title: Local lay rescuers with AEDs, alerted by text messages, contribute to early defibrillation in a Dutch out-of-hospital cardiac arrest dispatch system.
abstract: OBJECTIVE
  Public access defibrillation rarely reaches out-of-hospital cardiac arrest (OHCA) patients in residential areas. We developed a text message (TM) alert system, dispatching local lay rescuers (TM-responders). We analyzed the functioning of this system, focusing on response times and early defibrillation in relation to other responders.
  
  
  METHODS
  In July 2013, 14112 TM-responders and 1550 automated external defibrillators (AEDs) were registered in a database residing with the dispatch center of two regions of the Netherlands. TM-responders living <1000m radius of the patient received a TM to go to the patient directly, or were directed to retrieve an AED first. We analyzed 1536 OHCA patients where a defibrillator was connected from February 2010 until July 2013. Electrocardiograms from all defibrillators were analyzed for connection and defibrillation time.
  
  
  RESULTS
  Of all OHCAs, the dispatcher activated the TM-alert system 893 times (58.1%). In 850 cases ≥1 TM-responder received a TM-alert and in 738 cases ≥1 AED was available. A TM-responder AED was connected in 184 of all OHCAs (12.0%), corresponding with 23.1% of all connected AEDs. Of all used TM-responder AEDs, 87.5% were used in residential areas, compared to 71.6% of all other defibrillators. TM-responders with AEDs defibrillated mean 2:39 (min:sec) earlier compared to emergency medical services (median interval 8:00 [25-75th percentile, 6:35-9:49] vs. 10:39 [25-75th percentile, 8:18-13:23], P<0.001). Of all shocking TM-responder AEDs, 10.5% delivered a shock ≤6min after call.
  
  
  CONCLUSIONS
  A TM-alert system that includes local lay rescuers and AEDs contributes to earlier defibrillation in OHCA, particularly in residential areas.
authors.affiliation: Academic Medical Center, Department of Cardiology, Amsterdam, The Netherlands. Electronic address: j.a.zijlstra@amc.nl.
authors.forename: Jolande A
authors.initials: JA
authors.lastname: Zijlstra
authors.affiliation: Academic Medical Center, Department of Cardiology, Amsterdam, The Netherlands.
authors.forename: Remy
authors.initials: R
authors.lastname: Stieglis
authors.affiliation: Veiligheidsregio Noord-Holland Noord, Alkmaar, The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: Riedijk
authors.affiliation: Veiligheidsregio Noord-Holland Noord, Alkmaar, The Netherlands.
authors.forename: Martin
authors.initials: M
authors.lastname: Smeekes
authors.affiliation: Ambulance Oost, Hengelo, The Netherlands.
authors.forename: Wim E
authors.initials: WE
authors.lastname: van der Worp
authors.affiliation: Academic Medical Center, Department of Cardiology, Amsterdam, The Netherlands.
authors.forename: Rudolph W
authors.initials: RW
authors.lastname: Koster
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D003256:Community Participation / Q000706:statistics & numerical data*; D016208:Databases, Factual; D047548:Defibrillators / Q000706:statistics & numerical data; D004554:Electric Countershock / Q000379:methods / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D058996:Quality Improvement; D012042:Registries; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D060145:Text Messaging; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Automated external defibrillator; Cardiopulmonary resuscitation; Defibrillation; Out-of-hospital cardiac arrest