Broad goals of the proposed research

We propose an integrated knowledge translation (iKT) approach to study the feasibility of the “Neighbours saving Neighbours” (NsN) program. We aim to reduce the delay to cardiopulmonary resuscitation (CPR) and defibrillation during out-of-hospital cardiac arrest (OHCA). This study will assess feasibility of the program in this first implementation in a Canadian setting.

Background and rationale

Every year, there are approximately 40,000 OHCA in Canada with only 8-12% surviving. The probability of survival decreases by 7-10% per minute, so early treatment is paramount. Unfortunately, witnesses at the scene rarely provide cardiopulmonary resuscitation (CPR) or use an automated external defibrillator (AED). Paramedic response time, even in dense urban settings, is usually longer than 8 minutes. “Community volunteer responder” programs, involving the dispatch of vetted, trained and equipped local volunteers, aim to reduce the delay to treatment, but have never been studied in Canada. Supported by a CIHR Planning Grant, our team of knowledge users from the Heart and Stroke Foundation of Canada and 3 regional paramedic services along with resuscitation scientists and other implementation partners, met in June 2019 to develop a the NsN community first responder program and this research proposal.

Research aims and overview of methodology

Our objectives are to:

1. Measure the establishment of the NsN community volunteer responder program
2. Quantify the penetration of the NsN intervention
3. Measure the reduction in time to treatment associated with NsN dispatch
4. Measure the quality of chest compressions provided by NsN volunteers
5. Assess the safety of the NsN program for volunteers and patients
6. Determine the acceptability of the NsN program

We will recruit and train 750 volunteers in 75 target communities. NsN volunteers, equipped with an AED, will be dispatched by 9-1-1 operators simultaneously with paramedics for all nearby OHCA calls. We anticipate enrolling approximately 190 OHCA events over 2 years. We propose an observational, pragmatic, multi-method study to determine the feasibility and safety of the NsN program in 3 Ontario paramedic service catchment areas. Quantitative data will be captured from ambulance call reports, dispatch centre records, and AED downloads. Qualitative data will be derived from semi-structured interviews.

Nature of core expertise including collaborations

Partner funding has been secured from the Heart and Stroke Foundation of Canada (H&S) and

SaveStation. Other participants include paramedic service decision-makers, senior resuscitation scientists, provincial 9-1-1 dispatch service operators, a cardiac arrest survivor and knowledge translation experts.

Expected outcomes and significance

We expect that the NsN program will have a direct impact on target communities by reducing delay to

treatment and improving the probability of survival for people who suffer OHCA during the study. The data generated by this project will add to the scant global evidence base on community responder programs and also support policy decisions around scaling up NsN. Our data will inform future program improvements and the design of definitive effectiveness studies. If NsN is feasible, safe, acceptable and associated with reduced delay to treatment for victims of OHCA, it has the potential to save many lives in the future.