Elsevier

Resuscitation

Volume 82, Issue 10, October 2011, Pages 1273-1278
Resuscitation

Clinical Paper
Early cardiopulmonary resuscitation and use of Automated External Defibrillators by laypersons in out-of-hospital cardiac arrest using an SMS alert service

https://doi.org/10.1016/j.resuscitation.2011.05.008Get rights and content

Abstract

Aim

To evaluate an SMS service (SMS = short message service = text message) with which laypersons are alerted to go to patients with suspected out-of-hospital cardiac arrest and perform early cardiopulmonary resuscitation (CPR) and use an Automated External Defibrillator (AED). This study is the first to report on a program in which an emergency medical service (EMS) is able to alert citizens by sending them SMS messages on their mobile phone.

Methods

Web-based questionnaires were completed by laypersons who were sent an alert by the AED-Alert system between February 1, 2010 and April 30, 2010. Questions concerned the process of training, receiving alerts, actions taken and follow-up care.

Results

AED-Alert was activated for 52 patients suspected of cardiac arrest, sending 3227 alerts to 2287 laypersons. Out of 2168 eligible laypersons 1679 (77%) completed 2098 questionnaires, one for each alert. Action was taken in only 579 alerts. Laypersons were not in the patient's vicinity (41%), noticed alerts too late (35%), or other reasons (24%). In 298 alerts laypersons faced problems with retrieving AEDs (51%), finding addresses (29%), traffic (5%), or other (15%). Aid was provided in 75 alerts, involving 47 patients. Laypersons started early CPR and defibrillation (49%), assisted EMS personnel (52%), or took care of family (39%). Laypersons arrived before EMS personnel in 21 patients, started CPR and defibrillation in 18, and assisted EMS personnel in 9 patients.

Conclusion

Improvements of the SMS alert service by laypersons, the EMS, and through technical adjustments, could increase the number of laypersons who provide early aid.

Introduction

Sudden out-of-hospital cardiac arrest is a leading cause of death in developed countries. In the Netherlands, approximately 16,000 cases of sudden cardiac arrest occur out-of-hospital each year.1 The overall survival rate is between 5% and 10%,2 and depends on early recognition and call for help, cardiopulmonary resuscitation (CPR), defibrillation with an Automated External Defibrillator (AED), and advanced care.3

Over 40% of cardiac arrests occur due to ventricular fibrillation.4, 5, 6, 7 Survival rates for patients with this abnormal heart rhythm can reach up to 50–75% if early CPR and defibrillation are performed within 3–5 min after cardiac arrest.8 However, patient's chance of survival decreases approximately 7–10% with every minute delay in defibrillation.9, 10

Several studies report that in most communities, time from collapse to arrival of emergency medical service (EMS) personnel is 7–8 min or longer.11, 12 It is virtually impossible to reduce the delay by improving logistics and availability of EMS teams. Therefore, it is expected that further improvements can only be achieved by involving laypersons to perform CPR and defibrillation during the first minutes after cardiac arrest. Ambulance Oost, the EMS of Twente, started an early intervention program in 2008 and implemented the AED-Alert system. The program is unique in that it enables the EMS to alert laypersons by sending them an SMS message on their mobile phone requesting them to go to patients requiring emergency care in order to perform early CPR and defibrillation.

In this aspect it is essentially different from other existing programs.11, 14 Guidelines have been developed including planned and practised response, training of anticipated rescuers in CPR and use of the AED, link with the local EMS system, and continuous audit and quality improvement.8, 14, 15 This study aims to systematically collect relevant information with which to make recommendations for EMS providers who wish to adopt such a program. It is not, however, the goal to evaluate the clinical value of an SMS alert service.

Therefore, the objective of this study is to evaluate the process of alerting laypersons to go to patients with an out-of-hospital cardiac arrest and perform early CPR and defibrillation. The evaluation provides insight in the extent to which laypersons take action upon SMS alerts and provide first aid. Moreover, it identifies problems and potential solutions which may be used to improve the process. An efficient process is important since immediate resuscitation of patients with an out-of-hospital cardiac arrest is assumed to increase survival.11

Section snippets

Setting

This study evaluated initial consecutive emergency calls to the EMS provider from February 1, 2010 to April 30, 2010, in which an out-of-hospital cardiac arrest was suspected and laypersons had been alerted by AED-Alert. The AED-Alert system is part of a program which was started by the EMS in order to build a system that could alert citizens through SMS messages urging them to go to patients requiring emergency care in order to perform early CPR and defibrillation.

On April 30, 2010 almost 6000

Results

Between February 1, 2010 and April 30, 2010 AED-Alert was activated for 52 patients with a suspected out-of-hospital cardiac arrest. For each patient on average 62 laypersons were alerted (range: 1–407). During these 3 months, AED-Alert sent 3227 alerts to 2287 laypersons (Table 1). Laypersons often received one alert or two alerts during this period (range: 1–6). Most suspected cardiac arrests occurred in urban areas (42.3%) or areas with less than 10,000 inhabitants (32.7%). Alerts were often

Discussion

This study evaluated the AED-Alert process during a 3 month time window, by sending questionnaires to laypersons involved in an alert. In 52 patients, nurses at the dispatch centre suspected an out-of-hospital cardiac arrest in the emergency call, and activated the AED-Alert system. Laypersons provided aid in 75 (3.6%) of 2098 alerts. In 84% of 2098 evaluated alerts laypersons suggested several improvements. These included laypersons’ registration, mobile phone settings and carrying of mobile

Conclusion

Improvements of the SMS alert service by laypersons, the EMS, and through technical adjustments, could increase the number of laypersons who provide early aid. It is expected that by implementing similar programs in other emergency medical service regions, the overall survival of patients with a cardiac arrest outside the hospital increases. Other studies are needed to investigate patient quality of life and clinical outcomes, and to investigate to what extent this program is cost-effective in

Conflict of interest statement

No conflicts of interest to declare.

Acknowledgements

Special appreciation is extended to all laypersons who tested and completed questionnaires, the EMS Ambulance Oost for the fruitful collaboration, and R. Stieglis MSc of the Academic Medical Centre Amsterdam for the provision of additional data.

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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2011.05.008.

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