First-response treatment after out-of-hospital cardiac arrest: a survey of current practices across 29 countries in Europe

Abstract

BackgroundIn Europe, survival rates after out-of-hospital cardiac arrest (OHCA) vary widely. Presence/absence and differences in implementation of systems dispatching First Responders (FR) in order to arrive before Emergency Medical Services (EMS) may contribute to this variation. A comprehensive overview of the different types of FR-systems used across Europe is lacking.MethodsA mixed-method survey and information retrieved from national resuscitation councils and national EMS services were used as a basis for an inventory. The survey was sent to 51 OHCA experts across 29 European countries.ResultsForty-seven (92%) OHCA experts from 29 countries responded to the survey. More than half of European countries had at least one region with a FR-system. Four categories of FR types were identified: (1) firefighters (professional/voluntary); (2) police officers; (3) citizen-responders; (4) others including off-duty EMS personnel (nurses, medical doctors), taxi drivers. Three main roles for FRs were identified: (a) complementary to EMS; (b) part of EMS; (c) instead of EMS. A wide variation in FR-systems was observed, both between and within countries.ConclusionsPolicies relating to FRs are commonly implemented on a regional level, leading to a wide variation in FR-systems between and within countries. Future research should focus on identifying the FR-systems that most strongly influence survival. The large variation in local circumstances across regions suggests that it is unlikely that there will be a ‘one-size fits all’ FR-system for Europe, but examining the role of FRs in the Chain of Survival is likely to become an increasingly important aspect of OHCA research.

Smartphone-based dispatch of Community First Responders to Out-of-Hospital Cardiac Arrest - Statements from an International Consensus Conference

“…Currently, a multitude of successful CFR systems exists worldwide, which differ in several aspects, e.g. technology, training scope and funding (6,17). Even within single countries, varieties of CFR systems exist (7,17).…”

“…technology, training scope and funding (6,17). Even within single countries, varieties of CFR systems exist (7,17). This diversity could negatively affect effectiveness, safety and retention of personnel (7).…”

“…Diversities between different CFR systems arose due to different backgrounds: While some CFR programmes were strategically initiated by health care authorities in areas with risk of shortage, others are citizens' initiatives (6). Furthermore, geographical and infrastructural conditions in uence the systems, and distinctions have to be made between rural and urban areas (17). A Swedish study on dispatch of re ghters analysed the impact of population density: In rural areas the relative reduction in median time until rst chest compression was greater than in urban areas.…”

“…Hence, it is unclear, if there should be a minimum age to become a CFR. Most systems in Europe operate an age threshold of 16 years (17). Focused training for CFR could help alleviate the psychological burden.…”

“…This led to an increased rate of CPR performed before arrival of the EMS (14,15). The spectrum of volunteers deployed is ranging from lay persons without medical background to highly trained medical professionals (4,6,7,11,16,17,12,13,18).…”