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Letter to the Editor| Volume 151, P39-42, June 2020

Mobile phone systems to alert citizens as first responders and to locate automated external defibrillators: A European survey

  • Tommaso Scquizzato
    Affiliations
    Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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  • Roman Burkart
    Affiliations
    Interassociation of Rescue Services, Bern, Switzerland

    European Resuscitation Council (ERC), Niel, Belgium
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  • Robert Greif
    Affiliations
    Department of Anesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Bern, Switzerland

    School of Medicine, Sigmund Freud University Vienna, Vienna, Austria

    European Resuscitation Council (ERC), Niel, Belgium
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  • Koenraad G. Monsieurs
    Affiliations
    Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Belgium

    European Resuscitation Council (ERC), Niel, Belgium
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  • Giuseppe Ristagno
    Affiliations
    Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

    Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    European Resuscitation Council (ERC), Niel, Belgium
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  • Andrea Scapigliati
    Affiliations
    Fondazione Policlinico Universitario A. Gemelli, IRCCS, Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy

    European Resuscitation Council (ERC), Niel, Belgium
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  • Federico Semeraro
    Correspondence
    Corresponding author at: Department of Anaesthesia, Intensive Care and EMS, Maggiore Hospital, Bologna, Italy.
    Affiliations
    Department of Anaesthesia, Intensive Care and EMS, Maggiore Hospital, Bologna, Italy

    European Resuscitation Council (ERC), Niel, Belgium
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Published:April 03, 2020DOI:https://doi.org/10.1016/j.resuscitation.2020.03.009
Mobile phone systems to alert citizens as first responders and to locate automated external defibrillators: A European survey
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      To the Editor,
      Each year in Europe, cardiopulmonary resuscitation (CPR) is attempted in 56 out-of-hospital cardiac arrest (OHCA) patients per 100,000 population, with only 8% surviving to hospital discharge.
      • Gräsner J.-T.
      • Wnent J.
      • Herlitz J.
      • Perkins G.D.
      • Lefering R.
      • Tjelmeland I.
      • et al.
      Survival after out-of-hospital cardiac arrest in Europe – results of the EuReCa TWO study.
      Resuscitation. 2020; 148: 218-226
      One of the leading causes of this low survival rate is the delay between OHCA and the initiation of CPR with the use of an automated external defibrillator (AED). Despite extensive efforts in training community members to deliver early CPR and defibrillation, bystander CPR rates remain low, and the majority of trained citizens never have the opportunity to perform CPR and to use an AED. Nowadays, mobile phone technology offers the possibility to locate and alert citizens as first responders to a nearby OHCA. The development of these systems can increase CPR rates performed before ambulance arrival
      • Ringh M.
      • Rosenqvist M.
      • Hollenberg J.
      • Jonsson M.
      • Fredman D.
      • Nordberg P.
      • et al.
      Mobile-phone dispatch of laypersons for CPR in out-of-hospital cardiac arrest.
      N Engl J Med. 2015; 372: 2316-2325
      and improve survival to hospital discharge.
      • Caputo M.L.
      • Muschietti S.
      • Burkart R.
      • Benvenuti C.
      • Conte G.
      • Regoli F.
      • et al.
      Lay persons alerted by mobile application system initiate earlier cardio-pulmonary resuscitation: a comparison with SMS-based system notification.
      Resuscitation. 2017; 114: 73-78
      Moreover, apps and websites were developed to report and locate AEDs. Recently, the ESCAPE-NET network explored first responder treatments after OHCA through a survey across 29 countries in Europe and a considerable variation between countries was found.
      • Oving I.
      • Masterson S.
      • Tjelmeland I.B.
      • et al.
      First-response treatment after out-of-hospital cardiac arrest: a survey of current practices across 29 countries in Europe.
      Scand J Trauma Resusc Emerg Med. 2019; 27: 112
      To obtain a picture of available systems to alert citizens as first responders and to locate the nearest AED across Europe, we conducted an online survey from February 6th, 2020 to February 16th, 2020. The survey, composed of nine questions about the availability of these systems, was sent by email to 14,624 members of the European Resuscitation Council (ERC) and ERC Research NET.
      We received 805 valid answers from 32 European countries, yielding a response rate of 5.5%. We identified 34 different systems to alert citizens as first responders. More than half of the countries (62%) activated at least one system in one region. Almost every system (94%) required citizens to be trained in basic life support (BLS) to become part of the first responder network. Systems to map and locate the nearest AED were available in 25 European countries (78%). Other details of reported technologies are available in Table 1.
      Table 1Summary of systems to alert first responders and locate automated external defibrillators (AED) across Europe (ordered by country).
      CountrySystem technologySystem nameMinimal training requiredMap of AEDs
      AustriaAppLebensretterBLSLebensretter
      Covers some regions.
      AppLocal Response Österr. Rotes KreuzBLSWebsite: www.144.at/defi
      Covers the entire country.
      BelgiumApp, text messageEvappBLSStaying alive
      Covers the entire country.
      AppReanimBLSReanim
      Covers the entire country.
      EVapp
      Covers some regions.
      EHBO – Rode Kruis
      Covers some regions.
      Bosnia and HerzegovinaNo systems––No
      CroatiaAppStaying alive (only in one region)BLSStaying alive
      Covers some regions.
      CyprusNo systems––No
      Czech RepublicAppO2 SOSBLSZáchranka
      Covers the entire country.
      DenmarkAppHjerteløber (Heartrunner)Recommended BLSHjertestarter
      Covers the entire country.
      AppFirstAEDBLSHjerteløber
      Covers some regions.
      FinlandNo systems––No
      FranceAppSauvlifeNoSauvlife
      Covers the entire country.
      AppStayingaliveBLSStayingalive
      Covers the entire country.
      AppAFPR–Premiers RépondantsBLSAFPR–Premiers Répondants
      Covers some regions.
      GermanyAppMobile Retter (Mobile Rescuer)BLSLebensretter App
      Covers some regions.
      AppLebensretter AppBLSLand|Retter
      Covers some regions.
      AppMeine Stadt RettetBLSRegion der Lebensretter FirstAED
      Covers some regions.
      AppRegion der Lebensretter FirstAEDTrained medical staffMeine Stadt Rettet
      Covers some regions.
      AppCorhelperBLSCorhelper
      Covers some regions.
      AppLand|RetterBLSMV SCHOCKT
      Covers some regions.
      AppKATRETTERBLSDefikataster
      Covers the entire country.
      BLSDefi-Finder
      Covers some regions.
      GreeceNo systems–Staying alive
      Covers some regions.
      Website: http://kidssavelives.gr/map-wide/
      Covers the entire country.
      HungaryAppSzivcity Heart CitySzivcity Heart City
      Covers the entire country.


      Website “http://mnsza.hu/”
      Covers the entire country.
      IcelandNo systems––No
      IrelandText message system–BLSWebsite: http://cfr.i.e./maps/
      ItalyAppDAE RespondERNoDAEDove
      Covers the entire country.
      SafetyGOBLSDAE RespondER
      Covers some regions.
      AEDs Map AREU Lombardia
      Covers some regions.
      KosovoNo systems––No
      LithuaniaAppStan AED AlertBLSStan AED Alert
      Covers the entire country.
      LuxembourgPager–Firefighter or emergency medicine technicianWebsite: www.reagis.lu
      Covers the entire country.
      MaltaNo systems––AED Malta
      Covers the entire country.
      NetherlandsApp and text messageHartslagNu (HeartbeatNow)BLSEHBO
      Covers the entire country.


      HartslagNu
      Covers the entire country.
      NorwayNo systems––Hjelp 113
      Covers the entire country.
      PolandNo systems––Ratuj z sercem – mapa AED
      Ratuj życie
      Staying alive
      PortugalNo systems––DAE Portugal
      Covers the entire country.
      RomaniaAppExista un erouBLSExista un erou
      Covers some regions.
      RussiaApp“Спасатель рядом” (Rescuer Nearby)BLSNo
      SerbiaNo systems––Website: http://app.aedplus.rs/
      Covers the entire country.
      SloveniaAppIHELP?https://aed-baza.si
      Covers the entire country.
      Text messageBLSiHELP
      Covers the entire country.
      www.aed.si
      Covers some regions.
      SpainAppCardiocity112BLSCardiocity112
      Covers some regions.
      DEACAT
      Covers some regions.
      Ayuda a la Parada Cardiaca
      Covers some regions.
      Ariadna
      Covers some regions.
      Desfibriladores Salvavidas
      Covers the entire country.
      SwedenApp and text messageSMSLivräddare (Heartrunner)BLSSMSLivräddare
      Covers some regions.
      Website: http://hjartstartarregistret.se/
      Covers the entire country.
      SwitzerlandAppFondazione Ticino CuoreBLSFondazione Ticino Cuore
      Covers some regions.
      App1st Responder Kanton BernBLS1st Responder Kanton Bern
      Covers some regions.
      CH ResponderBLS
      UKAppGoodSamBLSGoodSAM
      Covers the entire country.
      British Heart Foundation “The Circuit”
      Covers the entire country.
      UkraineNo systems––No
      BLS = basic life support, AED = automated external defibrillator.
      a Covers some regions.
      b Covers the entire country.
      In the context of the International Liaison Committee on Resuscitation (ILCOR) Continuous Evidence Evaluation process, the Education Implementation and Teams (EIT) Task Force has recently systematically reviewed the evidence on first responders engaged by technology.
      • Semeraro F.
      • Zace D.
      • Bigham B.L.
      • et al.
      On behalf of the International Liaison Committee on Resuscitation EIT Task Force.
      First responder engaged by technology Consensus on Science with Treatment Recommendations [Internet]. International Liaison Committee on Resuscitation (ILCOR) EIT Task Force, Brussels, Belgium2019
      The 2020 treatment recommendation proposes that individuals registered in a first responders network and near to a suspected OHCA should be notified by a smartphone app or a text message to initiate CPR before ambulance arrival (strong recommendation, very low-certainty evidence).
      The results of this survey are consistent with previous reports. We found a large variability across Europe regarding the availability of these systems and their implementation. It would be appropriate to pursue a uniform standard for these systems. Moreover, a standardized approach similar to the Utstein Style form is highly encouraged to obtain a uniform reporting of these systems. In the next ERC 2020 guidelines, a chapter entitled System Saving Lives will cover these issues extensively.

      Conflict of interest

      None declared.

      References

        • Gräsner J.-T.
        • Wnent J.
        • Herlitz J.
        • Perkins G.D.
        • Lefering R.
        • Tjelmeland I.
        • et al.
        Survival after out-of-hospital cardiac arrest in Europe – results of the EuReCa TWO study.
        Resuscitation. 2020; 148: 218-226
        View in Article
        • Ringh M.
        • Rosenqvist M.
        • Hollenberg J.
        • Jonsson M.
        • Fredman D.
        • Nordberg P.
        • et al.
        Mobile-phone dispatch of laypersons for CPR in out-of-hospital cardiac arrest.
        N Engl J Med. 2015; 372: 2316-2325
        View in Article
        • Caputo M.L.
        • Muschietti S.
        • Burkart R.
        • Benvenuti C.
        • Conte G.
        • Regoli F.
        • et al.
        Lay persons alerted by mobile application system initiate earlier cardio-pulmonary resuscitation: a comparison with SMS-based system notification.
        Resuscitation. 2017; 114: 73-78
        View in Article
        • Oving I.
        • Masterson S.
        • Tjelmeland I.B.
        • et al.
        First-response treatment after out-of-hospital cardiac arrest: a survey of current practices across 29 countries in Europe.
        Scand J Trauma Resusc Emerg Med. 2019; 27: 112
        View in Article
        • Semeraro F.
        • Zace D.
        • Bigham B.L.
        • et al.
        On behalf of the International Liaison Committee on Resuscitation EIT Task Force.
        First responder engaged by technology Consensus on Science with Treatment Recommendations [Internet]. International Liaison Committee on Resuscitation (ILCOR) EIT Task Force, Brussels, Belgium2019 (Available from http://ilcor.org)
        View in Article

      Article info

      Publication history

      Published online: April 03, 2020
      Accepted: March 21, 2020
      Received: March 18, 2020

      Identification

      DOI: https://doi.org/10.1016/j.resuscitation.2020.03.009

      Copyright

      © 2020 Elsevier B.V. All rights reserved.

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