Out-of-hospital cardiac arrest is a significant public health problem. Every year
there are approximately 40,000 OHCA annually in Canada with only 8-12%
surviving to hospital discharge. Early cardiopulmonary resuscitation (CPR) and
defibrillation have been highlighted as key links in the “Chain of Survival” for
patients who suffer OHCA. Treatment for cardiac arrest is very time-sensitive;
the probability of survival decreases by approximately 10% for every minute that
CPR and defibrillation are not provided. In many Canadian communities,
especially those outside of dense urban settings, getting paramedics to the
scene quickly is difficult. In many cases, paramedics may be require more than
15-20 minutes from the 9-1-1 call to arrive on scene. As such, CPR and AED
use delivered by witnesses on the scene is of paramount importance but
happens in the minority of cases.
In countries outside of Canada, many EMS systems have developed community
responder programs to address this challenge. These programs involve offduty
health care professionals and lay people to respond in parallel with
professional EMS. These volunteer responders from the community receive
training, equipment and communications devices to facilitate this new tier of
response to 9-1-1 emergencies. This model is not well-established in Canada
and has never been rigorously tested. There are no community first responder
programs specifically targeting cardiac arrest in Canada.
In a partnership with resuscitation scientists from several Canadian universities,
the University of Edinburgh, and 2 local Paramedic services, we propose a
study to establish the feasibility of a cardiac arrest community responder
program in Canada. This is the first step in a planned research agenda to
determine effectiveness of community volunteer responders for cardiac arrest.
Data from this preliminary feasibility study will support the development of a
definitive clinical trial within the Canadian Resuscitation Outcomes Consortium
The project objectives are 1) to assess the feasibility of a community volunteer
cardiac arrest response program to provide rapid, high-quality basic life support
for victims of OHCA in Frontenac, Hastings and Prince Edward counties of
Southern Ontario, and 2) to assess the acceptability of the community volunteer
cardiac arrest responder program among key witnesses to OHCA (e.g. 9-1-1
callers, family members) and paramedics involved in emergency response
situations attended by community volunteer cardiac arrest responders.
We will implement volunteer teams in 40 targeted townships across Frontenac,
Hastings and Prince Edward Counties in Southeastern Ontario. Townships
outside of dense urban areas with a history of longer EMS response times will
be prioritized. Four to eight volunteers for each team will receive training in
basic life support, an AED and a dispatch communications device. The local 9-
1-1 service will dispatch the on-call team member when they are closer to the
cardiac arrest than the nearest EMS unit. Volunteers will be trained to provide
CPR and use the AED while professional crews are on their way. We will
measure the feasibility of volunteer recruitment, retention and training. Program
administrative data, clinical data, CPR quality data from the AED and clinical
outcomes will be used to satisfy objective 1. Semi-structured interviews with
witnesses, family members and responding paramedics will be used to
determine the acceptability of this new mode of responding to cardiac arrest
emergencies in the community.