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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

Andrell, Cecilia LU ; Dankiewicz, Josef LU orcid ; Todorova, Lizbet ; Olanders, Knut LU ; Ullén, Susann and Friberg, Hans LU (2022) In Resuscitation 179. p.131-140
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... (More)
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, sex, location, 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. (Less)
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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Out-of-hospital cardiac arrest (OHCA), Dual dispatch, Emergency medical dispatcher, First responders, Shockable initial rhythm
in
Resuscitation
volume
179
pages
10 pages
publisher
Elsevier
external identifiers
  • pmid:36028144
  • scopus:85137306539
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2022.08.012
language
English
LU publication?
yes
id
9e2c0ce4-b052-4e4b-b1b2-9f7e3c079bc7
date added to LUP
2022-10-06 22:55:20
date last changed
2022-10-17 09:35:10
@article{9e2c0ce4-b052-4e4b-b1b2-9f7e3c079bc7,
  abstract     = {{Aim<br/>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).<br/><br/>Method<br/>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, sex, location, witnessed event, bystander cardiopulmonary resuscitation and ambulance response time. Adjusted and conditional odds-ratios (aOR, cOR) with 95% confidence intervals (CI) are presented.<br/><br/>Results<br/>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.<br/><br/>Conclusion<br/>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.}},
  author       = {{Andrell, Cecilia and Dankiewicz, Josef and Todorova, Lizbet and Olanders, Knut and Ullén, Susann and Friberg, Hans}},
  issn         = {{0300-9572}},
  keywords     = {{Out-of-hospital cardiac arrest (OHCA); Dual dispatch; Emergency medical dispatcher; First responders; Shockable initial rhythm}},
  language     = {{eng}},
  pages        = {{131--140}},
  publisher    = {{Elsevier}},
  series       = {{Resuscitation}},
  title        = {{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}},
  url          = {{http://dx.doi.org/10.1016/j.resuscitation.2022.08.012}},
  doi          = {{10.1016/j.resuscitation.2022.08.012}},
  volume       = {{179}},
  year         = {{2022}},
}