P6416Emergency dispatch, smartphone app solution, first responders with distinct roles and automatic external defibrillators secures cardiopulmonal resuscitation in a rural area

Abstract

Background: Guidelines recommend cardiopulmonal resuscitation (CPR) within 5-6 minutes and early defibrillation with an automated external defibrillator (AED) with the purpose to increase survival rates from out of hospital cardiac arrest. The interactions between the emergency medical dispatcher, trained first responders with distinct roles and the timely use of an automated external defibrillator (AED) are the key ingredients for improving survival in a rural area. The rural area is characterized by 13,000 inhabitants and long distances to the nearest hospital. Purpose: This smartphone application (app) is an auxiliary to the public Emergency Medical Service and enables the dispatcher to send an organized team of first responders. The system organizes three first responders in a team: no. 1 hurries to the patient to give CPR; no. 2 brings the AED; and no. 3 is the on-site coordinator. The aim is to shorten the first responder response times at emergency calls and the time to the AED on-site to below 5-6 minutes in both public/rural/ residential settings. Methods: CPR and first aid is provided by 180 trained lay first responders who use their smartphone. One hundred AEDs are available around the clock and placed less than 2 kilometres apart. The app global positioning system GPS-track the 9 nearby first responders and chooses the three most optimally placed first responders who accepted the alarm. AEDs are located in GPS-controlled AED cabinets, so that the first responder can go for the visuable warning light and for the audible warning siren. Results: During 44 months the smartphone app GPS system was used 1612 times. The smartphone app entailed a guarantee for first responder CPR and a significant reduction in median response time from more than 10 minutes before to 4 minutes after. The response time was faster than the comparable median ambulance response time at 13 minutes. The AED was on-site in 98% of the cases and with a median on-site time below 6 minutes. The first responder response times were short all over the area (public//rural/residential settings). Many of the first responders developed a team spirit and more than thirty first responders accepted the smartphone alarm more than fifty times during the project period, although they were, of course, not dispatched every time. Three first responders arrived in 88%, two first responders in 7%, one first responder in 3% of the cases. The first responders arrived before the ambulance in 92% and at the same time in 4% of the cases. The first responders were involved in cardiac arrests, serious respiratory arrests, acute myocardial infarction, hangings, and divers with decompression sickness. Conclusion(s): This smartphone app GPS technology connect the dispatcher, the trained first responders and the strategic located AEDs. The app GPS tracking technology is a logistic solution that secure basic life support, timely use of an AED and increase the survival rate.