Introduction
Methods
Design and set up
Survey and information gathering
Definitions
Emergency medical services (EMS)
First responder (FR)
FR-system
Results
Types and roles of FRs in Europe
Variation in first responder-systems nationally and regionally
Characteristics of first responder-systems
Country, Region | Activation by | Location determination | 1. Response needed | Role on scene | Equipment | Training; Frequency | Feedback | Financial assistance (NOT including: salary) |
---|---|---|---|---|---|---|---|---|
2. Information provided by dispatcher | ||||||||
Austria (N = 8.220000) | Standard communication system | GPS | 1. Confirming the response 2. Location of victim; location of AED | 1. Get a local AED or from the vehicle; 2. Connect a breathing mask; 3. Attach pads and follow the AED instructions; 4. Perform CPR | 1. AED; 2. Safety jacket; 3. Mobile phone/pager; 4. Rescuer kit | Trained for CPR including use of an AED; Annually | Designated EMS staff discuss calls attended with firefighters | Payment of equipment; AED related disposables |
Czech Republic, (N = 10.521646) | Standard communication system | Address and GPS | 1. Subsequent call from dispatcher to firefighter or backwards 2. Location of victim; demographics; situational information | 1. Get an AED from the vehicle; 2. Connect a breathing mask; 3. Attach pads and follow the AED instructions; 4. Perform CPR | 1. AED; 2. Safety jacket; 3. Mobile phone/pager; 4. Rescuer kit; 5. BVM, 6. Oxygen | Trained for CPR including use of an AED; Annually | Designated EMS staff discuss calls attended with firefighters/Firefighters participate in a debrief with EMS staff immediately after an OHCA/the own training officers can also take part | No |
Denmark, Capital Region, Region Zealand, Region South (N = 3.879024) | Standard communication system | GPS | 1. No response from the firefighter is required 2. Location of victim | 1. Get an AED from the vehicle; 2. Attach pads and follow the AED instructions; 3. Perform CPR | 1. AED | Trained for CPR including use of an AED; Annually | None | No |
Denmark Central Region, Region North (N = 1.903148) | Standard communication system | GPS | 1. Confirming the response 2. Location of victim | 1. Get an AED from the vehicle; 2. Attach pads and follow the AED instructions; 3. Perform CPR | 1. AED; 2. Safety jacket; 3. Mobile phone/pager; 4. Rescuer kit | Trained for CPR including use of an AED; Introduced low dose, high frequency training | None | No |
England (N = 55.980000) | SMS or APP | Address | 1. No response from the firefighter is required 2. Location of victim, demographics (victim) & situational info | 1. Get an AED from the vehicle; 2. Connect a breathing mask; 3. Attach pads and follow the AED instructions; 4. Perform CPR; 5. They are trained in airway management OP airways | 1. AED; 2. Mobile phone/pager | Trained for CPR including use of an AED; Annually | Firefighter activity is described in the annual report/Firefighters receive a regular report of their activity/Firefighters receive written feedback on individual calls from the EMS | No |
Finland (N = 5.513000) | Standard communication system | GPS | 1. Confirming the response 2. Location of victim | 1. Get an AED from the vehicle; 2. Connect a breathing mask; 3. Attach pads and follow the AED instructions; 4. Perform CPR | 1. AED; 2. Safety jacket; 3. Mobile phone/pager; 4. Rescuer kit | Trained for CPR including use of an AED; Annually | Firefighter activity is described in the annual report | No |
Ireland (N = 4.830000) | Standard communication system; SMS | Not determined | 1. Following local fire and rescue dispatch protocols 2. Location of victim; demographics; situational information | 1. Get a local AED or from the vehicle; 2. Connect a breathing mask; 3. Attach pads and follow the AED instructions; 4. Perform CPR | 1. AED; 2. Safety jacket; 3. Mobile phone/pager; 4. Resuscitation kit | Trained for CPR including use of an AED; Bi-annually | Firefighter activity is described in the annual report/Firefighters participate in a debrief with EMS staff immediately after an OHCA | No |
Italy, Emilia Romagna (N = 4.453000) | APP | GPS | 1. Confirming the response 2. Location of victim & location of AED | 1. Get a local AED or from the vehicle; 2. Connect a breathing mask; 3. Attach pads and follow the AED instructions; 4. Perform CPR | 1. AED; 2. Safety jacket; 3. Mobile phone/pager; 4. Rescuer kit | Trained for CPR including use of an AED; Bi-annually | The responder manager sends an email to collect feedback by mail (but is not a routine) | Supported by Emilia Romagna Healthcare Region Funding and Fondazione del Monte di Bologna e Ravenna for development. |
Luxembourg (N = 6,020,050) | Standard communication system; SMS, Pager | Not determined | 1. Following local fire and rescue dispatch protocols 2. Location of victim; demographics; situational information | 1. Get an AED from the vehicle; 2. Attach pads and follow the AED instructions; 3. Perform CPR | 1. AED; 2. Safety jacket; 3. Mobile phone/pager; 4. Rescuer kit | Trained for CPR including use of an AED; initial advanced training in first aid (~ 40 h), annually 8 h training | None | No |
The Netherlands (N = 17.180000) | Standard communication system | GPS | 1. Confirming the response 2. Location of victim, demographics (victim) and situational information | 1. Get an AED from the vehicle; 2. Attach pads and follow the AED instructions; 3. Perform CPR; 4. Maintain a safe situation | 1. AED; 2. Safety jacket; 3. Mobile phone/pager | Trained for CPR including use of an AED; Annually | None | No |
Norway (N = 5.328212) | Standard communication system | Through communication with firefighter dispatch centre | 1. Confirming the response 2. Location of victim; situational information | 1. Get an AED from the vehicle; 2. Connect a breathing mask; 3. Attach pads and follow the AED instructions; 4. Perform CPR | 1. AED; 2. Safety jacket; 3. Rescuer kit | Trained for CPR including use of an AED; Firefighters are motivated to train every year | None | No |
Poland (N = 37.980000) | Standard communication system | Address | 1. Confirming the response 2. Location of victim | 1. Get an AED from the vehicle; 2. Connect a breathing mask; 3. Attach pads and follow the AED instructions; 4. Perform CPR | 1. AED; 2. Mobile phone/pager; 3. Rescuer kit | Trained for CPR including use of an AED; 3 years | NR | No |
Portugal (N = 10.290000) | Standard communication system | Address | 1. Using the radio 2. Location of victim; demographics; situational information | 1. Get an AED from the vehicle; 2. Connect a breathing mask; 3. Attach pads and follow the AED instructions; 4. Perform CPR | 1. AED; 2. Safety jacket; 3. Mobile phone/pager; 4. Rescuer kit | Training is not nationally organized, only in a few corporations firefighters are trained to use AED | NR | No |
Romania (N = 19.530000) | Standard communication system; SMS; Pager | GPS; Address | 1. Radio or phone report provide to the dispatch with physician on coordination 2. Location of victim; situational info | 1. Get an AED from the vehicle; 2. Connect a breathing mask; 3. Attach pads and follow the AED instructions; 4. Perform CPR; 5. IV line; 6. Combi-tube | 1. AED; 2. Safety jacket; 3. Mobile phone/pager; 4. Rescuer kit; 5. Valve mask; 6. IV; 7. Oxygen | Trained for CPR including use of an AED; Every two years | Firefighters receive a regular report of their activity/Designated EMS staff discuss calls attended with firefighters | Medical supplies, all materials for interventions; support for training and some equipment. |
Slovenia (N = 2.084000) | Standard communication system | Location is not determined or tracked - they are activated if the ETA of the first responders is faster than the ETA of the EMS team - we expect them to be within the located district | 1. Confirming the response 2. Location of victim | 1. One person in the team has the AED/or AED at the station; 2. Connect a breathing mask; 3. Attach pads and follow the AED instructions; 4. Perform CPR | 1. AED; 2. Mobile phone/pager; 3. Rescuer kit | Trained for CPR including use of an AED; Annually | Informally, e.g. reports on the results | Yes, not from the EMS but from the local municipality |
Sweden, Norbotten County (N = 251,295) | Standard communication system; SMS | GPS | 1. Confirming the response 2. Location of victim, demographics (victim) | 1. Get an AED from the vehicle; 2. Attach pads and follow the AED instructions; 3. Perform CPR | 1. AED; 2. Mobile phone/pager; 3. Rescuer kit | Trained for CPR including use of an AED; Annually | NR | No |
Sweden, Region Western Sweden (N = 2.016000) | Standard communication system | GPS | 1. Confirming the response 2. Location of victim, demographics (victim) | 1. Get an AED from the vehicle; 2. Connect a breathing mask; 3. Attach pads and follow the AED instructions; 4. Perform CPR | 1. AED; 2. Mobile phone/pager; 3. Rescuer kit | Trained for CPR including use of an AED; Annually | Meeting between EMS and fire fighters differs depending on municipality/sub region | No |
Sweden, Stockholm (N = 965,232) | Standard communication system | GPS | 1. The call is connected to the own dispatch centre whereby they confirm their response. 2. Location of victim & demographics (victim) | 1. Get an AED from the vehicle; 2. Attach pads and follow the AED instructions; 3. Perform CPR | 1. AED; 2. Mobile phone/pager; 3. Rescuer kit | Trained for CPR including use of an AED; Annually | Meeting a couple of times each year to discuss the collaboration | No |
Switzerland, Ticino Canton) (N = 353,709) | SMS or APP | Not determined | 1. Confirming the response 2. Location of victim, Location of AED, demographics (victim) & situational information | 1. Get an AED from the vehicle; 2. Connect a breathing mask; 3. Attach pads and follow the AED instructions; 4. Perform CPR; 5. Assistance to bystanders; 6. Integration in advanced resuscitation (with ambulance team) | 1. AED; 2. Safety jacket; 3. Mobile phone/pager; 4. Rescuer kit | Trained for CPR including use of an AED; Bi-annually | Designated EMS staff discuss calls attended with firefighters/Firefighters participate in a debrief with EMS staff immediately after an OHCA/Firefighters receive feedback based on AED data from the operational and clinical manager. They are invited to the annual ceremony, where survivors meet first responders | AED and rescue kit donated from Fondazione Ticino Cuore |
Country, Region | Active system | Method to activate | Location determination | 1. Response needed | Role onscene | Equipment | Training; Frequency | Registration | Feedback | Financial assistance | Emotional support | Other requirements to become a citizen-responder |
---|---|---|---|---|---|---|---|---|---|---|---|---|
2. Information provided by dispatcher | ||||||||||||
Austria (N = 8.220.000) | 24 h/7 | Standard communication system; SMS; Pager; APP | GPS | 1. Confirming the response 2. Location of victim; location of AED | 1. AED (private use); 2. Attach pads and follow AED instructions; 3. Perform CPR | 1. AED; 2. Safety jacket; 3. Rescuer Kit | Yes trained for CPR including use of an AED; Annually | In an online system: Online App (for EMS, Paramedics, Medical Students, Physicians) or as designated First Responders (EMS/Paramedics) that are on call (during their free time) | Citizen-responders receive a regular report of their activity/Designated EMS staff discuss calls attended with citizen-responders | Yes: equipment and AED related disposables | Yes | A minimum of 18 years for the citizen-responders is required |
Czech Republic Hradec Kralove Region (N = 550.804) | 24 h/7 | SMS; APP | GPS | 1. Confirming the response 2. Location of victim; location of AED; situational information (Possibility to call dispatch centre for additional information) | 1. Get a local AED; connect a breathing mask; 2. Attach pads and follow AED instructions; 3. Perform CPR Of note: Citizen-responders usually do not bring AEDs to the victim (density of local AEDs is low). They usually replace bystanders or relatives in doing high-quality CPR | 1. Safety jacket; 2. Pocket mask, 3. Smartphone | Yes trained for CPR including use of an AED; Any valid ERC course certificate is needed | In an online system: SW KISS SHARP (new name: O2 SOS), registration and information at fr.zzskhk.cz | Letter of thanks | Yes: safety vest, pocket mask, until 2017 also smartphone | Yes, critical incident stress management available on request | A minimum of 18 years for the citizen-responders is required and they must declare to have no criminal history. This must be proven by an official document issued by the state-wide registry. |
Denmark, Capital region, Central Region (N = 3.137.000) | 24 h/7 | APP | GPS | 1. Confirming the response 2. Location of victim; location of nearest accessible AED | 1. Get a local AED; 2. Attach pads and follow AED instructions; 3. Perform CPR | 1. AED | Not required but strongly recommended | In an online system: In the app server | Via mail and social media when asked for | No | Yes, critical incident stress management available on request | A minimum of 18 years for the citizen-responders is required |
Denmark, Region Zealand, Region South (N = 2.056.025) | 24 h/7 | APP | GPS | 1. Confirming the response 2. Location of victim; location of AED | 1. Get a local AED; 2. Attach pads and follow AED instructions; 3. Perform CPR; 4. If the citizen responder wants: guide the ambulance to the right address and assist the ambulance personnel. | 1. AED | Yes trained for CPR including use of an AED; at least a 4 h CPR training course | In an online system: In the app server | Via mail and social media when asked for | No | Yes, critical incident stress management available on request | A minimum of 18 years for the citizen-responders is required and absence of a criminal history regarding child abuse |
Englanda (N = 55.980000) | 24 h/7 | APP | GPS and Address | 1. Confirming the response 2. Location of victim; demographics (victim) and situational information | 1. Get an AED out of the vehicle; 2. Connect a breathing mask; 3. Attach pads and follow AED instructions; 4. Perform CPR; 5. They are trained in airway management | 1. AED; 2. Rescuer Kit | Yes trained for CPR including use of an AED; Annually | In an online system: In house database | Citizen-response activity is described in the annual report/Citizen-responders receive a regular report of their activity/Citizen-responders receive written feedback on individual calls from the EMS | No | Yes | Each Trust sets its own parameters. Most require a minimum of 16 or 18 years for the citizen-responders. Also, the criminal record is checked. |
Germanyb, Marburg-Biedenkopf, Gütersloh, Freiburg, Neckar-Odenwald-Kreis, Greifswald, Schleswig-Holstein (N = 3.661.774) | 24/7 | SMS; APP | GPS | 1. Confirming the response 2. Location of victim; location of AED | 1. Get a local AED; 2. Connect a breathing mask; 3. Attach pads and follow AED instructions; 4. Perform CPR | 1. AED; 2. Safety jacket; 3. Rescuer Kit | Yes trained for CPR including use of an AED; Annually | In an online system: In the app server/German Red Cross | No | No | Yes, they can choose to contact a special team for debriefing | A minimum age of 18 years for the responders is required |
Ireland (N = 4.830.000) | 24 h/7 | SMS | Not determined | 1. Confirming the response 2. Location of victim; location of AED; demographics (victim) and situational information | 1. Get a local AED or get an AED out of the vehicle; 2. Connect a breathing mask; 3. Attach pads and follow AED instructions; 4. Perform CPR | 1. AED; 2. Safety jacket; 3. Resuscitation kit bag | Yes trained for CPR including use of an AED; Monthly | Authorisation granted by Ambulance Officer | Citizen-response activity is described in the annual report/Citizen-responders receive a regular report of their activity/Designated EMS staff discuss calls attended with citizen-responders | Replacement of consumable equipment | Yes | A minimum age of 18 years for the citizen-responders is required and they must get Garda Clearance, i.e., confirmation must be received from the Irish police that the person does not have a criminal conviction of significance |
Italy Emilia Romagna (N = 4.453.000) | 24 h/7 | APP | GPS | 1. Confirming the response 2. Location of victim; location of AED | 1. Get a local AED; connect a breathing mask; 2. Attach pads and follow AED instructions; 3. Perform CPR | None | Yes trained for CPR including use of an AED; Bi-annually | In an online system: https://www.118er.it/dae/ | The responder manager sends an email to collect feedback by mail (but is not a routine) | No | No | No requirements |
Hungary (N = 9.800.000) | 24 h/7 | Standard communication system; APP | GPS | 1. One person from the dispatch centre calls the citizen to check whether she/he is able to go to the victim 2. Location of victim; location of AED | 1. Get a local AED; 2. Attach pads and follow AED instructions; 3. Perform CPR | 1. AED | Not required; There is not any training for them, it depends on the citizen. | In an online system: Szív city (szivcity.hu) | None | No | No | No requirements |
The Netherlands Except Amsterdam (N = 15.835350) | 24 h/7 | SMS; APP | GPS; Address | 1. No response is required 2. Location of victim; location of AED | 1. Get a local AED or get an AED out of the vehicle; 2. Attach pads and follow AED instructions; 3. Perform CPR | 1. AED | Yes trained for CPR including use of an AED; Annually | In an online system: Hartslag.nu | None | No | Hartslag.nu asks for an evaluation after the event | A minimum age of 18 years is required and no dispatch to OHCAs caused by a trauma or in children < 8 years |
Romania, Bucharest (N = 1.828.000) | NR | SMS | GPS | 1. No response is required 2. Location of victim; location of AED | 1. Get a local AED; 2. Attach pads and follow AED instructions; 3. Perform CPR | 1. AED | Yes trained for CPR including use of an AED; Only trained once | NR | Activity is described in the annual report | No | Informal emotional support from Ambulance Service Staff | A minimum age of 16 years for the citizen-responders is required |
Sweden, Norrbotten County (N = 251.295) | 24 h/7 | SMS | Triangulation by telephone towers | 1. No response is required 2. Location of victim | 1. Perform CPR | None | Yes trained for CPR including use of an AED; Responders should be educated but no specific follow up is done | In an online system: https://www.mobilraddare.se/ | NR | Yes, please describe the type of assistance given: not specified | Yes, if requested they can contact the project via email/telephone | A minimum age of 18 years is required and no dispatch to children < 8 years |
Sweden, Region western Sweden (N = 2.016.000) | During daytime: 07:00–22:59 | SMS | GPS | 1. Confirming the response 2. Location of victim; location of AED | 1. Get a local AED or get an AED out of the vehicle; 2. Attach pads and follow AED instructions; 3. Perform CPR | None | Yes trained for CPR including use of an AED; All should be trained once. The repetitions courses differs between individuals | Directly in the APP | None | No | Yes, crisis consultation if requested. | A minimum age of 18 years for the citizen-responders is required and no dispatch to children < 8 years |
Sweden, Stockholm (N = 965.232) | During daytime: 07:00–22:59 | SMS; APP | GPS | 1. Confirming the response 2. Location of victim; location of AED and situational information | 1. Get a local AED; 2. Attach pads and follow AED instructions; 3. Perform CPR | None | Yes trained for CPR including use of an AED; Only trained once | In an online system: Register directly via application | Via mail and social media when asked for | No | Yes, debriefing if needed (if requested crisis counselling is given up to 10 visits) | A minimum age of 18 years is required and no dispatch to children < 8 years |
Scotland (N = 543.800) | Book on with the control centre when available. Therefore, their coverage varies across the country at any given time | Standard communication system | GPS | 1. Confirming the response 2. Location of victim; situational information | 1. Get an AED out of the vehicle; 2. Connect a breathing mask; 3. Attach pads and follow AED instructions; 4. Perform CPR; 5. Insert airway if required | 1. AED; 2. Safety jacket; 3. Rescuer Kit | Yes trained for CPR including use of an AED; Community First Responders go through an initial 4 day training course and then are expected to attend monthly training sessions within their groups, which follow a structured programme | In an online system: After training and suitability checks have been completed they are put on a database and classed as an active responder) and then when available they book on and ACC colleagues can deploy them | Citizen-response activity is described in the annual report; Designated EMS staff discuss calls attended with citizen-responders/Citizen-responders receive written feedback on individual calls from the EMS/We have a network of Community Resilience Facilitators who meet with Community First Responder groups periodically and are available to support them | Yes: the can claim mileage costs if they have used their own vehicle. Scottish Ambulance Service also replaces any consumable items used during the course of the first responders attendance | Yes | A minimum age of 18 years for the citizen-responders is required and dispatch to adults only; all citizen-responders undergo a protection of vulnerable groups (PVG) check and, depending on feedback, a judgement is made on the suitability to be a citizen-responder. |
Switzerland, Ticino Canton (N = 353.709) | 24 h/7 | APP | Not determined | 1. Confirming the response 2. Location of victim; location of AED; demographic and situational information | 1. Get a local AED; 2. Connect a breathing mask | 1. Safety jacket | Yes trained for CPR including use of an AED; Bi-annually | In an online system: smartphone Application (MOMENTUM) and registration program created by us (fr.ticinocuore.ch) | Receive written feedback on individual calls from the EMS/ Participate in a debrief with EMS staff immediately after an OHCA/ Receive feedback based on AED data from the operational and clinical manager/Are invited to the annual ceremony, where survivors meet first responders | No | Yes, 24 h/7 days team of psychological counsellors | A minimum age of 18 years is required (of note: citizens are allowed to use an AED from age 14 years). Citizen-responders must adhere to the general conditions. They need to self-declare absence of a criminal record, but declarations are not checked. |
Switzerland, Region of Fribourg (N = 225.500) | 24 h/7 | APP | GPS | 1. Confirming the response 2. Location of victim; location of AED; demographics (victim) and situational information | 1. Get a local AED | 1. Safety jacket | Yes trained for CPR including use of an AED; Every two years | In an online system: Citizen responders must create an account in the app | Citizen-responder must complete a feedback sheet. Dependent of the answers, the foundation will contact the responder by phone. Sometimes citizen-responders can have immediately feedback from the EMS staff. | Yes, the foundation pay the replacement of AED consumable after intervention | Yes, citizen-responders have the possibility to call a psychological service | A minimum age of 18 years is required (of note: citizens are allowed to use an AED from age 14 years). Citizen-responders must adhere to the general conditions. They need to self-declare absence of a criminal record, but declarations are not checked. |
Country, Region | Activation by | Location determination | 1. Response needed | Role on scene (steps) | Equipment | Training, Frequency | Feedback | Financial assistance (NOT including: salary) | Other |
---|---|---|---|---|---|---|---|---|---|
2. Information provided by dispatcher | |||||||||
Austria (N = 8.220000) | Standard communication system; SMS; Pager; App | GPS | 1. Confirming the response 2. ocation of victim; location of AED (if applicable) | 1. Get a local AED or from the vehicle; 2. Attach pads and follow the AED instructions; 3. Perform CPR | 1. AED; 2. Safety jacket; 3. Mobile phone/Pager; 4. Rescuer kit | Yes trained for CPR including use of an AED; Annually | Police officers receive a regular report of their activity | AED equipment and related disposables | |
Belgium, Brussels (N = 1.208500) | Standard communication system | GPS | 1. Confirming the response 2. Location of victim | 1. Get an AED from the vehicle; 2. Attach pads and follow the AED instructions; 3. Perform CPR | 1. AED | Yes trained for CPR including use of an AED; Variable frequency (depends on police district) | There is no feedback to the officer’s superiors, after the intervention they are debriefed as part of the EMS team, at their demand. | NR | |
Czech Republic, (N = 10.521646) | Standard communication system | GPS and Address | 1. Subsequent call from dispatcher to police officer/ backwards 2. Location of victim; demographics (victim) and situational information | 1. Get an AED from the vehicle; 2. Connect a breathing mask; 3. Attach pads and follow the AED instructions; 4. Perform CPR | 1. AED; 2. Safety jacket; 3. Mobile phone/Pager; 4. BVM without oxygen | Yes trained for CPR including use of an AED; Annually | Designated EMS staff discuss calls attended with firefighters/ Police officers participate in a debrief with EMS staff immediately after an OHCA/ Regular meetings with police representatives/ EMS quality managers can take part if urgent problems need to be solved | AEDs located in some police cars are purchased by EMS | Police stations are usually located at places where no ambulance stations are |
England (N = 55.980000) | APP | Address | 1. Confirming the response 2. Location of victim; demographics (victim) and situational information | 1. Get an AED from the vehicle; 2. Connect a breathing mask; 3. Attach pads and follow the AED instructions; 4. Perform CPR; 5. Trained in airway management | 1.AED; 2. Mobile phone/Pager; 3. Rescuer kit | Yes trained for CPR including use of an AED; Annually | Police officer activity is described in the annual report/ Police officers receive a regular report of their activity; Police officers receive written feedback on individual calls from the EMS/ Police officers participate in a debrief with EMS staff immediately after an OHCA | No | |
Ireland (N = 4.830000) | SMS | Not determined | 1. Confirming the response 2. Location of victim; location of AED; demographics (victim) | 1. Get a local AED or from the vehicle or PAD; 2. Connect a breathing mask; 3. Attach pads and follow the AED instructions; 4. Perform CPR | 1. AED; 2. Safety jacket; 3. Mobile phone/Pager | Yes trained for CPR including use of an AED; Annually | Police officer activity is described in the annual report/ Police officers receive a regular report of their activity/ Police officers participate in a debrief with EMS staff immediately after an OHCA | Consumable equipment replacement | |
Italy, Emilia Romagna (N = 445,300) | App | GPS | 1. Confirming the response 2. Location of victim; Location of AED (if applicable) | 1. Get a local AED or from the vehicle; 2. Connect a breathing mask; 3. Attach pads and follow the AED instructions; 4. Perform CPR | 1. AED; 2. Safety jacket; 3. Mobile phone/Pager; 4. Rescuer kit | Yes trained for CPR including use of an AED; Bi-annually | The responder manager sends an email to collect feedback by mail (but is not a routine) | No | |
The Netherlands (N = 17.180000) | Standard communication system | GPS | 1. Confirming the response 2. Location of victim; demographics (victim) | 1. Get an AED from the vehicle; 2. Attach pads and follow the AED instructions; 3. Perform CPR; 4. Do safety measures and provide a safe workspace for people involved | 1. AED; 2. Safety jacket; | Yes trained for CPR including use of an AED; Annually | None | No | |
Sweden, Stockholm (N = 965,232) | Standard communication system | GPS | 1. Police is dispatched by their own dispatch centre. If available they answer by oral communication 2. Location of victim; demographics (victim) | NR | 1.AED; 2. Mobile phone/Pager | Yes trained for CPR including use of an AED | Meetings a couple of times each year where they discuss the collaboration | No | |
Switzerland, region of Fribourg (N = 225,500) | App; In case of OCHA, EMS dispatch centre calls the police dispatch centre to give the alarm. Police men can receive alarms from the police dispatch or from the app (like other first responders) | GPS | 1. Confirming the response 2. Location of victim | 1. Get an AED from the vehicle; 2. Attach pads and follow the AED instructions; 3. Perform CPR | 1. AED; 2. Safety jacket; 3. Mobile phone/Pager | Yes trained for CPR including use of an AED; Every 3 years | Police officers receive sometimes feedback but it is not systematic | Yes: AED Electrodes are paid by the first responders foundation | |
Switzerland, Ticino Canton (N = 353,709) | APP | Not determined | 1. Confirming the response 2. Location of victim; location of AED; demographics (victim) and situational information | 1. Get an AED from the vehicle; 2. Connect a breathing mask; 3. Attach pads and follow the AED instructions; 4. Perform CPR; assistance to bystanders; 5. Integration in advanced resuscitation (with ambulance team) | 1.AED; 2. Safety jacket; 3. Mobile phone/Pager; 4. Rescuer kit | Yes trained for CPR including use of an AED; Bi-annually | Designated EMS staff discuss calls attended with police officer/ Police officers receive written feedback on individual calls from the EMS/ Police officers participate in a debrief with EMS staff immediately after an OHCA/ Police officers receive feedback based on AED data from me. they are invited to the annual ceremony, where survivors meet first responders | Yes: AED and rescue kit donated free from Ticino Cure Foundation |
Response characteristics: availability and alerts
Equipment
Training and registration
National and regional policies
Country | Implementation: National or Regional | Short description of policy |
---|---|---|
Austria | Regional | Not reported |
Czech Republic | National and regional | There is a national policy related to professional FRs (firefighters/police officers). This policy is very general (e.g. CPR training requirement). All 14 regional EMS organizations in the country have been using professional FRs to some extent. They differ a little across the areas to optimise the best strategy per region. Only 1 EMS has also introduced a mobile app for alerting FRs, incl. Both off-duty EMS personnel and citizen FRs. Citizen FRs need to have a valid BLS/AED course certificate. |
Denmark | National and regional | Denmark has a strategy of engaging the community in saving lives after OHCA and succeeded in tripling the bystander rate and the survival after OHCA within the last 15 years. New programs dispatching citizen-responders through a smart phone application has been implemented within the last few years. The government of Denmark supports the 10 steps of increasing survival after OHCA defined by the Global Resuscitation Alliance, GRA: https://www.globalresuscitationalliance.org/wp-content/pdf/acting_on_the_call.pdf and has a national “Resuscitation Academy” program working to implement the 10 steps in the five Danish regional EMS organizations. Denmark also has some experience including professional fire fighters and police at OHCA already and expects to strengthen this collaboration within the next years. |
Ireland | National and regional | The National Ambulance Service has a history of FR involvement which predates the 2000s. General practitioners have been acting as FRs in selected parts of the country since the early 1990s. The first formal recommendation to support the development of first responders appears in the following national document which was produced by our Department of Health: “Reducing the Risk: A Strategic Approach. Report of the Task Force on Sudden Cardiac Death (2006)”. The National Ambulance Service has policy and procedure documents to support first responder involvement in cardiac arrest response. Ireland is in the process of developing a national OHCA strategy, which will include further specific recommendations to further the development of first response in Ireland. |
Italy | Regional | Law in Italy: Citizen trained in BLS are allowed to start CPR and to use an AED; citizens not trained can start CPR and use an AED accordingly to the law that regulates the “state of necessity” in emergency situations. The law in Italy for FRs and untrained lay people is a barrier to diffusion of bystander intervention. Some regions in Italy (Region of Emilia Romagna) implemented FRs. FRs will become more common in Italy in other regions (e.g., Province of Pavia). |
Luxembourg | Regional | Since July 1, 2018 Luxembourg is completely reorganised in only one EMS organisation for the country. Luxembourg has a FR system working in 56 out of 102 municipalities. This service is provided exclusively by volunteer firefighters because they are “in the system” and thus quite easily reachable. There are different modalities according to local circumstances. Either the FR get to the scene by their own means (when they have the equipment in their car) or they meet at the fire station to get their equipment before going to the scene. In Luxembourg, for the moment, there are only firefighters acting as “organized” FRs. Police is more reluctant to participate and there is no citizen-responder system. There is a mandatory training in CPR for school children since 2017 and the Luxembourg Resuscitation Council strives to train as many as possible persons in elementary CPR (hands-only) on a voluntary basis. |
Netherlands | National and regional | In the Netherlands, a national policy regarding citizen-responders was published, whereas the requirements for firefighters and police officers are described on regional level only. Regarding the implementation of AEDs and citizen-responders, the first policy was written in 2002. The reason to involve no citizen-responders in the capital Amsterdam is the proximity of police officers and firefighters (always shorter than 6 min to OHCA victim). |
Norway | National and regional | The Directory of health is working on policies and guidelines for FRs, including what a FR is, who can be called a FR and legal implications and concerns. There are 16 dispatch centres in Norway and they are all relating to firefighters as FRs in different ways |
Portugal | Regional | At the present moment, private investors are spreading AED programs with the main purpose to have a system with FRs in the event of an OHCA. In one region (21.000 people of 506.000) of Lisbon, police officers have been trained in BLS and AED. Portugal is in a preliminary process regarding the start of FRs. |
Slovenia | National and regional | In Slovenia, only voluntary fire fighters are implemented as FRs. This is due to a very extended network of firefighters brigades in Slovenia (literally, every village in Slovenia has a voluntary firefighters brigade). At the present moment, 35.000 volunteer fire fighters are organized in approximately 1500 fire fighters brigades. This number exceeds the number of policemen by six-times (approximately 5500 policemen). Voluntary firefighters in Slovenia are well organized and equipped (vehicles, communication, rescue equipment, etc.). On the other hand there is no nationwide strategy “how to organize FRs”. The Slovenian government released the document/regulation which basic conditions must be fulfilled to become a FR (skills, equipment, etc.). But the organization of FR is left to the local EMS. The local EMS firstly considers the need of first responders (especially in remote areas). Afterwards the local fire fighters brigade will be contacted to participate in a FR system (there is no obligation). Therefore, there are areas in Slovenia without FRs. Policemen patrol network is scarce compared to the fire fighters (there is interest by policemen to be also a part of a FR system). |
England | National and regional | In England, ambulance trusts are responsible for local implementation, but there is an overarching Governance Framework. |
Sweden | Regional based | Strategies or policies recommending establishment or the development of FRs in Sweden is lacking. Policies are regional. |
Switzerland | Regional based | In Switzerland all health issues (except the management of epidemics and disasters) are left to the cantons. It follows that with 26 cantons, there are 26 different health laws. Since the FR network is still considered ancillary to the EMS, there is no health law that takes this into account. This is the reason why there are so many different approaches (even inside the cantons). Only a few cantons have created a structure for the purpose of uniformly managing the FRs. Leading position and pioneer is Canton Ticino (https://www.ticinocuore.ch/en). The Swiss Resuscitation Council is working on a national strategy against OHCA. |