Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 13:16:100486.
doi: 10.1016/j.resplu.2023.100486. eCollection 2023 Dec.

Technology activated community first responders in Singapore: Real-world care delivery & outcome trends

Fahad Javaid Siddiqui  1 , Stephanie Fook-Chong  2 , Nur Shahidah  2   3 , Colin K Tan  4 , Jinn Yang Poh  5 , Wei Ming Ng  6 , Dennis Quah  7 , Yih Yng Ng  8   9 , Benjamin Sh Leong  10 , Marcus Eh Ong  1   3
Affiliations

Technology activated community first responders in Singapore: Real-world care delivery & outcome trends

Fahad Javaid Siddiqui et al. Resusc Plus. .

Abstract

Background: Community first responders (CFRs) strengthen the Chain of Survival for out-of-hospital cardiac arrest (OHCA) care. Considerable efforts have been invested in Singapore's CFR program, during the years 2016-2020, by developing an app-based activation system called myResponder. This paper reports on national CFR response indicators to evaluate the real-world impact of these efforts.

Methods: We matched data from the Singapore Civil Defence Force's CFR registry with the Pan Asian Resuscitation Outcomes Study (PAROS) registry data to calculate performance indicators. These included the number of CFRs receiving and accepting an issued alert per OHCA event. Also calculated were the fraction of OHCA events where CFRs received an issued alert, or accepted the alert, and arrived at the scene either before or after EMS. We also present trends of these indicators and compare the prevalence of these fractions between the CFR-attended and CFR-unattended OHCA events.

Results: Of 6577 alerted OHCA events, 42.7% accepted an alert, 50% of these arrived at the scene and 71% of them arrived before EMS. Almost all CFR response indicators improved over time even for the pandemic year (2020). The fraction of OHCA events where >2 CFRs received an alert increased from 62% to 96%; the same figure for accepting an alert did not change much but >2 CFRs arriving at the scene increased from 0% to 7.5%. The fraction of OHCA events with an automated external defibrillator applied and defibrillation performed by CFR increased from 4.2% to 10.3% and 1.6% to 3%, respectively. Statistically significant differences were observed in these indicators when CFR-attended and CFR-unattended OHCA events were compared.

Conclusion: This real-world study shows that activating CFRs using mobile technology can improve community response to OHCA and are bearing fruit in Singapore at a national level. Some targets for improvement and future research are highlighted in this report.

Keywords: AED; CPR; Community First Responder; Defibrillation; OHCA; Out-of-hospital cardiac arrest; Pre-hospital Emergency Care; Trends; myResponder.

PubMed Disclaimer

Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: MEH Ong reports grants from the Laerdal Foundation, Laerdal Medical, and Ramsey Social Justice Foundation for funding of the Pan-Asian Resuscitation Outcomes Study; an advisory relationship with Global Healthcare SG, a commercial entity that manufactures cooling devices. MEH Ong has a licensing agreement with ZOLL Medical Corporation and patent filed (Application no: 13/047,348) for a “Method of predicting acute cardiopulmonary events and survivability of a patient”. He is also the co-founder and scientific advisor of TIIM Healthcare, a commercial entity which develops real-time prediction and risk stratification solutions for triage. All other authors have no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
Screenshot of myResponder dashboard with information on cumulative registered and active CFRs, and number of cumulative cardiac arrest and fire cases responded to as of May 3, 2023. Active CFRs are defined as responders who turned on notifications for medical and/or fire alerts at any given point.
Fig. 2
Fig. 2
Community first responder program for confirmed Out-of-hospital cardiac arrest (OHCA) events in Singapore: Event selection and system function. (Percentages presented before the ‘|’ sign reflect the fraction of all the eligible cases, whereas the ones presented after are the proportion from the subset above). *Some of these CFRs might have arrived before EMS but forgot to log the time through app.
Fig. 3
Fig. 3
Trends of CFR response, bystander interventions and outcomes of OHCA cardiac arrest.
See this image and copyright information in PMC

References

    1. Hasselqvist-Ax I., Riva G., Herlitz J., et al. Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest. N Engl J Med. 2015;372:2307–2315. - PubMed
    1. Scquizzato T., Pallanch O., Belletti A., et al. Enhancing citizens response to out-of-hospital cardiac arrest: a systematic review of mobile-phone systems to alert citizens as first responders. Resuscitation. 2020;152:16–25. - PMC - PubMed
    1. Barry T., Doheny M.C., Masterson S., et al. Community first responders for out-of-hospital cardiac arrest in adults and children. Cochrane database Syst Rev. 2019;7 - PMC - PubMed
    1. Stroop R., Kerner T., Strickmann B., Hensel M. Mobile phone-based alerting of CPR-trained volunteers simultaneously with the ambulance can reduce the resuscitation-free interval and improve outcome after out-of-hospital cardiac arrest: a German, population-based cohort study. Resuscitation. 2020;147:57–64. - PubMed
    1. Lee S.Y., Do S.S., Lee Y.J., et al. Text message alert system and resuscitation outcomes after out-of-hospital cardiac arrest: a before-and-after population-based study. Resuscitation. 2019;138:198–207. - PubMed

LinkOut - more resources