Automated and app-based activation of first responders for prehospital cardiac arrest: an analysis of 16.500 activations of the KATRETTER system in Berlin

Abstract

Background: Bystander CPR is one of the main independent factors contributing to better survival after out-of-hospital cardiac arrest. Simultaneously, the rate of bystander CPR in Germany is below the European average. First responder applications (apps) contribute to reducing the time period without CPR (no-flow time) until professional help can arrive on-scene.

Methods: The KATRETTER app was introduced in Berlin as one of the first apps in Europe which do not require any medical qualifications to register as a first responder. The activation of volunteer first responders for suspected cardiac arrest cases through the Berlin Emergency Medical Services integrated control center was evaluated based on data collected between 16 Oct 2020 and 16 Oct 2022. Our descriptive analysis includes the number of registered first responders, number of activations, the number and percentages of accepted activations, as well as all reports where first responders arrived at the scene.

Results: As of 15 Oct 2022, a total of 10,102 first responders were registered in the state of Berlin. During this specified period, there were 16.505 activations of the system for suspected out-of-hospital cardiac arrest. In 38.4% of the accepted cases, first responders documented patient contact, and in 34.6% of cases with patient contact, CPR was performed. Only 2% of registered first responders did not have any medical qualifications.

Conclusions: Smartphone-based first responder applications should not be understood as a means of alerting professional help, but rather like a digitally amplified "call for help" in the vicinity of an emergency location. A large number of first responders can be recruited within 24 months, without large-scale public relations work necessary. No qualifications were required to become a first responder, contributing to a low-threshold registration process with the effect of a more widespread distribution of the app and cost reduction during implementation.

Keywords: Bystander CPR; Community first responder; Community response; Crowdsourcing; Dispatcher; Emergency medical services (MeSH); Out-of-hospital cardiac arrest (MeSH); Smart technology.

Fig. 1

Registering as a new first-responder within the KATRETTER application in Berlin

Fig. 2

Qualifications of KATRETTER first-responders in the state of Berlin

Fig. 3

Overview of case numbers, AED: Automated external defibrillator

Fig. 4

Detailed analysis of first responder activations through the KATRETTER system over time. Note: Because of a high number of false positive activations we deleted the Code 31D02 “Severe respiratory distress” from the list of dispatch codes which prompt automatic CFR activation in the dispatch system (see Table 1) on February 1st, 2022. This is the reason for the decrease of activations during that timeframe seen in this figure

Fig. 5

Distribution of causes for aborting a current mission