Results from the first 12 months of a fire first-responder program in Australia

doi:10.1016/S0300-9572(00)00355-5

Resuscitation

Volume 49, Issue 2, May 2001, Pages 143-150

https://doi.org/10.1016/S0300-9572(00)00355-5 Get rights and content

Abstract

Study objective: We aimed to reduce response times and time to defibrillation for out-of-hospital cardiac arrest patients through fire first-responders equipped with automatic external defibrillators (AEDs). The fire first-responders were added as an extra tier to the existing two-tired ambulance response. Methods: This prospective controlled trial set in Melbourne, Australia, consisted of a control area (277 km², population density 2343/km²-ambulance only dispatch) and a pilot area (171 km², population density 2290/km²-ambulance and fire first-responder dispatch). The main outcome measures were time to emergency medical service (EMS) arrival at scene for all cardiac arrest patients and time to defibrillation for cardiac arrest patients presenting in ventricular fibrillation (VF). The study participants were patients who suffered a cardiac arrest of presumed cardiac aetiology for which a priority 0 emergency response was activated. A total of 268 patients were located in the control area and 161 in the pilot (intervention) area. Results: The mean response time to arrival at scene was reduced by 1.60 (95% CI 1.21, 1.99) min, P<0.001. A large reduction in prolonged responses (≥10 min) to cardiac arrests was also observed in the pilot area (2%) compared with the control area (18%), χ=23.19, P<0.001. Mean time to defibrillation was reduced by 1.43 (95% CI 0.11, 2.98) min, P=0.068. Conclusion: The results from this study suggest that fire officers can be successfully trained in the use of AEDs and can integrate well into a medical response role. The combined response of ambulance and fire personnel significantly reduced the response interval and reduced time to defibrillation. This suggests that in appropriate situations other agencies could be considered for involvement in co-ordinated first-responder programs.

Resumen

Objectivo: Os autores tiveram por intenção a redução do tempo de resposta e do tempo para desfibrilação de doentes em paragem cardı́aca fora do hospital através da implementação de um programa de resposta rápida por bombeiros equipados com desfibriladores automáticos externos (DAEs). O programa de resposta rápida por bombeiros entrou de modo complementar ao modelo existente, de um sistema de ambulâncias organizadas ate ali em dupla resposta. Método: Este estudo prospectivo controlado montado em Melbourne na Austrália consistiu numa área de controle (277 km², densidade populacional de 2343/km²-ambulância isolada) e numa área piloto (171 km², densidade populacional de 2290/km²- ambulância mais resposta rápida). Os principais resultados a medir foram o tempo para chegada ao local para todos os doentes em paragem cardı́aca e de tempo para desfibrilação para os doentes em paragem cardı́aca que se apresentassem em fibrilação ventricular. Os participantes foram doentes que sofreram paragem de etiologia presumida como cardı́aca para qual foi activada a prioridade 0 no sistema de resposta de emergência. Um total de 268 doentes localizaram-se na área de controle e 161 na área piloto (de intervenção). Resultados: O tempo médio de resposta para chegada ao local foi reduzido em 1.60 min (95% IC 1.21, 1.99) P<0.001. Uma grande redução nas respostas prolongadas (>10 min) às paragens também foi observado na área piloto (2%) comparativamente à área de controle (18%) χ=23.19 P<0.001. O tempo médio para desfibrilação foi reduzido em 1,43 min (95% IC 0.11, 2.98) P=0.068. Conclusão: Os resultados deste estudo sugerem que os bombeiros podem ser treinados com sucesso no uso de DAE e podem integrar-se bem dentro de um papel da resposta médica. A resposta combinada de ambulância mais bombeiros reduziu de modo significativo o tempo de resposta e o tempo para desfibrilação. Isto sugere que em situações apropriadas outras instituições podem ser consideradas para envolvimento num programa coordenado de resposta rápida.

Introduction

Sudden onset of ventricular fibrillation (VF) is responsible for about 70% of cardiovascular deaths [1], [2], [3]. During the first 5–10 min after the onset the disorganized electrical activity is potentially reversible with electrical defibrillation [4]. The likelihood of survival after cardiac arrest is, therefore, determined by the rapid availability of trained individuals equipped with defibrillators [5].

Recent improvements in technology have allowed the development of new lightweight defibrillators with software capable of analyzing a patients cardiac rhythm and determining whether electrical cardioversion is appropriate[6]. Unlike earlier defibrillators, this equipment can be successfully applied by individuals with relatively little formal training. These features potentially allow for their use by a wide range of individuals likely to find themselves on the scene of a medical emergency [7].

In North America and Europe, various police and fire department personnel have been equipped with automatic external defibrillators (AEDs) and trained to be effective ‘first-responders’ to cardiac arrests[8], [9], [10], [11], [12], [13], [14]. Several studies have suggested that this strategy is effective in improving survival from cardiac arrest [8], [10], [12], [15]. However, a variety of methodological weaknesses including retrospective data collection, the use of historical controls and a lack of adherence to protocol have made the results difficult to interpret.

The present study examined the effect of adding fire first responders (trained and equipped with AEDs) to an existing two tiered emergency medical service (EMS) system on the outcome of cardiac arrest in Melbourne. The study was a planned prospective investigation, which compared outcomes in defined intervention and control areas within the city. The primary outcome was time to defibrillation for patients presenting in VF.

Section snippets

Study setting

Melbourne has a population of approximately 3 million, which is covered for medical emergencies by the Metropolitan Ambulance Service (MAS). The ambulance service operates a 2-tiered system of basic life support (BLS) ambulances and advanced life support (ALS) Mobile Intensive Care Ambulances (MICA). At the time of this study there were 108 ambulances and 31 MICA. All ambulance units are equipped with semi-automatic defibrillators.

The Metropolitan Fire and Emergency Services Board (MFESB)

Results

Results from data collected on cardiac arrest patients for 2 months prior to the start of the study, demonstrate the comparability of the control and pilot areas. Both areas were similar in population density, proportion of the population aged over 64, incidence of cardiac arrest, survival from cardiac arrest and mean ambulance response time (P>0.05 for all comparisons). Data on all patients presenting in VF to ambulance personnel in 1997 was also compared and no statistically significant

Discussion

Defibrillation is rarely successful if the duration of VF is greater than 10 min. A previous study in Melbourne showed that the mean ambulance response time to cardiac arrest patients was 9.4±3.6 min [17]. This is the response interval from when an event is recorded at the central communications center to the arrival at scene of an ambulance. With the addition of the delay of the public in dialing 000 and the delay from arrival at scene to defibrillation, early defibrillation (<10 min from

Conclusion

The implementation of fire first-responders equipped with defibrillators has been an important addition to an EMS system where early defibrillation was not regularly provided. The combined response of ambulance and fire personnel significantly reduced the response interval and reduced time to defibrillation.

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Results of an inventory of dispatched FR-systems for OHCA in Europe were combined with aggregate ROSC and survival data from the EuReCa-TWO study and additionally collected data. Regression analysis (weighted on number of patients included per region) was performed to study the association between having a dispatched FR-system and ROSC and survival-rates to hospital discharge in the total population and in patients with shockable initial rhythm, witnessed OHCA and bystander cardiopulmonary resuscitation (CPR; Utstein comparator group). For regions without a dispatched FR-system, the theoretical survival-rate if a dispatched FR-system would have existed was estimated.
We included 27 European regions. There were 15,859 OHCAs in the total group and 2,326 OHCAs in the Utstein comparator group. Aggregate ROSC and survival-rates were significantly higher in regions with an FR-system compared to regions without (ROSC: 36% [95%CI 35%-37%] vs. 24% [95%CI 23%–25%]; P<0.001; survival in total population [N=15.859]: 13% [95%CI 12%–15%] vs. 5% [95%CI 4%–6%]; P<0.001; survival in Utstein comparator group [N=2326]: 33% [95%CI 30%–36%] vs. 18% [95%CI 16%–20%]; P<0.001), and in regions with more than one FR-type compared to regions with only one FR-type. All main FR-types were associated with higher survival-rates (all P<0.050).
European regions with dispatched FRs showed higher ROSC and survival-rates than regions without.
This project/work has received funding from the European Union's Horizon 2020 research and innovation programme under acronym ESCAPE-NET, registered under grant agreement No 733381 (IO, HLT and MTB) and the European Union's COST programme under acronym PARQ, registered under grant agreement No CA19137 (IO, DC, HLT, MTB). HLT and MTB were supported by a grant from the Netherlands CardioVascular Research Initiative, Dutch Heart Foundation, Dutch Federation of University Medical Centres, Netherlands Organization for Health Research and Development, Royal Netherlands Academy of Sciences - CVON2017-15 RESCUED (HLT), and CVON2018-30 Predict2 (HLT and MTB).
Evaluation of new first response initiatives in emergency services
2020, Socio-Economic Planning Sciences
By training and equipping human resources from other public service sectors than emergency response, to act as first responders, it is possible to reduce the first response times at a low cost. Before launching such an initiative, it is however important to evaluate the potential benefits. In this work, a method for doing this kind of evaluation is developed and applied to a potential initiative, utilizing fire service day personnel as new first responders. By developing a smartphone application and performing an experiment, sending alerts to potential first responders, and combining this with expert reviews of the possible value of their contribution, it is possible to estimate the response time reductions, as well as the monetary benefits of the initiative. The results show that there is a monetary benefit, even with a low number of new first responders, but that it is highly dependent on how quickly they can start travelling towards the emergency site.
Implementation of a bundle of Utstein cardiopulmonary resuscitation programs to improve survival outcomes after out-of-hospital cardiac arrest in a metropolis: A before and after study
2018, Resuscitation
The study aimed to determine the effect of community implementation of a bundles of cardiopulmonary resuscitation (CPR) programs on outcomes in out-of-hospital cardiac arrest (OHCA).
A before- and after-intervention study was performed in a metropolis. Emergency medical services (EMS)-treated adults and cardiac OHCAs were included. Three new CPR programs was implemented in January 2015: 1) a high-quality dispatcher-assisted CPR program (DACPR), 2) a multi-tier response (MTR) program using fire engines or basic life support vehicles, and 3) a feedback CPR (FCPR) program with professional recording and feedback of CPR process. The outcomes (cerebral performance category 1 or 2, good CPC) and survival to discharge) were compared between study period (2015–2016) and control period (2013–2014).
Overall, 6201 and 6469 patients were included in the control period and the study period, respectively. During the post-intervention period, the proportion of OHCA patients who underwent three types of cardiopulmonary resuscitation programs increased significantly compared to those in the pre-intervention period. DACPR increased from 38.3% to 44.3%, MTR increased from 0.0% to 37.5%, and FCPR increased from 25.3% to 61.5%. (All p values <0.001). Good neurological recovery and survival to discharge were significantly increased from 5.4% to 6.8%, and from 9.6% to 10.9%. The adjusted odds ratio (95% confidence intervals) of the study period was 1.45 (1.12–1.87) for good CPC, and 1.31 (1.09–1.58) for survival to discharge.
The citywide implementation of a bundle of UTIS CPR programs was associated with significantly better OHCA outcomes.
Security officers responding to residential fire alarms: Estimating the effect on survival and property damage
2018, Fire Safety Journal
Decreasing the response time to residential fires leads to more people being saved, fewer injuries, less property damage and a lesser environmental impact. One way of reducing the response time to fires is to allow the municipal fire and rescue services to cooperate with other actors. This study evaluates a potential agreement between the fire and rescue service of a Swedish municipality (Helsingborg) and a private security officers' firm. A geographic information system (GIS) simulation is used to estimate the reduced response times. The result is combined with a statistically estimated measure of the risk of fatality for marginal changes in the response time to find the effect on survival rates and property damage. The results show that the response time is 52 s on average faster using security officers for residential fires. Combining this gain in response time with the relation to fatalities and adjusting for the fact that security officers are less effective imply a decreased death rate by 0.0105 or 1.3% per year. The project has positive economic effects with the benefits estimated to be 1.4 (saved lives) and respectively 2.3 (saved lives and property damage) times higher than the costs.
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Proposed Irish legislation aimed at increasing survival from out-of-hospital-cardiac-arrest (OHCA) mandates the provision of automated external defibrillators (AEDs) in a comprehensive range of publicly accessible premises in urban and rural areas. This study estimated the clinical and cost effectiveness of the legislation, compared with alternative programme configurations involving more targeted AED placement.
We used a cost-utility analysis to estimate the costs and consequences of public access defibrillation (PAD) programmes from a societal perspective, based on AED deployment by building type. Comparator programmes ranged from those that only included building types with the highest incidence of OHCA, to the comprehensive programme outline in the proposed legislation. Data on OHCA incidence and outcomes were obtained from the Irish Out-of-Hospital-Cardiac-Arrest Register (OHCAR). Costs were obtained from the Irish health service, device suppliers and training providers.
The incremental cost effectiveness ratio (ICER) for the most comprehensive PAD scheme was €928,450/QALY. The ICER for the most scaled-back programme involving AED placement in transport stations, medical practices, entertainment venues, schools (excluding primary) and fitness facilities was €95,640/QALY. A 40% increase in AED utilisation when OHCAs occur in a public area could potentially render this programme cost effective.
National PAD programmes involving widespread deployment of static AEDs are unlikely to be cost-effective. To improve cost-effectiveness any prospective programmes should target locations with the highest incidence of OHCA and be supported by efforts to increase AED utilisation, such as improving public awareness, increasing CPR and AED training, and establishing an EMS-linked AED register.
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2014, Resuscitation
Citation Excerpt :
Other less obvious factors such as the skill-level of the first treating EMS team can also explain the growth in these events over time. Preliminary results of a first-responder programme in our EMS system demonstrated that the addition of a BLS-tier significantly increased attempted resuscitation rates despite fewer favourable baseline characteristics.17 In the current study, more than 20% of partial resuscitation attempts with documented evidence of irreversible death occurred when ALS or ICP personnel discontinued resuscitation attempts commenced by BLS responders.
Success rates from cardiopulmonary resuscitation (CPR) are often quantified by Utstein-style outcome reports in populations who receive an attempted resuscitation. In some cases, evidence of futility is ascertained after a partial resuscitation attempt has been administered, and these cases reduce the overall effectiveness of CPR. We examine the impact of partial resuscitation attempts on the reported outcomes of out-of-hospital cardiac arrest (OHCA) in Victoria, Australia.
Between 2002 and 2012, 34,849 adult OHCA cases of presumed cardiac aetiology were included from the Victorian Ambulance Cardiac Arrest Registry. Resuscitation attempts lasting ≤10 min in cases which died on scene were defined as a partial resuscitation. We used logistic regression to identify factors associated with a partial resuscitation attempt in the emergency medical service (EMS) treated population. Survival outcomes with and without partial resuscitations were compared across included years.
The proportion of partial resuscitations in the overall EMS treated population increased significantly from 8.6% in 2002 to 18.8% in 2012 (p for trend < 0.001), and were largely supported by documented evidence of irreversible death. Partial resuscitations were independently associated with older age, female gender, initial non-shockable rhythm, prolonged downtime, and lower skill level of EMS personnel. Selectively excluding partial resuscitations increased event survival by 7.6% (95% CI 4.1–11.2%), and survival to hospital discharge increased by 3.1% (95% CI 0.5–5.7%) in 2012 (p < 0.001 for both).
In our EMS system, evidence of futility was often identified after the commencement of a partial resuscitation attempt. Excluding these events from OHCA outcome reports may better reflect the overall effectiveness of CPR.

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Results from the first 12 months of a fire first-responder program in Australia☆

Abstract

Resumen

Introduction

Section snippets

Study setting

Results

Discussion

Conclusion

Am. J. Cardiol.

Am. J. Cardiol.

Ann. Emerg. Med.

Ann. Emerg. Med.

Ann. Emerg. Med.

Resuscitation

Ann. Emerg. Med.

Lancet

Ann. Emerg. Med.

Resuscitation

Resuscitation

Cardiac arrest and resuscitation: a tale of 29 cities

Ann. Emerg. Med.

Out-of-hospital cardiac arrest

Med. J. Aust.