences of working as a paid part-time firefighter

“…Enabling the retention of PTFs in rural areas is important not only for the FRSs but also for emergency medical services (EMSs) because PTFs are often used as an additional resource. Common concepts in rural areas are while waiting for ambulance (WWFA) and dual dispatch with PTFs and an ambulance; these are important co-uses of resources to shorten response time (Raun et al, 2019;Svensson et al, 2019;Nordberg et al, 2015;Saner et al, 2013). Fire stations in Sweden are dimensioned after specific criteria for response times, leading to a higher density of fire stations and thereby shorter response times in rural areas, when compared to EMSs.…”

“…Enabling the retention of PTFs in rural areas is important not only for the FRSs but also for emergency medical services (EMSs) because PTFs are often used as an additional resource. Common concepts in rural areas are while waiting for ambulance (WWFA) and dual dispatch with PTFs and an ambulance; these are important co-uses of resources to shorten response time (Raun et al. , 2019; Svensson et al.…”