Denmark has seen a dramatic increase in survival from heart attacks after it began recruiting volunteers and arming some of them with smartphone technology that alerts them to nearby cardiac emergencies and helps them locate automated external defibrillators, or AEDs. The volunteers are then asked to enter residences and perform CPR until an ambulance arrives.
There are similar apps in the United States, but concerns about safety and willingness of people to accept untrained volunteers into private homes have prevented a similar wide use of PulsePoint, a North American responder app. But if those concerns are overcome, the United States could “significantly improve” its survival rate, leading experts say.
There is no “reason why we should not pursue this,” said professor of medicine Thomas Rea, who studies prehospital emergency care at the University of Washington.
In Denmark, the survival rate for out-of-hospital cardiac arrest has increased from 4 percent to 16 percent in the past 20 years. In the United States, before the pandemic hit, the survival rate stood at 9.8 percent.
“They are certainly a beacon to other communities on how to improve survival,” said Mickey Eisenberg, a pioneer in prehospital resuscitation and a professor at the University of Washington.
With 70 percent of all cardiac arrests out of hospital in the United States taking place in residences, getting help at home is key to a better survival rate, experts say. PulsePoint alerts nearby volunteers who took CPR training or who are off-duty emergency responders and notify them with a distinctive alert tone that someone has gone into cardiac arrest in their vicinity, usually in a public place, such as shopping malls, work places or streets. Very few calls are to private homes.
The app will guide them on a map to the exact address and the closest AED.
In a handful of pilot communities around the country, PulsePoint alerts verified responders who are professionals to cardiac arrests in residences. But civilians are never called to residences because of concerns over their safety when entering the home of a stranger.
Yet the experience so far from the pilot communities dispatching off-duty professionals show there “isn’t a safety concern,” said Rea, who studied the pilot programs and found that responders were well received.
“Maybe we’re not thinking forward quite as fast as we could,” he said.
In Denmark, the smartphone Heartrunner community first responder app allows dispatchers from the national health emergency number 112 nationwide to contact up to 20 volunteers within a 1.1 mile radius from the scene of a cardiac arrest. The dispatcher will alert ambulance services, and may guide the person who called in to commence CPR until volunteers arrive.
“Can you run?” the app asks and volunteers responding “yes” are either first directed to the address shown on the screen or to the nearest available AED and then the scene.
Of the more than 100,000 registered Danish volunteers, 75 percent do not have a professional background in health care, surveys show. But that doesn’t matter, said Freddy Lippert, director of Copenhagen Emergency Medical Services, the first service to integrate the heart runner app in its services emergency response and invite ordinary citizens to download it in 2017.
“The patient is dead” — meaning his or heart has stopped due to cardiac arrest — “and if you don’t do anything, 9 out of 10 will be dead forever,” he said.
Eisenberg, the resuscitation pioneer who has been developing CPR techniques and teaching them for more than 30 years, said the Danish experience suggests the huge potential this technology would have in the United States.
“You can do the math: If a neighbor can get to the scene and start CPR within three to five minutes of a collapse, there’s a reasonable chance of successful resuscitation,” he said. “If nothing is done for 10 minutes, it’s a very low probability of success.”
In Denmark, civilians respond faster than professionals to more than 4 in 10 cardiac arrests out of hospitals, data from the Danish Cardiac Arrest Registry show.
How this all works was clear on a recent Sunday evening, when the fast response of neighbors activated by the Heartrunner app probably saved Erik Harry Kaxe, 81, when his heart stopped beating in his home on the outskirts of Hedensted, a small town in western Denmark. Within minutes, 10 strangers living nearby had arrived to his rescue — well before the ambulance arrived 17 minutes after the call.
Hannelene Kortegaard, a social and health-care assistant, and her husband, a truck driver, had just finished dinner when the loud alarm sounded from their Heartrunner app.
As they drove to Kaxe’s address, shown on the app’s screen, an emergency services operator was dispatching the ambulance and guiding Kaxe’s wife to perform CPR.
Several other volunteers notified by the app arrived along with the Kortegaards, carrying multiple AED’s. Kortegaard performed CPR, she said, while another volunteer prepared a defibrillator. With plenty of volunteers available, it was “a hectic atmosphere,” Kortegaard said, but it meant they could do more than just CPR.
Having responded to similar calls in the past, she was comfortable to lead the small army of volunteers and directed some to wait by the main road to guide the ambulance to the house. Others cleared furniture to make room for the stretcher and helped Kaxe’s distressed wife call their daughter. They also helped move Mopse, the dog, out of the way to the bathroom — with a bowl of water, too.
When the ambulance arrived, Kaxe was breathing. He survived the ordeal and is now rehabilitating at home. “Dying wasn’t difficult, but waking up is,” he said in a recent phone interview.
This strong response from volunteers is a sign of a change in attitudes to civilian response over the past 20 years — and a cornerstone in Denmark’s improved survival rate. In 2001, witnesses used CPR in 1 in 5 cardiac arrests out of hospital; today, the number is 4 in 5.
“Hospitals didn’t believe ordinary people could make a difference,” said Lippert, adding that bystanders saving a heart attack victim “was such a rare sight.”
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