Directly to the Heart of the Matter

"They are certainly a beacon to other communities on how to improve survival."

"You can do the math: If a neighbour can get to the scene and start CPR within three to five minutes of a collapse, there's a reasonable chance of successful resuscitation."

"If nothing is done for ten minutes, it's a very low probability of success [survival]."

Dr.Mickey Eisenberg, prehospital resuscitation, professor, University of Washington

"The patient is dead [meaning his or her heart has stopped due to cardiac arrest] and if you don't do anything, nine out of ten will be dead forever."

"Hospitals didn't believe ordinary people could make a difference."

Freddy Lippert, director, Copenhagen Emergency Medical Services

Lead Image © THANAGON / Adobe Stock

 

They did, and they do, however. Civilians in Denmark respond faster than do professionals to over four in ten cardiac arrests out of hospitals, according to data from the Danish Cardiac Arrest Registry. The Heartrunner app used in Denmark enabled a swift response of neighbours to save the life of 81-year-old Erik Harry Kaxe whose heart stopped while at home on the outskirts of a small town in western Denmark. Within minutes of being alerted ten strangers who lived close by had arrived to give assistance, before the arrival of the ambulance 17 minutes later.

A social and health-care assistant, Hannelene Kortegaard received the alarm sounding from her Heartrunner app. She and her husband drove to the address given, a map shown on the app's screen while an emergency services operator dispatched an ambulance and guided Mrs. Kaxe to perform CPR. Other volunteers the app notified arrived on scene with a number of AEDs. As Kortegaaard performed CPR, another volunteer prepared a defibrillator. Kortegaard assigned volunteers to wait outside to direct the ambulance.

Others comforted Mr. Kaxe's wife, while someone was delegated to take care of the family dog. Kaxe survived his ordeal. "Dying wasn't difficult, but waking up is", he said in an interview. In 2001 in
Denmark, witnesses used CPR in one of five cardiac arrests occurring outside a hospital. That number is now four in five. And the citizens of Denmark have their dramatic upswing in survival from heart attack courtesy of smartphone technology alerting volunteers to an emergency cardiac arrest.

 

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The app alerts volunteers to the occurrence of nearby cardiac emergencies, directing them to the location of automated external defibrillators (AEDs). The app asks volunteers to enter residences and perform CPR until the arrival of an ambulance. Concerns of safety and the acceptance of people who are untrained volunteers to enter private homes have largely prevented a similar use of PulsePoint, a North American responder app, to take place in the United States. Should such concerns be overcome according to leading experts, the U.S. could "significantly improve" its own survival rate.

The out-of-hospital survival rate in Denmark increased from four percent to 15 percent over the course of the past twenty years. Before the pandemic occurred the survival rate in the United States stood at 9.8 percent. 70 percent of all cardiac arrests that occur out of hospital in the United States occur in residences; persuading volunteers that it is a necessary requirement in saving lives to enter homes to improve survival rates in the U.S. represents a life-saving goal.

Pulse Point is designed to alert volunteers who happen to be nearby, who had taken CPR training, or who are off-duty emergency responders, notifying them through a distinctive alert tone when someone has gone into cardiac arrest in their near vicinity in places such as shopping malls, workplaces or streets. The function of the app is also to guide them on a map to the precise address and the location of the closest AED.

PulsePoint alerts verified responders who happen to be professionals, to cardiac arrests in residences whereas civilian volunteers are not called to residences reflecting safety concerns on entering the home of a stranger. "Maybe we're not thinking forward quite as fast as we could", commented professor of medicine Dr.Thomas Rea, who studies prehospital emergency care at the University of Washington. 

 

 

The app in Denmark allows dispatchers from the national health emergency number 112 to contact up to 20 volunteers within a 1.77km radius from the scene of a cardiac arrest where the dispatcher goes on to alert ambulance services while guiding the person who called in to commence CPR  until the arrival of volunteers. "Can you run?" asks the app as volunteers respond "yes" and are then directed to the address shown on the screen or alternatively to the nearest available AED and then toward the scene of the emergency.

There are over 100,000 registered Danish volunteers, 74 percent of whom have no professional background in health care, according to surveys. Danish volunteers have taken to the app and the responsibility that falls to volunteers, a sign of a change in attitudes to civilian response ... to become a cornerstone in the nation's improved survival rate.