First responder systems can stay operational under pandemic conditions: results of a European survey during the COVID-19 pandemic

Camilla Metelmann,Georg Trummer,Karl Christian Thies,Bernd W Böttiger,Michael P Müller,Bibiana Metelmann

doi:10.1186/s13049-022-00998-3

Abstract

BackgroundDispatching first responders (FR) to out-of-hospital cardiac arrest in addition to the emergency medical service has shown to increase survival. The promising development of FR systems over the past years has been challenged by the outbreak of COVID-19. Whilst increased numbers and worse outcomes of cardiac arrests during the pandemic suggest a need for expansion of FR schemes, appropriate risk management is required to protect first responders and patients from contracting COVID-19. This study investigated how European FR schemes were affected by the pandemic and what measures were taken to protect patients and responders from COVID-19.MethodsTo identify FR schemes in Europe we conducted a literature search and a web search. The schemes were contacted and invited to answer an online questionnaire during the second wave of the pandemic (December 2020/ January 2021) in Europe.ResultsWe have identified 135 FR schemes in 28 countries and included responses from 47 FR schemes in 16 countries. 25 schemes reported deactivation due to COVID-19 at some point, whilst 22 schemes continued to operate throughout the pandemic. 39 schemes communicated a pandemic-specific algorithm to their first responders. Before the COVID-19 outbreak 20 FR systems did not provide any personal protective equipment (PPE). After the outbreak 19 schemes still did not provide any PPE. The majority of schemes experienced falling numbers of accepted call outs and decreasing registrations of new volunteers. Six schemes reported of FR having contracted COVID-19 on a mission.ConclusionsEuropean FR schemes were considerably affected by the pandemic and exhibited a range of responses to protect patients and responders. Overall, FR schemes saw a decrease in activity, which was in stark contrast to the high demand caused by the increased incidence and mortality of OHCA during the pandemic. Given the important role FR play in the chain of survival, a balanced approach upholding the safety of patients and responders should be sought to keep FR schemes operational.

Highlights

Dispatching first responders (FR) to out-of-hospital cardiac arrest in addition to the emergency medical service has shown to increase survival
Eight responses were excluded from further analyses: one scheme was not located within Europe; one region had not fully implemented a FR system at the time of the survey; four participants did not answer key questions of the questionnaire; and for two schemes more than one response was received
Reasons for stopping the system were described as lack of knowledge about the new virus, the perceived high risk of transmission as well as lack of personal protective equipment (PPE)

Summary

Introduction

Dispatching first responders (FR) to out-of-hospital cardiac arrest in addition to the emergency medical service has shown to increase survival. Whilst increased numbers and worse outcomes of cardiac arrests during the pandemic suggest a need for expansion of FR schemes, appropriate risk management is required to protect first responders and patients from contracting COVID-19. Metelmann et al Scand J Trauma Resusc Emerg Med (2022) 30:10 of cardiac arrest are of vital importance [2] and survival can be doubled to tripled, if CPR starts before arrival of the emergency medical service (EMS) [3, 4]. During the last decade many different systems were implemented to dispatch first responders (FR) to out-of-hospital cardiac arrests (OHCA) [5,6,7,8,9,10,11,12]. The American Heart Association guidelines 2020 as well as the European Resuscitation Council (ERC) Guidelines 2021 strongly encourage the implementation of FR systems [20, 21]

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