The association of fire or police first responder initiated interventions with out of hospital cardiac arrest survival



      Fire and police first responders are often the first to arrive in medical emergencies and provide basic life support services until specialized personnel arrive. This study aims to evaluate rates of fire or police first responder-initiated cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use, as well as their associated impact on out-of-hospital cardiac arrest (OHCA) outcomes.


      We completed a secondary data analysis of the MI-CARES registry from 2014 to 2019. We reported rates of CPR initiation and AED use by fire or police first responders. Multilevel modeling was utilized to evaluate the relationship between fire/police first responder-initiated interventions and outcomes of interest: ROSC upon emergency department arrival, survival to hospital discharge, and good neurologic outcome.


      Our cohort included 25,067 OHCA incidents. We found fire or police first responders initiated CPR in 31.8% of OHCA events and AED use in 6.1% of OHCA events. Likelihood of sustained ROSC on ED arrival after CPR initiated by a fire/police first responder was not statistically different as compared to EMS initiated CPR (aOR 1.01, CI 0.93–1.11). However, fire/police first responder interventions were associated with significantly higher odds of survival to hospital discharge and survival with good neurologic outcome (aOR 1.25, 95% CI 1.08–1.45 and aOR 1.40, 95% CI 1.18–1.65, respectively). Similar associations were see when examining fire or police initiated AED use.


      Fire or police first responders may be an underutilized, potentially powerful mechanism for improving OHCA survival. Future studies should investigate barriers and opportunities for increasing first responder interventions by these groups in OHCA.


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      1. Strategies to Improve Cardiac Arrest Survival: A Time to Act. Institute of Medicine. Accessed August 6, 2019.

      2. Daya M, Schmicker R, May S, Morrison L. Current burden of cardiac arrest in the United States: Report from the Resuscitation Outcomes Consortium. Pap Comm Comm Treat Card Arrest Curr Status Future Dir. Published online June 30, 2015.

        • Malta Hansen C.
        • Kragholm K.
        • Pearson D.A.
        • et al.
        Association of bystander and first-responder intervention with survival after out-of-hospital cardiac arrest in North Carolina, 2010–2013.
        JAMA. 2015; 314: 255-264
      3. Cardiac Arrest Registry to Enhance Survival: 2020 Annual Report.

        • Abir M.
        • Fouche S.
        • Lehrich J.
        • et al.
        Variation in pre-hospital outcomes after out-of-hospital cardiac arrest in Michigan.
        Resuscitation. 2021; 158: 201-207
        • Larsen M.P.
        • Eisenberg M.S.
        • Cummins R.O.
        • Hallstrom A.P.
        Predicting survival from out-of-hospital cardiac arrest: A graphic model.
        Ann Emerg Med. 1993; 22: 1652-1658
        • Vleet L.M.V.
        • Hubble M.W.
        Time to first compression using medical priority dispatch system compression-first dispatcher-assisted cardiopulmonary resuscitation protocols.
        Prehosp Emerg Care. 2012; 16: 242-250
        • Myerburg Robert J.
        • Jeffrey Fenster
        • Mauricio Velez
        • et al.
        Impact of community-wide police car deployment of automated external defibrillators on survival from out-of-hospital cardiac arrest.
        Circulation. 2002; 106: 1058-1064
      4. 9. Griffith B. Opinion: Increase cardiac arrest outcomes by updating police dispatch protocols. Police1. Accessed April 16, 2021.

      5. Raun L, Pederson J, Campos L, Ensor K, Persse D. Effectiveness of the dual dispatch to cardiac arrest policy in Houston, Texas. J Public Health Manag Pract JPHMP. Published online September 2018. 10.1097/PHH.0000000000000836.

        • Hansen S.M.
        • Hansen C.M.
        • Fordyce C.B.
        • et al.
        Association between driving distance from nearest fire station and survival of out-of-hospital cardiac arrest.
        J Am Heart Assoc. 2018; 7
        • Klassen A.B.
        • Core S.B.
        • Lohse C.M.
        • Sztajnkrycer M.D.
        A descriptive analysis of care provided by law enforcement prior to EMS arrival in the United States.
        Prehospital Disaster Med. 2018; 33: 165-170
        • Husain S.
        • Eisenberg M.
        Police AED programs: A systematic review and meta-analysis.
        Resuscitation. 2013; 84: 1184-1191
      6. Cardiac Arrest Registry to Enhance Survival: About CARES.

      7. Cardiac Arrest Registry to Enhance Survival: CARES Fact Sheet.

      8. Cardiac Arrest Registry to Enhance Survival (CARES): 2021 Data Dictionary.

      9. Vellano K, Crouch A, Rajdev M, McNally B, The CARES Registry Group. Cardiac Arrest Registry to Enhance Survival (CARES): Report on the Public Health Burden of Out-of-Hospital Cardiac Arrest.

      10. Michigan CARES. MI-CARES Bi‐Annual Population Assessment.; 2016.

      11. SAS Software.

        • Cummins R.O.
        • Ornato J.P.
        • Thies W.H.
        • Pepe P.E.
        Improving survival from sudden cardiac arrest: the “chain of survival” concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association.
        Circulation. 1991; 83: 1832-1847
        • Ono Y.
        • Hayakawa M.
        • Iijima H.
        • et al.
        The response time threshold for predicting favourable neurological outcomes in patients with bystander-witnessed out-of-hospital cardiac arrest.
        Resuscitation. 2016; 107: 65-70
        • Bailey E.D.
        • Wydro G.C.
        • Cone D.C.
        Termination of resuscitation in the prehospital setting for adult patients suffering nontraumatic cardiac arrest.
        Prehosp Emerg Care. 2000; 4: 190-195
        • Hawkins S.C.
        • Shapiro A.H.
        • Sever A.E.
        • Delbridge T.R.
        • Mosesso V.N.
        The role of law enforcement agencies in out-of-hospital emergency care.
        Resuscitation. 2007; 72: 386-393
        • Papson K.
        • Mosesso V.N.J.
        Ten years of police defibrillation: program characteristics and personnel attitudes.
        Prehospital Emerg Care Off J Natl Assoc EMS Physicians Natl Assoc State EMS Dir. 2005; 9: 186-190
        • Valenzuela T.D.
        • Roe D.J.
        • Nichol G.
        • Clark L.L.
        • Spaite D.W.
        • Hardman R.G.
        Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos.
        N Engl J Med. 2000; 343: 1206-1209
        • Hasselqvist-Ax I.
        • Riva G.
        • Herlitz J.
        • et al.
        Early Cardiopulmonary resuscitation in out-of-hospital cardiac arrest.
        N Engl J Med. 2015; 372: 2307-2315
        • Mosesso V.N.
        • Davis E.A.
        • Auble T.E.
        • Paris P.M.
        • Yealy D.M.
        Use of automated external defibrillators by police officers for treatment of out-of-hospital cardiac arrest.
        Ann Emerg Med. 1998; 32: 200-207
        • Hollenberg J.
        • Riva G.
        • Bohm K.
        • et al.
        Dual dispatch early defibrillation in out-of-hospital cardiac arrest: the SALSA-pilot.
        Eur Heart J. 2009; 30: 1781-1789
        • Saner H.
        • Morger C.
        • Eser P.
        • von Planta M.
        Dual dispatch early defibrillation in out-of-hospital cardiac arrest in a mixed urban–rural population.
        Resuscitation. 2013; 84: 1197-1202
        • Nordberg P.
        • Jonsson M.
        • Forsberg S.
        • et al.
        The survival benefit of dual dispatch of EMS and fire-fighters in out-of-hospital cardiac arrest may differ depending on population density – A prospective cohort study.
        Resuscitation. 2015; 90: 143-149
        • Nordberg P.
        • Hollenberg J.
        • Rosenqvist M.
        • et al.
        The implementation of a dual dispatch system in out-of-hospital cardiac arrest is associated with improved short and long term survival.
        Eur Heart J Acute Cardiovasc Care. 2014; 3: 293-303