SGEM#306: Fire Brigade and the Staying Alive App for OHCAs in Paris

Date: October 21st, 2020 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician, creator of the excellent #FOAMed project called First10EM.com and a member of the #SGEMHOP team. Reference: Derkenne et al. Mobile Smartphone Technology Is Associated With Out-of-hospital Cardiac Arrest Survival Improvement: The First Year "Greater Paris Fire Brigade" Experience. AEM Oct 2020. Case: You are waiting in line for coffee, discussing the latest SGEM Hot Off the Press episode on twitter, when an alert pops up on your phone. It says that someone in the grocery store next door has suffered a cardiac arrest and needs your help. You remember installing this app at a conference last year, but this is the first time you have seen an alert. You abandon your coffee order and quickly head next-door, where you are able to start cardiopulmonary resuscitation (CPR) and direct a bystander to find the store’s automated external defibrillator (AED) while waiting for emergency medical services (EMS) to arrive. After the paramedics take over, you wonder about the evidence for this seemingly miraculous intervention. Background: Out of hospital cardiac arrest (OHCA) is something that we have covered many times on the SGEM. SGEM#64: Classic EM Papers (OPALS Study) SGEM#136: CPR – Man or Machine? SGEM#143: Call Me Maybe for Bystander CPR SGEM#152: Movin’ on Up – Higher Floors, Lower Survival for OHCA SGEM#162: Not Stayin’ Alive More Often with Amiodarone or Lidocaine in OHCA SGEM#189: Bring Me to Life in OHCA SGEM#231: You’re So Vein – IO vs. IV Access for OHCA SGEM#238: The Epi Don’t Work for OHCA SGEM#247: Supraglottic Airways Gonna Save You for an OHCA? SGEM#275: 10th Avenue Freeze Out – Therapeutic Hypothermia after Non-Shockable Cardiac Arrest The American Heart Association promotes the “Chain-of-Survival”. There are five steps in the Chain-of-Survival for OHCA: Step One – Recognition and activation of the emergency response system Step Two – Immediate high-quality cardiopulmonary resuscitation Step Three – Rapid defibrillation Step Four – Basic and advanced emergency medical services Step Five – Advanced life support and post arrest care Bystander CPR and early defibrillation are key components of the out of hospital cardiac arrest chain of survival. Unfortunately, most patients don’t receive these crucial interventions. Many people are trained in CPR but never use their skills, because it is unlikely that they will happen to be in exactly the right place at the right time. They may be willing and able to help, but if the patient in need is one block over, they may never know about it. The advent of the smart phone with GPS capability means that we should be better able to direct individuals trained in basic life support (BLS) to those in need around them. We should also be able to use smart phones to more easily identify the closest AEDs. Over the last decade, numerous apps have been developed to do exactly that, but the impact of those apps on clinical outcomes is still unclear. Clinical Question: Is the use of a smart phone app that can match trained responders to cardiac arrest victims and indicate the closest available AEDs associated with better clinical outcomes? Reference: Derkenne et al. Mobile Smartphone Technology Is Associated With Out-of-hospital Cardiac Arrest Survival Improvement: The First Year "Greater Paris Fire Brigade" Experience. AEM Oct 2020. Population: Cardiac arrests from a single emergency medical service (EMS) agency in Paris, France that were called through the central dispatch center and occurred while the chief dispatcher was available to participate, occurred in a public area, and in which there was not obvious environmental danger. Intervention: Alerts were sent through the Staying Alive app to volunteers trained in BLS who were within 500 meters of the reported cardiac arrest.