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Creating a sustainable community cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) program that reaches underserved communities poses a challenge for the emergency medical services (EMS) community. Attendance, funding, and resources have all been linked to struggles surrounding community CPR/AED programs. Through our experience in conducting CPR/AED trainings in underserved regions of eastern North Carolina, we propose a method of effectively utilizing existing organizations and institutions of learning to expand and maintain a sustainable community CPR/AED program. Furthermore, we demonstrate 10 cornerstones in developing relationships within the community to increase attendance and participation in diverse communities.

EMS and public health are different disciplines that often overlap. Both share the common goal of disease and injury prevention. Since the development of EMS, a variety of public health initiatives have improved the health of our communities. This chapter will discuss the history of public health and general concepts of public health as they relate to EMS. Mass vaccination as a public health service will be described along with other examples of surveillance and database development useful for collaborating with public health authorities. After reading this chapter, the reader will understand the importance of collaboration with public health agencies, the origins of epidemiology, needs assessments as a public health tool, surveillance and databases that can be useful in EMS, the promise of technology in improving survival from out‐of‐hospital cardiac arrest, and the possible role of paramedics in mass vaccination.

Approximately 55 out-of hospital-cardiac arrests (OHCAs) per 100,000 person-years occur annually worldwide, with only 8% patients surviving to hospital discharge. However, in rural communities, such as the East Neuk of Fife in Scotland, factors such as prolonged emergency response times and barriers to bystander cardiopulmonary resuscitation (CPR) and defibrillation- pose a serious challenge to survival for cardiac arrest patients. Barriers to bystander action globally involve a lack of awareness of cardiac arrest and the importance of CPR and defibrillator, the bystander effect and the blind panic phenomenon. Thus, this project aims to evaluate community-based training initiatives in East Neuk of Fife, Scotland where there are longer emergency response times of up to 40 minutes, to improve bystander action and cardiac arrest outcomes.Through collaboration with East Neuk First Responders, we implemented and evaluated various community training programs, including the ‘Lunchtime Lifesaver’ initiative, which provides CPR and automated external defibrillator (AED) training to untrained individuals. Qualitative interviews and participant feedback were collected alongside cardiac arrest outcome data to assess the effectiveness of these training initiatives in real-world emergencies.In 2023, all 14 recorded cardiac arrests in the East Neuk region involved bystander CPR and defibrillation, resulting in 3 cases of Return of Spontaneous Circulation (ROSC) and one 30-day survival. Participant feedback showed that key barriers to bystander action were successfully addressed, including the blind panic phenomenon, empowering community members to act swiftly during emergencies.The findings from this project highlight not only the effectiveness of community-based training initiatives in rural Scotland but also their potential scalability. These programs, which directly address common barriers to bystander intervention, can be adapted for rural and deprived regions with delayed emergency response times and low CPR bystander provision rates, improving survival rates on a larger scale globally.

Despite major advancements in cardiovascular medicine, sudden cardiac death (SCD) continues to be an enormous medical and societal challenge, claiming millions of lives every year. Efforts to prevent SCD are hampered by imperfect risk prediction and inadequate solutions to specifically address arrhythmogenesis. Although resuscitation strategies have witnessed substantial evolution, there is a need to strengthen the organisation of community interventions and emergency medical systems across varied locations and health-care structures. With all the technological and medical advances of the 21st century, the fact that survival from sudden cardiac arrest (SCA) remains lower than 10% in most parts of the world is unacceptable. Recognising this urgent need, the Lancet Commission on SCD was constituted, bringing together 30 international experts in varied disciplines. Consistent progress in tackling SCD will require a completely revamped approach to SCD prevention, with wide-sweeping policy changes that will empower the development of both governmental and community-based programmes to maximise survival from SCA, and to comprehensively attend to survivors and decedents’ families after the event. International collaborative efforts that maximally leverage and connect the expertise of various research organisations will need to be prioritised to properly address identified gaps. The Commission places substantial emphasis on the need to develop a multidisciplinary strategy that encompasses all aspects of SCD prevention and treatment. The Commission provides a critical assessment of the current scientific efforts in the field, and puts forth key recommendations to challenge, activate, and intensify efforts by both the scientific and global community with new directions, research, and innovation to reduce the burden of SCD worldwide.

Background Out-of-hospital cardiac arrest (OHCA) remains a leading cause of sudden cardiac death globally. Early bystander intervention using CPR and an AED significantly improves survival outcomes. This study aimed to assess willingness to perform CPR and use an AED among non-healthcare community participants in a CPR fun run, and to identify influencing factors. Methods A cross-sectional study was conducted in Melaka, Malaysia, between November 2021 and October 2022, involving 217 randomly selected participants who had previously taken part in the Melaka CPR Fun Run from 2018 to 2020. Data were collected using the validated FIXED questionnaire, covering sociodemographic, knowledge of CPR and AED, training status, perceptions regarding CPR and the use of an AED, attitudes, self-efficacy, subjective norms, and barriers. Results The mean willingness score to perform CPR and use an AED was 33.14 ± 7.87 out of 40. Only three factors remained significantly associated with willingness: self-efficacy (β = 0.950, p  < 0.001), perception (β = 0.569, p  < 0.001), and barriers (β = −0.403, p  < 0.001). Notably, for the subgroup analysis showed that participants who attended more CPR training sessions had better perception ( r  = 0.155, p  = 0.022) and self-efficacy ( r  = 0.246, p  < 0.001. Conclusions Participants demonstrated a high willingness to perform CPR and use an AED. Willingness was significantly influenced by self-efficacy, perception, and perceived barriers. Although CPR training did not directly affect willingness, it showed a weak but significant correlation with improved perception and self-efficacy. These findings highlight the need for interventions that enhance psychological readiness, beyond just increasing training frequency, to strengthen community response in out-of-hospital cardiac arrest situations.

Rates of out of hospital cardiac arrest are higher in deprived communities. Bystander Cardiopulmonary Resuscitation (BCPR) can double the chance of survival but occurs less often in these communities in comparison to more affluent communities. People living in deprived communities are, therefore, doubly disadvantaged and there is limited evidence to explain why BCPR rates are lower. The aim of this paper is to examine the barriers to administering BCPR in deprived communities. Mixed method qualitative study with ten single sex focus groups (n = 61) conducted in deprived communities across central Scotland and 18 semi-structured interviews with stakeholders from the UK, Europe and the USA. Two key themes related to confidence and environmental factors were identified to summarise the perceived barriers to administering BCPR in deprived communities. Barriers related to confidence included: self-efficacy; knowledge and awareness of how, and when, to administer CPR; accessing CPR training; having previous experience of administering BCPR; who required CPR; and whether the bystander was physically fit to give CPR. Environmental barriers focused on the safety of the physical environment in which people lived, and fear of reprisal from gangs or the police. Barriers to administering BCPR identified in the general population are relevant to people living in deprived communities but are exacerbated by a range of contextual, individual and environmental factors. A one-size-fits-all approach is not sufficient to promote 'CPR readiness' in deprived communities. Future approaches to working with disadvantaged communities should be tailored to the local community.

Objective Low- and middle-income countries (LMICs) continue to bear the major burden of morbidity and mortality associated with out-of-hospital cardiac arrest (OHCA) and life-threatening bleeding post-trauma. While bystander cardiopulmonary resuscitation (CPR) and bleeding control trainings in developed countries have assessed their impact on bystanders’ knowledge and ability to act during an emergency, limited studies have been conducted in low-resource settings, specifically in the context of bystanders’ self-efficacy and confidence after training. Therefore, this study aimed to determine the impact of a novel bystander training program by assessing the change in knowledge, confidence, and self-efficacy of laypeople in performing CPR and bleeding control before and after training. Methods A prospective study was implemented at a healthcare facility in a South Asian LMIC to determine the impact of a national initiative aimed at providing CPR and bleeding control skills to its citizens. Adult (≥ 18 years), non-medical employees of the institution were included. Data on participants’ demographics, knowledge, confidence, and self-efficacy in performing CPR and bleeding control were collected before (Time 1), immediately post-training (Time 2), and six-months post-training (Time 3). These responses were compared to ascertain the change in identified parameters using percentages and paired t-tests, with a p-value < 0.05 considered statistically significant. Results Of 200 respondents, 89.0% ( n  = 178) had no prior training in CPR or bleeding control. A significant increase in knowledge and self-efficacy was noted for both the skills from time 1 to 2 and from time 1 to 3 (all p-values < 0.001), without any association noted with their educational status. However, a decrease was noted in both these parameters from time 2 to 3, indicating the need for timely refresher trainings. A considerable increase was seen in both short- and long-term confidence of participants in performing CPR and bleeding control, with a notable decrease in fears/concerns about injuring themselves/victims or getting sued. Conclusion The empowerment of bystanders as first responders can play a pivotal role in saving lives. Conducting biannual refresher trainings, encouraging bystander protection at a policy level, and expanding the program regardless of the participants’ education can make such training effective and sustainable in low-resource settings.

Students have long been among those most emotionally and physically affected by natural or manmade disasters, yet universities and colleges continue to lack effective disaster response and mitigation practices. This research identifies how students’ socio-demographics and disaster preparedness indicators (DPIs) impact their awareness of the dangers of disasters and their ability to survive and cope with the changes that disasters bring. A comprehensive survey was designed and distributed to university students to gain an in-depth understanding of their perceptions of disaster risk reduction factors. A total of 111 responses were received, and the impact of the socio-demographics and DPIs on the students’ disaster awareness and preparedness were evaluated by employing structural equation modeling. The results indicate that the university curriculum impacts the disaster awareness of students while the establishment of university emergency procedures impacts the disaster preparedness of students. The purpose of this research is to enable university stakeholders to identify the DPIs that are important to the students so that they can upgrade their programs and design effective DRR courses. It will also aid policymakers in redesigning effective emergency preparedness policies and procedures.

Background: Bystander cardiopulmory resuscitation (CPR) and using an automated exterl defibrillator (AED) can improve out-of-hospital cardiac arrest survival. However, bystander CPR and AED rates remained consistently low. The goal of this systematic review was to assess factors influencing community willingness to perform CPR and use an AED for out-of-hospital cardiac arrest survival (OHCA) victims, as well as its barriers.Methods: The review processes (PROSPERO: CRD42021257851) were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Alyses (PRISMA) review protocol; formulation of review questions; systematic search strategy based on identification, screening, and eligibility using established databases including Scopus, Web of Science, and Medline Complete via EBSCOhost; quality appraisal; and data extraction and alysis. There is identification of full-text jourl articles that were published between 2016 and 2021 and written in English.Results: Of the fil 13 articles, there are six identified factors associated with willingness to perform CPR and use an AED, including socio-demographics, training, attitudes, perceived norms, self-efficacy, and legal obligation. Younger age, men, higher level of education, employed, married, having trained in CPR and AED in the previous 5 years, having received CPR education on four or more occasions, having a positive attitude and perception toward CPR and AED, having confidence to perform CPR and to apply an AED, and legal liability protection under emergency medical service law were reasons why one would be more likely to indicate a willingness to perform CPR and use an AED. The most reported barriers were fear of litigation and injuring a victim.Conclusions: There is a need to empower all the contributing factors and reduce the barrier by emphasizing the importance of CPR and AEDs. The role played by all stakeholders should be strengthened to ensure the success of intervention programs, and indirectly, that can reduce morbidity and mortality among the community from OHCA.

Background Bystander CPR is one of the main independent factors contributing to better survival after out-of-hospital cardiac arrest. Simultaneously, the rate of bystander CPR in Germany is below the European average. First responder applications (apps) contribute to reducing the time period without CPR (no-flow time) until professional help can arrive on-scene. Methods The KATRETTER app was introduced in Berlin as one of the first apps in Europe which do not require any medical qualifications to register as a first responder. The activation of volunteer first responders for suspected cardiac arrest cases through the Berlin Emergency Medical Services integrated control center was evaluated based on data collected between 16 Oct 2020 and 16 Oct 2022. Our descriptive analysis includes the number of registered first responders, number of activations, the number and percentages of accepted activations, as well as all reports where first responders arrived at the scene. Results As of 15 Oct 2022, a total of 10,102 first responders were registered in the state of Berlin. During this specified period, there were 16.505 activations of the system for suspected out-of-hospital cardiac arrest. In 38.4% of the accepted cases, first responders documented patient contact, and in 34.6% of cases with patient contact, CPR was performed. Only 2% of registered first responders did not have any medical qualifications. Conclusions Smartphone-based first responder applications should not be understood as a means of alerting professional help, but rather like a digitally amplified “call for help” in the vicinity of an emergency location. A large number of first responders can be recruited within 24 months, without large-scale public relations work necessary. No qualifications were required to become a first responder, contributing to a low-threshold registration process with the effect of a more widespread distribution of the app and cost reduction during implementation.