https://doi.org/10.4081/ecj.2023.11568
Influence of bystander activation on pre-hospital emergency care response time: systematic review
Submitted: 6 July 2023
Accepted: 18 September 2023
Published: 12 October 2023
Accepted: 18 September 2023
Abstract Views: 701
PDF: 219
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
This article presents a systematic review and analysis of grey literature to identify and address gaps in knowledge regarding the role and influence of bystander activation on pre-hospital emergency care (PEC) response time. We conducted a systematic search for full-text articles published since 2000 in Web of Science, PubMed, Science Direct, and Google Scholar databases. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using “pre-hospital emergency care response time” and “bystanders” as search keywords. The risk of bias was assessed using the ROBINS-I tool. Our analysis included forty-six relevant studies meeting the inclusion criteria. However, we observed that many studies were poorly reported, posing risks of selection and detection biases. Additionally, we identified methodological and study design weaknesses in five studies. Given the critical role of PEC services in saving lives and preventing medical complications, the timely provision of these services is paramount. Bystanders play a central role in activating emergency medical services (EMS) and providing cardiopulmonary resuscitation. Prompt calls to EMS by bystanders resulted in reduced PEC response times, improved survival chances, and better neurological outcomes, particularly among out-of-hospital cardiac arrest patients. There is substantial evidence that prompt bystander activation of EMS significantly reduces PEC response times, thereby saving lives and strengthening existing PEC systems. However, further research is necessary to accurately assess the impact of different interventions aimed at enhancing bystander activation of EMS and reducing PEC response times.
Reynolds A, Sawe H, Rubiano A, et al. Strengthening health systems to provide emergency care. World Bank, 2017.
DOI: https://doi.org/10.1596/978-1-4648-0527-1_ch13
McCoy C, Menchine M, Sampson S. Emergency medical services out-of-hospital scene and transport times and their association with mortality in trauma patients presenting to an urban Level I trauma center. Ann Emerg Med 2013;61:167–74.
DOI: https://doi.org/10.1016/j.annemergmed.2012.08.026
Musyoka F, Kioko A. Pre-hospital emergency care system: Utilization of ambulance services in Nairobi County. Emerg Care J 2021;17:10217.
DOI: https://doi.org/10.4081/ecj.2021.10217
WHO. WHO Emergency care system framework, 2 May 2018. Available from: https://www.who.int/publications/i/item/who-emergency-care-system-framework
Balajee S, Pasi O, Etoundi G, et al. Sustainable model for public health emergency operations centers for global settings. Emerg Infect Dis 2017;23:S190.
DOI: https://doi.org/10.3201/eid23S1.170435
Balhara K, Bustamante A, Selvam W, et al. Bystander assistance for trauma victims in low-and middle-income countries: a systematic review of prevalence and training interventions. Prehosp Emerg Care 2019;23:389-410.
DOI: https://doi.org/10.1080/10903127.2018.1513104
Nasrollahzadeh A, Khademi A, Mayorga E. Real-time ambulance dispatching and relocation. Manufact Service Operations Manag 2018;20:467-480.
DOI: https://doi.org/10.1287/msom.2017.0649
WHO, Emergency care systems for universal health coverage: ensuring timely care for acutely ill and injured. World Health Organization, 2019.
Calvello E, Broccoli M, Risko N. Emergency care and health systems: consensus-based recommendations and future research priorities. Acad Emerg Med 2013;20:1278–88.
DOI: https://doi.org/10.1111/acem.12266
Huang JB, Lee KH, Ho YN, et al. Association between prehospital prognostic factors on out-of-hospital cardiac arrest in different age groups. BMC Emerg Med 2021;21:3.
DOI: https://doi.org/10.1186/s12873-020-00400-4
Kobusingye O, Hyder A, Bishai D. Emergency medical services. World Bank, 2016.
Merchant R, Topjian A, Panchal A. Part 1: Executive summary: 2020 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2020;142:337–357.
DOI: https://doi.org/10.1161/CIR.0000000000000918
Lee D, Moon H, Heo N. Association between ambulance response time and neurologic outcome in patients with cardiac arrest. Am J Emerg Med 2019;37:1999-2003.
DOI: https://doi.org/10.1016/j.ajem.2019.02.021
Sirikul W, Piankusol C, Wittayachamnankul B, et al. A retrospective multi-centre cohort study: Pre-hospital survival factors of out-of-hospital cardiac arrest (OHCA) patients in Thailand. Resuscitation Plus 2022;9:100196.
DOI: https://doi.org/10.1016/j.resplu.2021.100196
Ong M, Do Shin S, De Souza N, et al. Outcomes for out-of-hospital cardiac arrests across 7 countries in Asia: The Pan Asian Resuscitation Outcomes Study (PAROS). Resuscitation 2015;96:100-108.
DOI: https://doi.org/10.1016/j.resuscitation.2015.07.026
Hoang B, Do N, Vu D. Outcomes for out-of-hospital cardiac arrest transported to emergency departments in Hanoi, Vietnam: A multi-centre observational study. Emerg Med Australas 2021;33:541–546.
DOI: https://doi.org/10.1111/1742-6723.13750
Do S, Luong C, Pham D. Survival after out-of-hospital cardiac arrest, Viet Nam: Multi-centre prospective cohort study, Bull World Health Organ 2021;99:50–61.
DOI: https://doi.org/10.2471/BLT.20.269837
Hsu H, Tiba M, Boehman A. et al. Aerosol generation during chest compression and defibrillation in a swine cardiac arrest model, Resuscitation 2021;159:28-34.
DOI: https://doi.org/10.1016/j.resuscitation.2020.12.004
Hsieh J, Chiang W, Sun T, et al. A prediction model for patients with emergency medical service witnessed out-of-hospital cardiac arrest. J Formosan Med Assoc 2021;120:1229-1236.
DOI: https://doi.org/10.1016/j.jfma.2020.09.017
Mattila S, Puolakka T, Ritvonen J, et al. Targets for improving dispatcher identification of acute stroke. Int J Stroke 2019;14:409-416.
DOI: https://doi.org/10.1177/1747493019830315
Chen Y, Liao C, Huang C. et al. The effect of implementing mechanical cardiopulmonary resuscitation devices on out-of-hospital cardiac arrest patients in an urban city of Taiwan. Int J Of Environ Res Public Health 2021;18:3636.
DOI: https://doi.org/10.3390/ijerph18073636
Funada A, Goto Y, Tada H, Yamagishi M. Effects of prehospital epinephrine administration on neurologically intact survival in bystander-witnessed out-of-hospital cardiac arrest patients with initial non-shockable rhythm: Based on emergency medical service response time. Circulation 2017;136:A15244-A15244.
Rajagopal S, Kaye R, Lall R, et al. Characteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrests and opportunities to improve community response to cardiac arrest. Resuscitation 2016;109:110-115.
DOI: https://doi.org/10.1016/j.resuscitation.2016.09.014
Chang I, Lee C, Do Shin S, et al. Effects of dispatcher-assisted bystander cardiopulmonary resuscitation on neurological recovery in paediatric patients with out-of-hospital cardiac arrest based on the pre-hospital emergency medical service response time interval. Resuscitation 2018;130:49-5.
DOI: https://doi.org/10.1016/j.resuscitation.2018.06.029
Tanaka H, Ong M, Siddiqui J. et al. Modifiable factors associated with survival after out-of-hospital cardiac arrest in the Pan-Asian resuscitation outcomes study. Ann Emerg Med 2018;71:608-617.
DOI: https://doi.org/10.1016/j.annemergmed.2017.07.484
Ornato P, Peberdy A, Siegel R, et al. Delay to initiation of out-of-hospital cardiac arrest EMS treatments. Am J Emerg Med 2021;41:60-65.
DOI: https://doi.org/10.1016/j.ajem.2020.12.024
Leung P, Wong T, Tong K, Kan G. Out of Hospital cardiac arrest in Hong Kong. Prehospital Emerg Care 2001;5:308-311.
DOI: https://doi.org/10.1080/10903120190939887
Ong E, Chan Y, Anantharaman V, et al. Cardiac arrest and resuscitation epidemiology in Singapore (Case in Study). Prehospital Emerg Care 2003;7:427-433.
DOI: https://doi.org/10.1080/312703002120
Alumran A, Albinali H, Saadah A, Althumairi A. The effects of ambulance response time on survival following out-of-hospital cardiac arrest. Open Access Emerg Med 2020;12:421.
DOI: https://doi.org/10.2147/OAEM.S270837
Alqudah Z, Nehme Z, Williams A, et al. Impact of temporal changes in the epidemiology and management of traumatic out-of-hospital cardiac arrest on survival outcomes. Resuscitation 2021;158:79-87.
DOI: https://doi.org/10.1016/j.resuscitation.2020.11.026
Nehme Z, Andrew E, Bernard S, et al. Can drones improve survival rates in mountain areas, providing automated external defibrillators? Resuscitation 2020;8305:1-2.
DOI: https://doi.org/10.1016/j.resuscitation.2019.11.016
Lancaster G, Herrmann W. Computer simulation of the effectiveness of novel cardiac arrest response systems. Resuscitation Plus 2021;7:100153.
DOI: https://doi.org/10.1016/j.resplu.2021.100153
Park G, Oh S, Chon B, Kim S. The maximum diameter of the left ventricle may not be the optimum target for chest compression during cardiopulmonary resuscitation: a preliminary, observational study challenging the traditional assumption. J Cardiothorac Vascular Anesth 2020;34:383-391.
DOI: https://doi.org/10.1053/j.jvca.2019.07.005
Bürger A, Wnent J, Bohn A, et al. The effect of ambulance response time on survival following out-of-hospital cardiac arrest: an analysis from the German resuscitation registry," Deutsches Ärzteblatt International 2018;115:541.
DOI: https://doi.org/10.3238/arztebl.2018.0541
Rajan S, Wissenberg M, Folke F, et al. Association of bystander cardiopulmonary resuscitation and survival according to ambulance response times after out-of-hospital cardiac arrest. Circulation 2016;134:2095-2104.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.116.024400
Lim S, Smith K, Dyson K, et al. Incidence and outcomes of out‐of‐hospital cardiac arrest in Singapore and Victoria: a collaborative study. J American Heart Assoc 2020;9:e015981.
DOI: https://doi.org/10.1161/JAHA.119.015981
Navab E, Esmaeili M, Poorkhorshid N, et al. Predictors of out of hospital cardiac arrest outcomes in pre-hospital settings; a retrospective cross-sectional study. Arch Acad Emerg Med 2019;7:36.
Tsai S, Chaou H, Huang C, et al. Features of hospital and emergency medical service in out-of-hospital cardiac arrest patients with shockable rhythm. Am J Emerg Med 2017;35:1222-1227.
DOI: https://doi.org/10.1016/j.ajem.2017.03.032
Yasunaga H, Miyata H, Horiguchi H, et al. Population density, call-response interval, and survival of out-of-hospital cardiac arrest. Int J Health Geogr 2011;10:1-9.
DOI: https://doi.org/10.1186/1476-072X-10-26
Wei Y, Pek P, Doble B, et al. Strategies to improve survival outcomes of out-of-hospital cardiac arrest (OHCA) given a fixed budget: a simulation study. Resuscitation 2020;149:39-46.
DOI: https://doi.org/10.1016/j.resuscitation.2020.01.026
Huang H, Ho Y, Tsai M, et al. Response time threshold for predicting outcomes of patients with out-of-hospital cardiac arrest. Emerg Med Int 2021;2021.
DOI: https://doi.org/10.1155/2021/5564885
Stroop R, Kerner T, Strickmann B, et al. 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.
DOI: https://doi.org/10.1016/j.resuscitation.2019.12.012
Claesson A, Lindqvist J, Herlitz J. Cardiac arrest due to drowning—changes over time and factors of importance for survival. Resuscitation 2014;85:644-648.
DOI: https://doi.org/10.1016/j.resuscitation.2014.02.006
Renkiewicz G, Hubble W, Wesley R, et al. Probability of a shockable presenting rhythm as a function of EMS response time. Prehospital Emerg Care 2014;18:224-230.
DOI: https://doi.org/10.3109/10903127.2013.851308
Mathiesen T, Bjørshol A, Kvaløy T, Søreide E. Effects of modifiable prehospital factors on survival after out-of-hospital cardiac arrest in rural versus urban areas. Critical Care 2018;22:1-9.
DOI: https://doi.org/10.1186/s13054-018-2017-x
Agarwal D, Hess P, Atkinson J, White D. Ventricular fibrillation in Rochester, Minnesota: experience over 18 years. Resuscitation 2009;80:1253-1258.
DOI: https://doi.org/10.1016/j.resuscitation.2009.07.019
Finn J, Jacobs G, CD'Arcy H, Oxer F. Outcomes of out-of-hospital cardiac arrest patients in Perth, Western Australia, 1996–1999. Resuscitation 2001;51:247-255.
DOI: https://doi.org/10.1016/S0300-9572(01)00408-7
Swain A, Barry T, Hoyle R, et al. Outcomes from out-of-hospital cardiac arrest in the Wellington region of New Zealand. Does use of the Fire Service make a difference, NZ Med J 2011;124:81-90.
Björnsson M, Marelsson S. Prehospital cardiac life support in the Reykjavik area 1999-2002. Laeknabladid 2006;92:591-597.
Cady E, Weaver D, Pirrallo G, Wang E. Effect of emergency medical technician–placed Combitubes on outcomes after out-of-hospital cardiopulmonary arrest. Prehospital Emerg Care 2009;13:495-499.
DOI: https://doi.org/10.1080/10903120903144874
Margey R, Browne L, Murphy E, et al. The Dublin cardiac arrest registry: temporal improvement in survival from out-of-hospital cardiac arrest reflects improved pre-hospital emergency care. Europace 2011;13:1157-1165.
DOI: https://doi.org/10.1093/europace/eur092
Soo H, Gray D, Young T, Hampton R. Circadian variation in witnessed out of hospital cardiac arrest. Heart 2000;84:370-376.
DOI: https://doi.org/10.1136/heart.84.4.370
Ong M, Yan X, Lau G, et al. Out-of-hospital cardiac arrests occurring in primary health care facilities in Singapore. Resuscitation 2007;74:38-43.
DOI: https://doi.org/10.1016/j.resuscitation.2006.11.004
Pleskot M, Hazukova R, Stritecka H, Cermakova E. The highest incidence of out-of-hospital cardiac arrest during a circadian period in survivors. Int Heart J 2008;49:183-192.
DOI: https://doi.org/10.1536/ihj.49.183
Moon S, Ryoo W, Ahn Y, et al. Association of response time interval with neurological outcomes after out-of-hospital cardiac arrest according to bystander CPR. Am J Emerg Med 2020;38:1760-1766.
DOI: https://doi.org/10.1016/j.ajem.2020.05.108
J. H. Pek H, de Korne F, Hannawa A, et al. Dispatcher-assisted cardiopulmonary resuscitation for paediatric out-of-hospital cardiac arrest: A structured evaluation of communication issues using the SACCIA® safe communication typology. Resuscitation 2019;139:144-151.
DOI: https://doi.org/10.1016/j.resuscitation.2019.04.009
Ningwa A, Muni K, Oporia F, et al. The state of emergency medical services and acute health facility care in Uganda: findings from a National Cross-Sectional Survey. BMC Health Serv Res 2020;20:1-10.
DOI: https://doi.org/10.1186/s12913-020-05508-8
Park J, Song K, Do Shin S, et al. Timely bystander CPR improves outcomes despite longer EMS times. Am J Emerg Med 2017;35:1049-1055.
DOI: https://doi.org/10.1016/j.ajem.2017.02.033
Meng Q, Weng J. Uncertainty analysis of accident notification time and emergency medical service response time in work zone traffic accidents. Traffic Injury Prevention 2013;14:150-158.
DOI: https://doi.org/10.1080/15389588.2012.708886
Apiratwarakul K, Ienghong K, Mitsungnern T, et al. Use of a motorlance to deliver emergency medical services; a prospective cross sectional study. Arch Acad Emerg Med 2019;7:1.
Kyungho J, Kyunghee K, Yoonhee J, Kyungdong H. Analysis of the time intervals in 119 ambulance services. Fire Sci Engineering 2016;30:128-134.
DOI: https://doi.org/10.7731/KIFSE.2016.30.4.128
Dadashzadeh A, Dehghannejhad J, Shams S, et al. Situation of response and transport time in pre-hospital traumatic patients from scene to hospital in Tabriz–Iran. Nursing Midwifery J 2016;14:728-737.
Korakot A, Suzuki T, Celebi I, et al. Motorcycle ambulance, policy to promote health and sustainable development in large cities. Prehospital Disaster Med 2022;37:78-83.
DOI: https://doi.org/10.1017/S1049023X21001345
Ono Y, Hayakawa M, Iijima H. The response time threshold for predicting favourable neurological outcomes in patients with bystander-witnessed out-of-hospital cardiac arrest. Resuscitation 2016;107:65–70.
DOI: https://doi.org/10.1016/j.resuscitation.2016.08.005
Alsolamy S, Al-Sabhan A, Alassim N, et al. Management and outcomes of patients presenting with sepsis and septic shock to the emergency department during nursing handover: retrospective cohort study. BMC Emergency Med 2018;18:1-5.
DOI: https://doi.org/10.1186/s12873-018-0155-8
Fleischman R, Lundquist M, Jui J, et al. Predicting ambulance time of arrival to the emergency department using global positioning system and Google maps. Prehospital Emerg Care 2013;17:458-465.
DOI: https://doi.org/10.3109/10903127.2013.811562
Herlitz J, Svensson L, Holmberg S, et al. Efficacy of bystander CPR: intervention by lay people and by health care professionals. Resuscitation 2005;66:291-295.
DOI: https://doi.org/10.1016/j.resuscitation.2005.04.003
Valente T, Perez M. Emergency response to vehicle collisions: feedback from emergency medical service providers. Safety 2020;6:48.
DOI: https://doi.org/10.3390/safety6040048
Lee H, How K, Lu H, et al. Improved survival outcome with continuous chest compressions with ventilation compared to 5: 1 compressions-to-ventilations mechanical cardiopulmonary resuscitation in out-of-hospital cardiac arrest. J Chinese Med Assoc 2013;76:158-163.
DOI: https://doi.org/10.1016/j.jcma.2013.01.001
Hidayat N, Ahsan, Rahayu, Lestari R. Response time, waiting time and service quality in emergency department. Int J Public Health 2020;9:199-204.
DOI: https://doi.org/10.11591/ijphs.v9i3.20435
Chen Y, Yu H, Chen J, et al. Dispatcher-assisted cardiopulmonary resuscitation: disparity between urban and rural areas. Emerg Med Int 2020;2020.
DOI: https://doi.org/10.1155/2020/9060472
Thakore S, McGugan A, Morrison W. Emergency ambulance dispatch: is there a case for triage? J Royal Soc Med 2002;95:126-129.
DOI: https://doi.org/10.1258/jrsm.95.3.126
Smith K, McNeil J. Cardiac arrests treated by ambulance paramedics and fire fighters. Med J Australia 2002;177:305-309.
DOI: https://doi.org/10.5694/j.1326-5377.2002.tb04788.x
Jennings P, Pasco J. Survival from out‐of‐hospital cardiac arrest in the Geelong region of Victoria, Australia. Emerg Med 2001;13:319-325.
DOI: https://doi.org/10.1046/j.1035-6851.2001.00235.x
Crandall M, Sharp D, Unger E, et al. Trauma deserts: distance from a trauma center, transport times, and mortality from gunshot wounds in Chicago. Am J Public Health 2013;103:1103-9.
DOI: https://doi.org/10.2105/AJPH.2013.301223
Giorgia B. The crisis of Italian emergency medicine and speciality: The point of view of COSMEU. Emerg Care J 2022;18:10385.
DOI: https://doi.org/10.4081/ecj.2022.10385
How to Cite
Musyoka, F. N., Tenambergen, W., Mapesa, J., Ndolo, A., Agot, G., China, J., Koyio, L., Ngunu, C., Mulonzi, M., & Njeri, V. (2023). Influence of bystander activation on pre-hospital emergency care response time: systematic review. Emergency Care Journal, 19(4). https://doi.org/10.4081/ecj.2023.11568
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