Table 4 Analysis of national policies relating to First Responders, per country

Austria

Regional

Not reported

Czech Republic

National and regional

There is a national policy related to professional FRs (firefighters/police officers). This policy is very general (e.g. CPR training requirement). All 14 regional EMS organizations in the country have been using professional FRs to some extent. They differ a little across the areas to optimise the best strategy per region. Only 1 EMS has also introduced a mobile app for alerting FRs, incl. Both off-duty EMS personnel and citizen FRs. Citizen FRs need to have a valid BLS/AED course certificate.

Denmark

National and regional

Denmark has a strategy of engaging the community in saving lives after OHCA and succeeded in tripling the bystander rate and the survival after OHCA within the last 15 years. New programs dispatching citizen-responders through a smart phone application has been implemented within the last few years.

The government of Denmark supports the 10 steps of increasing survival after OHCA defined by the Global Resuscitation Alliance, GRA: https://www.globalresuscitationalliance.org/wp-content/pdf/acting_on_the_call.pdf and has a national “Resuscitation Academy” program working to implement the 10 steps in the five Danish regional EMS organizations.

Denmark also has some experience including professional fire fighters and police at OHCA already and expects to strengthen this collaboration within the next years.

Ireland

National and regional

The National Ambulance Service has a history of FR involvement which predates the 2000s. General practitioners have been acting as FRs in selected parts of the country since the early 1990s. The first formal recommendation to support the development of first responders appears in the following national document which was produced by our Department of Health:

“Reducing the Risk: A Strategic Approach. Report of the Task Force on Sudden Cardiac Death (2006)”.

The National Ambulance Service has policy and procedure documents to support first responder involvement in cardiac arrest response. Ireland is in the process of developing a national OHCA strategy, which will include further specific recommendations to further the development of first response in Ireland.

Italy

Regional

Law in Italy: Citizen trained in BLS are allowed to start CPR and to use an AED; citizens not trained can start CPR and use an AED accordingly to the law that regulates the “state of necessity” in emergency situations.

The law in Italy for FRs and untrained lay people is a barrier to diffusion of bystander intervention.

Some regions in Italy (Region of Emilia Romagna) implemented FRs. FRs will become more common in Italy in other regions (e.g., Province of Pavia).

Luxembourg

Regional

Since July 1, 2018 Luxembourg is completely reorganised in only one EMS organisation for the country.

Luxembourg has a FR system working in 56 out of 102 municipalities. This service is provided exclusively by volunteer firefighters because they are “in the system” and thus quite easily reachable. There are different modalities according to local circumstances. Either the FR get to the scene by their own means (when they have the equipment in their car) or they meet at the fire station to get their equipment before going to the scene.

In Luxembourg, for the moment, there are only firefighters acting as “organized” FRs. Police is more reluctant to participate and there is no citizen-responder system.

There is a mandatory training in CPR for school children since 2017 and the Luxembourg Resuscitation Council strives to train as many as possible persons in elementary CPR (hands-only) on a voluntary basis.

Netherlands

National and regional

In the Netherlands, a national policy regarding citizen-responders was published, whereas the requirements for firefighters and police officers are described on regional level only.

Regarding the implementation of AEDs and citizen-responders, the first policy was written in 2002. The reason to involve no citizen-responders in the capital Amsterdam is the proximity of police officers and firefighters (always shorter than 6 min to OHCA victim).

Norway

National and regional

The Directory of health is working on policies and guidelines for FRs, including what a FR is, who can be called a FR and legal implications and concerns.

There are 16 dispatch centres in Norway and they are all relating to firefighters as FRs in different ways

Portugal

Regional

At the present moment, private investors are spreading AED programs with the main purpose to have a system with FRs in the event of an OHCA. In one region (21.000 people of 506.000) of Lisbon, police officers have been trained in BLS and AED. Portugal is in a preliminary process regarding the start of FRs.

Slovenia

National and regional

In Slovenia, only voluntary fire fighters are implemented as FRs. This is due to a very extended network of firefighters brigades in Slovenia (literally, every village in Slovenia has a voluntary firefighters brigade). At the present moment, 35.000 volunteer fire fighters are organized in approximately 1500 fire fighters brigades. This number exceeds the number of policemen by six-times (approximately 5500 policemen). Voluntary firefighters in Slovenia are well organized and equipped (vehicles, communication, rescue equipment, etc.).

On the other hand there is no nationwide strategy “how to organize FRs”. The Slovenian government released the document/regulation which basic conditions must be fulfilled to become a FR (skills, equipment, etc.). But the organization of FR is left to the local EMS. The local EMS firstly considers the need of first responders (especially in remote areas). Afterwards the local fire fighters brigade will be contacted to participate in a FR system (there is no obligation). Therefore, there are areas in Slovenia without FRs.

Policemen patrol network is scarce compared to the fire fighters (there is interest by policemen to be also a part of a FR system).

England

National and regional

In England, ambulance trusts are responsible for local implementation, but there is an overarching Governance Framework.

Sweden

Regional based

Strategies or policies recommending establishment or the development of FRs in Sweden is lacking. Policies are regional.

Switzerland

Regional based

In Switzerland all health issues (except the management of epidemics and disasters) are left to the cantons. It follows that with 26 cantons, there are 26 different health laws. Since the FR network is still considered ancillary to the EMS, there is no health law that takes this into account. This is the reason why there are so many different approaches (even inside the cantons). Only a few cantons have created a structure for the purpose of uniformly managing the FRs. Leading position and pioneer is Canton Ticino (https://www.ticinocuore.ch/en).

The Swiss Resuscitation Council is working on a national strategy against OHCA.