BACKGROUND: In Europe, survival rates after out-of-hospital cardiac arrest (OHCA) vary widely. Presence/absence and differences in implementation of systems dispatching First Responders (FR) in order to arrive before Emergency Medical Services (EMS) may contribute to this variation. A comprehensive overview of the different types of FR-systems used across Europe is lacking. METHODS: A mixed-method survey and information retrieved from national resuscitation councils and national EMS services were used as a basis for an inventory. The survey was sent to 51 OHCA experts across 29 European countries. RESULTS: Forty-seven (92%) OHCA experts from 29 countries responded to the survey. More than half of European countries had at least one region with a FR-system. Four categories of FR types were identified: (1) firefighters (professional/voluntary); (2) police officers; (3) citizen-responders; (4) others including off-duty EMS personnel (nurses, medical doctors), taxi drivers. Three main roles for FRs were identified: (a) complementary to EMS; (b) part of EMS; (c) instead of EMS. A wide variation in FR-systems was observed, both between and within countries. CONCLUSIONS: Policies relating to FRs are commonly implemented on a regional level, leading to a wide variation in FR-systems between and within countries. Future research should focus on identifying the FR-systems that most strongly influence survival. The large variation in local circumstances across regions suggests that it is unlikely that there will be a 'one-size fits all' FR-system for Europe, but examining the role of FRs in the Chain of Survival is likely to become an increasingly important aspect of OHCA research.

Centre for Resuscitation Science Department for Medicine Karolinska Institutet Stockholm Sweden

Department of Anaesthesia Intensive Care and Emergency Medical Services Ospedale Maggiore Bologna Italy

Department of Cardiology Copenhagen University Hospital Gentofte Hellerup Denmark

Department of Clinical and Experimental Cardiology Heart Center Amsterdam Cardiovascular Sciences Amsterdam UMC Department of Cardiology Heart Center Academic Medical Center University of Amsterdam Meibergdreef 9 1105 AZ Amsterdam The Netherlands

Department of Emergency Medicine Grigore T Popa University of Medicine and Pharmacy Iasi Romania

Department of General Practice National University of Ireland Galway and National Ambulance Service Dublin Ireland

Emergency Medical Services Copenhagen University of Copenhagen København Denmark

Emergency Medical Services of the Hradec Kralove Region Czech Republic and Department of Anaesthesiology and Intensive Care Medicine University Hospital Hradec Králové Hradec Králové Czech Republic

Netherlands Heart Institute Utrecht The Netherlands

Norwegian National Advisory Unit on Prehospital Emergency Medicine Oslo Norway

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