Trained and equipped volunteers are alerted by smartphone to quickly respond to emergencies. Photos David LaCombe
Something special is happening in Jersey City, N.J. Over the past year and a half, residents, visitors and commuters have made EMS and emergency medical care a hot topic in the local community. But what started as a conversation about EMS providers has evolved into a new, community-centered approach to saving lives.
They’re called CBECs—community-based emergency caregivers—and they’re taking bystander care to a new level. Armed with 60-hours of emergency medical responder (EMR) training and equipped with a defibrillator, oxygen and basic medical supplies, these CBECs are available 24 hours a day, seven days a week to respond and provide lifesaving care before the arrival of an ambulance, with an ambitious goal of reaching patients within two minutes.
CBECs are community volunteers who come from all backgrounds. From students to shop owners to construction workers to accountants, they all have one thing in common: a desire to make a difference in their community. More than 700 residents and commuters have volunteered for the program so far, with more applications arriving every day.
Jersey City’s EMS providers are no stranger to innovation. In 2006, Jersey City Medical Center (JCMC) EMS was a pioneer in utilizing predictive modeling for ambulance deployment, reducing average ambulance response times for life-threatening emergencies to less than six minutes. JCMC EMS was an early adopter of intraosseous infusion, LUCAS 2 mechanical chest compression devices and pit-crew CPR.
With a return of spontaneous circulation (ROSC) rate for witnessed v fib in excess of 60%, and a survival to discharge rate of nearly 30%, JCMC EMS realized the next step to increase cardiac arrest survival was by getting early, effective CPR to the patients sooner.
In 2014, JCMC EMS launched a community CPR initiative, offering dozens of free community CPR courses across the city. The agency also launched an initiative to develop a comprehensive publically accessible AED registry in tandem with the deployment of the PulsePoint smartphone app for local citizens. Yet, at the end of the year, the JCMC EMS leadership team realized there was still a segment of the population that wasn’t receiving bystander CPR.
Shortly after being elected in 2013, Jersey City Mayor Steven Fulop heard about an innovative Israeli program that utilizes trained civilians as a part of the emergency response system to address similar concerns. The program’s founder, Eli Beer, started the program in 2006—since then, it has grown to more than 2,500 volunteers across Israel in less than a decade. The United Hatzalah Foundation has been funding the Israeli program through philanthropic donations. They’re now using their expertise and incentive grants to help partner with local business and donors to fund the program in the United States.
Fulop contacted the leaders of the program and connected them with JCMC EMS, which became the first U.S. system to implement the program, which they named United Rescue.
THE TECHNOLOGY TWIST
United Rescue focuses on two main gaps in EMS response: disaster surge and remote areas. The program is similar to other citizen volunteer models, but with a technological twist. When a 9-1-1 call is received, the EMS dispatcher sends the closest ambulance while another dispatcher uses special NowForce crowdsourcing smartphone technology to locate any volunteers close to the emergency. These volunteers are then notified via a smartphone alert so they can respond to the emergency rapidly and provide lifesaving care in those critical moments prior to the arrival of JCMC ambulances. This especially makes a difference for victims of trauma, choking, acute cardiac emergencies, stroke and other time-dependent conditions, who often need medical attention before an ambulance arrives.
CBECs currently respond on foot, but eventually the program will grow to model other international programs that utilize motorcycles and other modes of transportation such as bicycles and specially equipped Segways.
As a part of the program, existing JCMC EMS employees are piloting the use of motorcycles and first response vehicles, with fantastic results thus far. Discussions are underway to potentially expand the program to other professions with “patrol-like” responsibilities, such as police officers, taxicab drivers and vehicle service technicians.
Each CBEC undergoes a full pre-employment screening that mimics the process of hiring JCMC EMTs and paramedics, including a full background check, medical screening and interview process. Successful applicants then begin an 84-hour training program that includes 60 hours of classroom training and 24 hours of clinical rotations, all provided and supervised by JCMC EMS staff. Once completed, CBECs are issued a specially labeled American National Standards Institute-compliant identifying vest, a basic medical bag that includes oxygen, and an AED.
One of the most appealing aspects of the new program for the city and JCMC EMS is that the program is 100% philanthropically funded, with donors, foundations, corporations and national supporters endorsing the innovative lifesaving projects.
One of the major catalysts that moved this program forward is best described by one of Jersey City’s new United Rescue CBECs. Brian Onieal, a retired Jersey City police lieutenant and an early advocate for the program, recalls an incident during the Northeast Christmas blizzard of 2010, in which his neighbor collapsed and was in cardiac arrest.
As local emergency resources were stretched thin due to the devastating weather conditions, Brian was home with his family, unaware that his friend and neighbor was in need. He said during the program’s planning process, “If I had only known, I could have responded and perhaps made a difference.” United Rescue now gives citizens the capacity to know when their neighbors are in need, and the resources to make a true clinical difference.
United Rescue can also address the needs of remote and specialized communities by supplementing the volunteer fire and law enforcement agencies that often provide emergency care prior to the arrival of an ambulance.
Public access defibrillation programs are present throughout the world, yet until now the concept has been to bring the responder to the AED, rather than the AED with the responder.
FILLING IN THE GAPS
United Rescue in Jersey City is examining some of the response gaps specific to the area— one of the most densely populated areas in the country. With more than 10,000 new homes under construction and only a few roads in and out, the already congested city is seeing unprecedented levels of traffic. Consolidated communities, such as colleges, universities, business and housing developments, also pose unique challenges, especially as many of them have nonsequential numbering or a single street address. These factors, as well as security gates and one-way streets pose challenges for responding EMS crews and often delay response. By utilizing local CBECs who are familiar with the area, care can arrive faster.
When a 9-1-1 call is received, an EMS dispatcher sends a smartphone alert via NowForce crowdsourcing software so that any nearby United Rescue CBEC can respond rapidly.
In Jersey City, where more than a dozen new high-rise buildings are currently under construction, including a 95-story building, vertical response time is critical. Even an ambulance sitting outside a high-rise building will experience a several minute delay making patient contact. United Rescue partners with businesses, building security and high-rise residents to have in-building responders who can provide emergent care until EMS is able to make patient contact.
Ultimately, the goal of United Rescue is to get care to patients as quickly as possible. The program has a set an ambitious goal of just two minutes from time of 9-1-1 call to arrival at the patient’s side. JCMC EMS knows this can be done.
United Rescue isn’t a completely new concept. First responder programs have existed in the U.S. for as long as the EMS system has been around. However, many of these programs in cities are limited by deployment of first responder apparatus. Rural communities and collegiate EMS systems have deployed similar programs, but few are based on GPS crowdsourcing. Public access defibrillation programs are present throughout the world, yet until now the concept has been to bring the responder to the AED, rather than the AED with the responder.
In August 2015, United Rescue piloted a single quick response vehicle (QRV) to evaluate the potential impact of a community responder. Average response times from time of phone pick-up to wheels stopping quickly dropped to just three minutes and 48 seconds.
JCMC EMS is looking forward to seeing how a fully integrated, high-performance ALS/BLS/citizen responder system can save lives by getting the right level of care to the patient in the right amount of time.
To learn more about these programs, visit:
United Rescue: www.unitedrescue.us
United Hatzalah: www.israelirescue.org
Jersey City Medical Center EMS: www.jcmcems.org