Critical and underutilized: Fire and police responders associated with
higher cardiac arrest survival rates

Date:
March 29, 2022
Source:
Michigan Medicine - University of Michigan
Summary:
Police and fire first responders are often first on the scene during
an out-of-hospital cardiac arrest, and a new study finds that their
intervention correlates with significantly higher chances of patient
survival and hospital discharge with good neurological outcomes.

Researchers say non-medical first responders are likely
underutilized as lifesaving resources in these cases.



FULL STORY ==========================================================================
In a cardiac arrest, everything comes down to how quickly you "get on
the chest." Every minute CPR is not initiated or an automated external defibrillator, or AED, is not utilized, the chance of survival decreases
by 7- 10%.


==========================================================================
A new study finds that survival rates increase when first responders
in police and fire departments intervene in out-of-hospital cardiac
arrests. However, the paper published in Resuscitation suggests these non-medical first responders are likely underutilized as lifesaving
resources.

Researchers from Michigan Medicine analyzed more than 25,000 cardiac
arrest incidents in the state from 2014 to 2019. They found that police
and fire first responders initiated CPR in 31.8% of out-of-hospital
cardiac arrests, and police accounted for AED use in 6.1% of
incidents. Those interventions were associated with significantly
higher chances of survival and hospital discharge with good neurological outcomes.

"It is clear that these non-medical first responders play a critical role
in time saved to chest compressions," said Mahshid Abir, M.D., M.Sc.,
senior author of the paper and an emergency physician at University of
Michigan Health, Michigan Medicine. "In fact, in communities that were
the highest performing in the state as far as survival is concerned, those responders work closely with emergency medical services to cross-train and debrief after incidents. When these agencies see their role as not just preventing crime or stopping fires, but also saving lives, it improves
the overall chain of survival for cardiac events." The likelihood of the return of a sustained heart rhythm for out-of-hospital cardiac arrest
didn't change significantly when CPR or defibrillation was initiated
by an EMS provider versus a non-medical first responder. However,
the survival rate for initiation by non-medical first responders was significantly higher.

In fact, for patients who had CPR initiated by non-medical first
responders, the odds of survival were 1.25 times higher. Similarly,
patients who had an AED applied by police were 1.4 times more likely
to survive.



==========================================================================
"Our findings reinforce what we know: whoever can start CPR and utilize
an AED first is the best person to do it," said Rama Salhi, M.D.,
M.H.S., M.Sc., lead author of the paper and national clinical scholar
at the U-M Institute for Healthcare Policy and Innovation. "Sometimes,
that's bystanders, but for a large percentage who have unwitnessed cardiac arrests, police and fire are on the scene first. Current evidence suggests
this may be in upwards of 50% of cardiac arrest calls. In a disease where seconds and minutes matter, this can be lifechanging." Non-medical first responders can treat cardiac arrest similar to overdose, Abir says. When
they receive an overdose call, law enforcement officials will often
administer naloxone, or Narcan, which can reverse overdose and save lives.

"If we make it mission-oriented to begin with, because you want to get
buy-in from folks, we can give them the training to optimize giving
chest compressions," said Abir, who is also an associate professor
of emergency medicine at University of Michigan Medical School. "Some
people are just not comfortable doing this, so training them in these applications, including AEDs, and purchasing them for first responder
vehicles would save more lives in the most effective way." The research
team recognizes that in some communities where there may be fractured
or complicated relationships with law enforcement, people might not be comfortable with anything other than an ambulance arriving on scene.

"All of these responders can make a huge difference in the survival of a person's loved one, so we need to educate the communities around when and
for what to call 9-1-1, and also who shows up and why they need to open
the door," Abir said. "If we take this extra step to educate around the emergency response system overall, it will help improve the relationships
and outcomes." Michigan Medicine has partnered with first responders in Washtenaw and Livingston counties to create the Out-of-Hospital Cardiac
Arrest Learning Community, which works to improve survival rates through awareness and implementation of lifesaving interventions in the region.



==========================================================================
The learning community has several work groups focused on AED
accessibility, community engagement and more.

"Ultimately the goal is to think creatively about how to get care to
our patients in the least amount of time," said Salhi, an emergency
physician at U- M Health. "This means empowering all members of our
community to get involved and save someone's life." Additional authors
include Stuart Hammond, B.S., Jessica L. Lehrich, M.S., Michael O'Leary,
B.S., Neil Kadmar, M.A., Christine Brent, M.D., Carlos F.

Mendes de Leon, Ph.D., Robert Neumar, M.D., Ph.D., Brahmajee
K. Nallamothu, M.D., all of Michigan Medicine, and Christopher Nelson,
Ph.D., Peter Mendel, Ph.D., both of RAND Corporation, and Bill Forbush
of the City of Alpena Fire Department, Alpena County EMS: Bill Forbush
This work is part of the National Heart, Lung, and Blood Institute-funded Enhancing Pre-hospital Outcomes for Cardiac Arrest (EPOC) project.


========================================================================== Story Source: Materials provided by
Michigan_Medicine_-_University_of_Michigan. Original written by Noah
Fromson. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Rama A. Salhi, Stuart Hammond, Jessica L. Lehrich, Michael O'leary,
Neil
Kamdar, Christine Brent, Carlos F. Mendes de Leon, Peter Mendel,
Christopher Nelson, Bill Forbush, Robert Neumar, Brahmajee
K. Nallamothu, Mahshid Abir. The association of fire or police
first responder initiated interventions with out of hospital
cardiac arrest survival.

Resuscitation, 2022; 174: 9 DOI: 10.1016/j.resuscitation.2022.02.026 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/03/220329090738.htm

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