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The survival rate of patients with traumatic cardiac arrest is 3% or lower. Cardiac arrest witnessed by emergency medical services (EMS) accounts for approximately 16% of prehospital traumatic cardiac arrests, but the prognosis is unknown. We aimed to compare the 1-month survival rate of cardiac arrest witnessed by EMS with that of cardiac arrest witnessed by bystanders and unwitnessed cardiac arrest in traffic trauma victims; further, the time from injury to cardiac arrest was assessed.This analysis used the Utstein Registry in Japan and included data of 3883 patients with traumatic cardiac arrest caused by traffic collisions registered between 2014 and 2019 in Japan.The 1-month survival rate was 10.9% in the EMS-witnessed cardiac arrest group; this was significantly higher than that in the bystander-witnessed (7.2%) and unwitnessed (5.6%) cardiac arrest groups (P 0.01). The median time from injury to cardiac arrest was 18 min (25% quartile: 12, 75% quartile: 26).The 1-month survival rate was significantly higher in the EMS-witnessed cardiac arrest group than in the bystander-witnessed and unwitnessed cardiac arrest groups. It is important to prevent progression to cardiac arrest in trauma patients with intact respiratory function and pulse rate at the time of contact with EMS. A system for early recognition of severe trauma is needed, and a doctor's car or helicopter can be requested as needed. We believe that early recognition and prompt intervention will improve the prognosis of prehospital traumatic cardiac arrest.

Background: All people have rights to take first aids equally because they have risk for sudden cardiac arrest at any time. Japan employs mainly two inclusive strategies for rapid response first aid. The first is public services such as fire trucks and ambulance response. The second is increasing the number of first responders. However, many residents are geographically unaware whether public services in their areas provide quick responses during emergencies, such as cardiac arrest. For this reason, they lack knowledge the necessity of mutual aid, which enables nearby neighbors who have undergone proper training to respond and provide first aid. Thus, the study aims to identify geographically specific areas where mutual aid is essential for rapid response first aid.Methods: The study targeted 20 cities in Japan designated by government ordinance and to simulate response areas reachable by public service. The driving conditions with 3 min were simulated with the speed limits, which are obeyed by the Japanese Road Traffic Act. Also, the populations covered in the areas was calculated in each targeted city.Results: The simulated map appears to render easy recognition of weak areas that may benefit from rapid response and may necessitate mutual aid. The maximum, minimum, and median population coverage rates are 65%, 22%, and 38.5%, respectively.Conclusion: The study indicates that mutual aid for rapid response is essential to most of the targeted areas in the case of sudden cardiac arrest. Moreover, mutual aid can be implemented strategically by geographic visualization and numerical values for equal rapid response first aid.

IntroductionShortening response time to an emergency call leads to the success of resuscitation by chest compression and defibrillation. However, response by ambulance or fire truck is not fast enough for resuscitation in Japan. In rural areas, response times can be more than 10 minutes. One possible way to shorten the response time is to establish a system of first responders (eg, police officers or firefighters) who are trained appropriately to perform resuscitation. Another possible way is to use a system of Community First Responders (CFRs) who are trained neighbors. At present, there are no call triage protocols to decide if dispatchers should activate CFRs.ObjectiveThe aim of this study was to determine the predictability to detect if dispatchers should activate CFRs.MethodsTwo CFR call triage protocols (CFR protocol Ver.0 and Ver.1) were established. The predictability of CFR protocols was examined by comparing the paramedic field reports. From the results of sensitivity of CFR protocol, the numbers of annual CFR activations were calculated. All data were collected, prospectively, for four months from October 1, 2012 through January 31, 2013.ResultsThe ROC-AUC values appear slightly higher in CFR protocol Ver.1 (0.857; 95% CI, 79.8-91.7) than in CFR protocol Ver.0 (0.847; 95% CI, 79.0-90.3). The number of annual CFR activations is higher in CFR protocol Ver.0 (7.47) than in CFR protocol Ver.1 (5.45).ConclusionTwo call triage protocols have almost the same predictability as the Medical Priority Dispatch System (MPDS). The study indicates that CFR protocol Ver.1 is better than CFR protocol Ver.0 because of the higher predictability and low number of activations. Also, it indicates that CFRs who are not medical professionals can respond to a patient with cardiac arrest.NarikawaK, SakamotoT, KubotaK, SuzukawaM, YonekawaC, YamashitaK, ToyokuniY, YasudaY, KobayashiA, IijimaK. Predictability of the call triage protocol to detect if dispatchers should activate Community First Responders. Prehosp Disaster Med. 2014;29(5):1-5.