Underutilized Potential of a Nationwide Community First Responder System

BACKGROUND: Community first responder (CFR) systems have been implemented to reduce time to cardiopulmonary resuscitation (CPR) and defibrillation after out-of-hospital cardiac arrest (OHCA). In the Capital Region of Denmark, CFR system activation relies on manual activation by emergency medical service (EMS) call takers, which may lead to underutilization of the system.

OBJECTIVES: The aim of this study was to examine the proportion of OHCAs in which the CFR system was activated and to identify characteristics of OHCAs associated with system activation.

METHODS: This register-based study in the Capital Region of Denmark included all OHCAs from September 2017 to December 2023. Excluded were OHCAs with exclusion criteria for CFR system activation (OHCAs caused by suicide, trauma, or OHCAs in nursing homes) and OHCAs not recognized by call takers. Binomial regression models were used to calculate relative risks for system activation in relation to patient age and sex, EMS response time, time of day, and OHCA location. Age, EMS response time, and time of day were modeled categorically. Differences in system activation between call takers were analyzed, excluding low-volume call takers, and interaction tests were performed to identify potential effect modifiers.

RESULTS: Call takers activated the CFR system in 2,486 (57.5%) of 4,320 OHCAs eligible for CFR system activation. The following characteristics were associated with higher likelihood of CFR system activation: patient age 51 to 80 years; OHCAs in private homes (risk ratio [RR]: 1.53; 95% CI: 1.41-1.66), longer EMS response time (RR: 1.27; 95% CI: 1.13-1.44), and OHCAs occurring in nighttime in private homes (RR: 1.10; 95% CI: 1.03-1.19). Female patients aged 0 to 20 years, 66 to 80 years, and >80 years received less CFR system activation compared with male patients in the same age groups (RR: 0.25 [95% CI: 0.02-0.95]; RR: 0.88 [95% CI: 0.81-0.96]; and RR: 0.77 [95% CI: 0.68-0.86], respectively). Finally, considerable variability was observed in CFR system activation among call takers (Q1-Q3: 48.0%-68.0%).

CONCLUSIONS: The CFR system was activated in <60% of eligible OHCAs. CFR system activation was higher among certain patient groups, and excessive variability in CFR system activation among call takers was identified. These findings are important for improving CFR systems.