The contribution of lay rescuers in out-of-hospital cardiac arrest

Early defibrillation is one of the major determinants of survival in out-of-hospital cardiac arrest (OHCA). To achieve early defibrillation, public access defibrillation programs have been implemented. To address the need for early defibrillation, also in residential areas, a dispatcher driven alert system has been implemented that uses text messages to direct trained lay rescuers (text message responders) with automated external defibrillators (AEDs) to OHCA patients. The first part of this thesis focuses on the evaluation of the text message alert system. We found that this system contributes to earlier defibrillation, a higher percentage of bystander CPR and improved survival rates in OHCA patients in residential areas. Since the introduction of the text message alert system, lay rescuers are more often involved in resuscitation attempts. Resuscitation attempts are stressful events and may lead to post-traumatic stress disorder (PTSD). We investigated the short-term psychological impact and PTSD-related symptoms in text message responders who provided assistance in an OHCA. No responders showed PTSD-related symptoms, even if they perceived severe short-term psychological impact. Since the introduction of the text message alert system, AED use in OHCAs almost tripled. With increasing use of AEDs, reports of AED failure also increased. However, in most cases the origin of AED failure is unknown. In this thesis, we describe how often AEDs are failing and whether this has a device-related or operated-related cause. We found that errors associated with AED use are rare and if they do occur, are mainly related to the operator and circumstances of use