TCPR Link - Enhancing Volunteer - Dispatcher Teamwork in Cardiac Arrest

Most out-of-hospital cardiac arrests happen at home, there is therefore a need to utilize nearby CPR competent volunteers to reduce time to start of CPR and to ensure good quality of CPR. Current volunteer solutions are administrated from the medical dispatch centers with little quality assurance. Pilot data from Singapore shows that these non-professionals volunteers, often fail to provide good CPR. When sending out volunteers, the experienced dispatcher is blind to what happens at the scene. The volunteers attempt resuscitation without professional support. Almost no data is captured that can be used for quality improvement. To mitigate this, we are developing a system to link the inexperienced CPR volunteer with an experienced medical dispatcher through real time video streaming from the cardiac arrest and real-time feedback on CPR. This is done by connecting a small unit with the size of a credit card (CPRcard) which measures CPR quality, to an app and connect it to the myResponder Volunteer system in Singapore. We are making a web solution for the medical dispatchers to receive real-time CPR quality feedback in addition to video streaming from the volunteer via the app. This makes them better equipped to provide targeted coaching to the caller. The data collected during the real incidents will be managed for the purpose of quality improvement and research, with the goal to save more lives from cardiac arrest by improving the quality of CPR provided. CPRcard was CE marked and registered in Singapore in 2021 and the first shipment is sent to Singapore. About 30 iterations of the app and corresponding web functionality has been developed by Laerdal the last year, and some of these have been tested in simulated cardiac arrests by Singapore General Hospital. The simulations in Singapore have been conducted with callers and first responders from the public, coached by medical dispatcher at Singapore Civil Defense Force (995). Today, there are registered 103 000 myResponders who have responded to more than 42 000 cases of suspected cardiac arrest. In parallel, 164 simulations with 65 participants (as first responders) have been conducted until now at Stavanger Acute medicine Foundation for Education and Research (SAFER), with the goal to optimize use of time until start of CPR, in addition to test the user interface and functionality. In some of the simulations at SAFER, the medical dispatcher was from Singapore Civil Defense Force 995. CPR data, observations and interview, together with randomized tests on user interface has provided the foundation for iterative development of the system and use in simulations. The temporary result from the simulations indicates that it is useful for first responders to receive real-time feedback from the app on CPR quality and that the medical dispatcher can provide more targeted coaching by having real-time video and CPR quality available. More simulations and formative studies are planned as part of the preparation for the clinical trial in Singapore.

THE BACKGROUND As a leading cause of early death, cardiovascular diseases kills nearly 18 M people annually. One third of the deaths are caused by sudden cardiac arrest (CA), a condition where the heart stops pumping blood. Resuscitation science shows that early quality cardiopulmonary resuscitation (CPR) increases the chance of survival. Witnesses to the out-of-hospital cardiac arrest are often the best people to administer life-saving treatment, but only 54% of the OHCA in Singapore involve bystander CPR, and 6.5% survives. There is supporting evidence that CPR volunteers who are dispatched by the ambulance service can do CPR before arrival of the EMS system. THE GAPS With most CA happening at home, and people living in high rise buildings, there is a need to utilize nearby CPR competent volunteers. However, current volunteer solutions are administrated from ambulance dispatch centers with little quality assurance. Pilot data from Singapore shows that these non-professionals volunteers, often fail to provide good CPR. When sending out volunteers, the experienced dispatcher is blind to what happens at the scene. The volunteers attempt resuscitation without professional support. Almost no data is captured that can be used for quality improvement. THE SOLUTION To mitigate this, we will link the inexperienced CPR volunteer with an experienced ambulance dispatcher and give both real time CPR feedback to improve quality of care. The TCPR Link Innovation comprises: - A CPR real-time feedback device and app, integrated with the myResponder Volunteer system (Singapore). - Web application for ambulance dispatchers to receive CPR Card feedback real time and coach volunteers - Data management of video, audio and CPR quality collected during real incidents for QI and research THE PARTNERS We will work together with Singapore General Hospital, Singapore Civil Defense Force and SAFER to develop, implement and evaluate in simulation and in a clinical study in Singapore.