A study on patients in cardiac arrest to determine the effect of equipping GoodSAM responders with an ultraportable defibrillator on 30-day survival

In 2018, Ambulance Victoria and St John Ambulance New Zealand rolled out the Smartphone Activated Medics smartphone application (GoodSAM). GoodSAM application alerts off-duty health professionals, emergency services workers, and public members with CPR training to potential OHCA events in their vicinity, allowing them to respond and deliver life-saving Cardiopulmonary resuscitation (CPR) and defibrillation. Importantly, the app also alerts first responders to the location of a nearby Automated External Defibrillator (AED) if one exists. The GoodSAM app is integrated into the emergency call system (Triple Zero (000) in Australia or Triple One (111) in New Zealand), and if available, GoodSAM responders are activated simultaneously with emergency ambulances in each region, ensuring no additional delays to care. Dispatch of GoodSAM responder results in a loud warning siren being emitted from a first responder’s mobile. GoodSAM responders can either accept or reject an alert, and if no response is received within 20 seconds, the GoodSAM system automatically alerts another nearby responder. To ensure responder safety, the alerts are cancelled if the call-taker suspects the situation is unsafe. GoodSAM responders who accept the alert are provided with the location of the patient and the nearest public access defibrillation (PAD) if available. The GoodSAM responder then may collect the AED (if available) and proceed to the patient to render assistance or proceed directly without an AED. Registered GoodSAM responders identified as high-frequency responders (clusters) will be randomised 1:1 to receive either a CellAED® or no CellAED®. CellAED® is an ultraportable, fully automated AED that can be carried in a handbag or pocket and is simple to use. High-frequency responders will be defined as GoodSAM responders who have accepted at least 3 OHCA alerts over the last three years. The treatment allocation will remain unchanged over the life of the trial (24 months). For all high-frequency GoodSAM responders randomised to the CellAED® arm: 1. Responders will receive a CellAED® by post and will be asked to watch a short (10 minute) instructional video on its application. An instructional pamphlet detailing the operation of the CellAED® will also be provided. The instructional video and pamphlet will be designed specifically for the trial. Information regarding the storage and carriage of the CellAED® will be explicitly covered in detail. The CellAED® will be replaced automatically on the date of expiry or after every use. 2. Normal activation procedures will apply according to the region’s default response radius. In Victoria, any local government area with a population >7500 receives up to three GoodSAM activations within 500 metres of the scene location. Less populated areas have an activation radius of 5000 metres. In New Zealand, up to 3 GoodSAM activations occur for responders within 1000 metres of the scene location. 3. Responders will be flagged within the GoodSAM app as having an AED in their possession. In addition, the location of the next closest public access defibrillation (PAD) will be provided during alert activation. 4. For alerts where two or more GoodSAM responders with a CellAED® device accept the alert, one of the responders will still be instructed to retrieve the closest AED according to standard operating procedures. 5. Monthly emails and push notifications will be sent to GoodSAM responders with reminders about the optimal storage and carriage of the CellAED® device. Monitoring adherence of the intervention will be through the Victorian Ambulance Cardiac Arrest Registry (VACAR), and The St John New Zealand OHCA Registry (SOCAR), which routinely collect such information.