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Lapidus O, Jonsson M, Svensson L, Hollenberg J, Berglund E, Riva G, Claesson A, Nordberg P, Rosenqvist M, Forsberg S, Nord A, Ringh M. Effects of a volunteer responder system for out-of-hospital cardiac arrest in areas of different population density - A retrospective cohort study. Resuscitation 2023; 191:109921. [PMID: 37543160 DOI: 10.1016/j.resuscitation.2023.109921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Volunteer responder dispatch to nearby out-of-hospital cardiac arrests using a smartphone application can increase the proportion of patients receiving cardiopulmonary resuscitation. It is unknown how population density is related to the efficacy of a volunteer responder system. This study aimed to compare the response time of volunteer responders and EMS dispatched to suspected OHCAs in areas of different population density. METHODS A total of 2630 suspected OHCAs in Stockholm County during 2018-2020 where at least one dispatched volunteer responder reached the patient were identified through the HeartRunner™ application database. Study outcome was the proportion of cases where volunteer responders arrived at the scene before EMS, as well as the difference in time between the arrival of volunteer responders and EMS. RESULTS Volunteer responders arrived before EMS in 68% of examined cases (n = 1613). Higher population density was associated with a lower proportion of cases where volunteer responders arrived at the scene before EMS. Time on scene before arrival of EMS was highest in areas of low population density and averaged 4:07 (mm:ss). Response time was significantly shorter for volunteer responders compared to EMS across all population density groups at 4:47 vs 8:11 (mm:ss) (p < 0.001); the largest difference in response time was found in low population density areas. CONCLUSION Volunteer responders have significantly shorter response time than EMS regardless of population density, with the greatest difference in low population density areas. Although their impact on clinical outcome remains unknown, the benefits of dispatching volunteer responders to OHCAs may be greatest in rural areas.
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Affiliation(s)
- Oscar Lapidus
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
| | - Martin Jonsson
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Leif Svensson
- Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Jacob Hollenberg
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Ellinor Berglund
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Gabriel Riva
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Andreas Claesson
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Per Nordberg
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Mårten Rosenqvist
- Karolinska Institutet, Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Sune Forsberg
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Anette Nord
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Mattias Ringh
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
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Tikkanen V, Arsic M, Henricson M. The general attributes and competence for nurses in a single responder unit: A modified Delphi study. BMC Emerg Med 2023; 23:93. [PMID: 37605125 PMCID: PMC10441716 DOI: 10.1186/s12873-023-00868-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/09/2023] [Indexed: 08/23/2023] Open
Abstract
AIM The aim of this study was to describe the general attributes and competence that nurses in the ambulance's single responder units are considered to need. BACKGROUND The development of ambulance care has led to an increased need for new units and working methods. Single responder unit is a single crewed unit that often uses for the patient assessments, to refer patients to the right level of care and to release regular ambulances. There is a lack of description of the needed competence for the nurses within single responder unit. METHODS Modified Delphi with three rounds was used. The first round was conducted with focus group interviews and analysed with content analysis. Five competence categories and 19 subcategories were identified. The second and third rounds were conducted through surveys using a 4-point Likert scale and analysed with descriptive statistics. RESULTS The ability to communicate with other healthcare providers to achieve one's goal, the ability to create a good encounter alone and to have appropriate professional experience were identified as the most important general attributes and competencies. CONCLUSIONS A central competence in prehospital emergency care is the ability to independently assess and treat patients with varying care needs in complex environments. To be able to work in SRU requires good communication and collaborations skills with other healthcare providers but it is also a prerequisite for creating a good patient relationship. Work experience of taking care of varying patients and situations is also needed in SRU.
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Affiliation(s)
- Viivi Tikkanen
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
- School of Health, Care and Social Welfare, Mälardalens University, Eskilstuna, Sweden.
- Falck Ambulance Stockholm, Stockholm, Sweden.
| | - Marija Arsic
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
- Emergency Department, North Älvsborg County Hospital, Trollhättan, Sweden
| | - Maria Henricson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Andréll C, Dankiewicz J, Todorova L, Olanders K, Ullén S, Friberg H. Firefighters as first-responders in out-of-hospital cardiac arrest- a retrospective study of a time-gain selective dispatch system in the Skåne Region, Sweden. Resuscitation 2022; 179:131-140. [PMID: 36028144 DOI: 10.1016/j.resuscitation.2022.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022]
Abstract
AIM To analyze the impact of a time-gain selective, first-responder dispatch system on the presence of a shockable initial rhythm (SIR), return of spontaneous circulation (ROSC) and 30-day survival after out-of-hospital cardiac arrest (OHCA). METHOD A retrospective observational study comprising OHCA registry data and dispatch data in the Skåne Region, Sweden (2010-2018). Data were categorized according to dispatch procedures, two ambulances (AMB-only) versus two ambulances and firefighter first-responders (DUAL-dispatch), based on the dispatcher's estimation of a time-gain. Dual dispatch was sub-categorized by arrival of first vehicle (first-responder or ambulance). Logistic regressions were used, additionally with groups matched (1:1) for age, witnessed event, bystander cardiopulmonary resuscitation and ambulance response time. Adjusted and conditional odds-ratios (aOR, cOR) with 95% confidence intervals (CI) are presented. RESULTS Of 3,245 eligible cases, 43% were DUAL-dispatches with first-responders first on scene (FR-first) in 72%. Despite a five-minute median reduction in response time in the FR-first group, no association with SIR was found (aOR 0.83, 95%CI 0.64-1.07) nor improved 30-day survival (aOR 1.03, 95%CI 0.72-1.47). A positive association between ROSC and the FR-first group (aOR 1.25, 95%CI 1.02-1.54) disappeared in the matched analysis (cOR 1.12, 95%CI 0.87-1.43). Time to first monitored rhythm was 7:06 minutes in the FR-first group versus 3:01 in the combined AMB-only/AMB-first groups. CONCLUSION In this time-gain selective first-responder dispatch system, a shorter response time was not associated with increased SIR, improved ROSC rate or survival. Process measures differed between the study groups which could account for the observed findings and requires further investigation.
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Affiliation(s)
- Cecilia Andréll
- Center for Cardiac Arrest, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden. Remissgatan 4, S-22185 Lund, Sweden; Team CPR, Practicum Clinical Skills Centre, Region Skåne, Sweden. Jan Waldenströms gata 24, S-20502 Malmö, Sweden.
| | - Josef Dankiewicz
- Center for Cardiac Arrest, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden. Remissgatan 4, S-22185 Lund, Sweden; Department of Cardiology, Skåne University Hospital, Lund, Sweden. Entrégatan 7, S-221 85 Lund, Sweden
| | - Lizbet Todorova
- Medicine Services University Trust, Region Skåne, SE-221 85, Lund, Sweden
| | - Knut Olanders
- Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden. Entrégatan 7, S-221 85 Lund, Sweden
| | - Susann Ullén
- Clinical Studies Sweden, Skåne University Hospital, Lund, Sweden. Remissgatan 4, S-221 85 Lund, Sweden
| | - Hans Friberg
- Center for Cardiac Arrest, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden. Remissgatan 4, S-22185 Lund, Sweden; Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden. Carl-Bertil Laurells gata 9, S-205 02 Malmö, Sweden
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