There’s power in your community—bystanders ready to help save more lives from sudden cardiac arrest (SCA). But how can you seize that potential and activate your citizens to change patient outcomes? The answer is PulsePoint.
The PulsePoint Respond app
PulsePoint Respond is an enterprise-class, software-as-a-service (SaaS) pre-arrival solution designed to support public safety agencies working to improve cardiac arrest survival rates through improved bystander performance and active citizenship. Where adopted, PulsePoint Respond empowers everyday citizens to provide life‐saving assistance to victims of sudden cardiac arrest. Application users who have indicated they are trained in cardiopulmonary resuscitation (CPR) and willing to assist in case of an emergency can now be notified if someone nearby is having a cardiac emergency and may require CPR. If the cardiac emergency is in a public place, the location-aware application will alert trained citizens in the vicinity of the need for bystander CPR simultaneous with the dispatch of advanced medical care. The application also directs these citizen rescuers to the exact location of the closest publicly accessible Automated External Defibrillator (AED).
How it can help
SCA can happen to anyone, at any time, but PulsePoint Respond empowers CPR-trained citizens to help improve patient outcomes and save lives by reducing collapse-to-CPR and collapse-to-deﬁbrillation times. And when citizens are more aware of and engaged with the health of their community, they become better partners with your team—and a critical part of your response efforts.
Imagine that you are in a restaurant having lunch with a few friends. You hear a siren in the distance and think to yourself, “I wonder where they are going?” The siren gets louder and closer, and then you actually see a fire engine approaching in the distance. Suddenly, surprisingly, the engine turns into the parking lot and parks right in front of the crowded restaurant where you’re eating. That’s when you learn that right next door, someone is unconscious after suffering a cardiac arrest. If you only knew, maybe you could have made a difference.
This scenario will likely be a thing of the past as the PulsePoint app gains widespread adoption. PulsePoint Respond is an innovative new location-aware phone application that empowers everyday citizens to provide life-saving assistance to victims of Sudden Cardiac Arrest. Communities can now use the application to dispatch CPR-trained citizens to major cardiac emergencies where the potential need for bystander CPR is high.
Notifications are made simultaneously with the dispatch of paramedics to anyone within the area that is CPR-trained and has indicated their willingness and ability to assist during an SCA emergency. These notifications are only made if the victim is in a public place and only to potential rescuers that are in the immediate vicinity of the emergency. When notifications do occur they intend to target potential citizen rescuers that are primarily within walking distance of the event.
At the time of need, users that have opted-in receive a push notification accompanied by a distinctive alert tone. The notification is followed by a map display showing the dispatched location of the emergency along with the precise location of the citizen rescuer – providing for easy navigation between the two. The map display also shows the exact location of the nearest AEDs. In many cases nationwide, nearby AEDs have not been used when they may have made a big difference. The application aims to address this type of failure by informing citizen rescuers where the nearest AED is located – in real-time and in context of their current location.
In addition to life-saving CPR notifications, the application provides a complete virtual window into the emergency communication centers of PulsePoint-enabled agencies. Mobile users have real-time access to emergency activity as it’s occurring in these communities.
App users are able to view active incidents – including the current response status of dispatched units (enroute, on scene, etc.) – and instantly pinpoint incident locations on an interactive map. Curious as to where that fire engine or ambulance that just passed is headed? Is there an accident up ahead causing this traffic tie-up? Just tap the application to quickly find the incident location or plan an alternate route. A log of recent incidents and a photo gallery of significant events can also be easily accessed.
Users can also choose to be notified of incidents by type when they are dispatched and listen in on live emergency radio traffic via the modern version of the traditional fire scanner.
Don’t live in a covered community? You’ll still find listening to the live action of dispatchers, firefighters and paramedics informative and interesting.
For the professional responder PulsePoint Respond can improve situational awareness, increase incident and resource visibility and enhance overall interoperability with neighboring systems.
- The PulsePoint mobile app alerts CPR-trained bystanders to someone nearby having a sudden cardiac arrest that may require CPR.
- The app is activated by the local public safety communications center simultaneous with the dispatch of local fire and EMS resources.
- The purpose of the app is to increase the survival rates of cardiac arrest victims by:
- Reducing collapse-to-CPR times by increasing citizen awareness of cardiac events beyond a traditional “witnessed” area.
- Reducing collapse-to-defibrillation times by increasing awareness of public access defibrillator (AED) locations through real-time mapping of nearby devices.
- The app is only activated if the event is occurring in a public place (the app is not activated for residential addresses).
- In addition to the life-saving CPR/AED functionality, the app provides a virtual window into fire and EMS activity in the community, offering a unique opportunity for civic engagement and transparency.
- Since the app requires a connection to the local public safety communications center, it is only available where adopted and implemented by the local Fire/EMS agency.
- Development and support for the application is provided by the PulsePoint Foundation, a nonprofit organization established to guide, enhance and expand the reach of the app.
- Sudden Cardiac Arrest (SCA) is a leading cause of death in the United States, accounting for an estimated 325,000 deaths each year (SCA kills nearly 1,000 people a day or one person every two minutes).
- Survival rates nationally for SCA are less than 8%.
- Delivery of CPR is life-saving first aid, and can sustain life until paramedics arrive by helping to maintain vital blood flow to the heart and brain.
- Only about a third of SCA victims receive bystander CPR.
- Without oxygen-rich blood, permanent brain damage or death can occur in less than 8 minutes. After 10 minutes there is little chance of successful resuscitation. Even in modern urban settings the response times for professional rescuers commonly approach these time frames.
- The American Heart Association estimates that effective bystander CPR, provided immediately after sudden cardiac arrest, can double or triple a person’s chance of survival.
- SCA can happen to anyone at any time. Many victims appear healthy with no known heart disease or other risk factors.
- In April 2008, the American Heart Association revised its recommendations and encouraged lay bystanders to use compression-only CPR as an alternative to the combined rescue breathing and chest compression method. It is believed that this change will significantly increase the willingness of bystanders to perform CPR.
- Sudden Cardiac Arrest is not the same as a heart attack. A heart attack occurs when blood vessels in the heart get clogged, preventing blood flow to sections of heart muscle. A heart attack, however, can lead to SCA by triggering an abnormal heart rhythm. SCA may be compared to an electrical problem in the heart, in contrast to a heart attack, which is more of a plumbing problem.
- Fifty-seven percent of adults in the U.S. say they have undergone training in cardiopulmonary resuscitation (CPR), most often due to work or school requirements. Most say they would be willing to use CPR to help a stranger. Most say they would be willing to use an automated external defibrillator (AED). Eleven percent say they have used CPR in an actual emergency.
How does the App Work?
The application has three primary components – the mobile app, a middle tier web service, and a dispatch system interface.
The mobile app is provided and maintained by the PulsePoint Foundation. Apps are currently available for the iPhone and iOS device platform and Android devices. One version of the software (on each platform) supports all agencies using the app (there is not a separate app for each agency). A configuration screen within the app allows users to select their desired agency or agencies. Member agencies can also provide a connection to local radio traffic to enable a streaming radio feed within the app.
The middle tier is a (Amazon EC2) cloud-based web service that manages communications between the personal mobile devices and the emergency communication centers of member agencies. The service provides encrypted communication and secure identification (HTTPS with SSL/TLS protocol) to connected agencies within a highly reliable environment. This service is also provided and maintained by the PulsePoint Foundation.
Emergency communication centers communicate with the middle tier service through an application programming interface (API). An API is simply a set of rules and specifications that software programs can follow to communicate with each other. The PulsePoint API serves as an interface between Computer-aided Dispatch (CAD) systems and PulsePoint services.
How do I deploy the app in my community?
The first step is to build consensus for the app in your community. Determine who should be involved in such a decision and assemble them to discuss the matter and ask questions. Typical attendance might include representatives from Fire, EMS, Communications, Information Technology, Public Information/Outreach, Leadership/Elected Officials, Labor, and affiliated non-governmental organizations such as the local heart association chapter, hospital board/foundation, etc., in addition to interested members of the community. You should also contact your Computer-aided Dispatch vendor at this point to begin discussing the interface requirements and any associated costs. If the vendor has already installed the interface in other accounts this should be a straightforward request. If they haven’t, contact our implementation partner, Physio-Control, and they will provide assistance in getting them the support they need to get up and running on the service.
The application also requires data on all publicly accessible AEDs in your jurisdiction. If this information is dated or incomplete, now is the time to consider fully re-validating these records. PulsePoint provides a powerful, easy-to-use visual registry to accurately place each AED at its precise location.
Once your organization has made the decision to move forward, contact Physio-Control for complete assistance along the path to a successful implementation.
What are the costs involved in implementing the app?
The costs associated with implementing PulsePoint vary depending on agency size and dispatch environment. See Pricing on the Implementation page for a complete cost breakdown. The foundation and our implementation partner Physio-Control can help you develop a precise budget for your organization.
Why has the PulsePoint Foundation partnered with Physio-Control?
The PulsePoint Foundation is a small non-profit with a very big mission – a mission too big to accomplish alone. The vision to increase cardiac arrest survival rates in a massive way worldwide is an effort that requires collaboration with other organizations, such as Physio-Control, that share our vision. Such strategic relationships allow the PulsePoint Foundation to meet growing demand without incurring many of the overhead costs associated with marketing, implementing and supporting the PulsePoint app on a worldwide basis.
The partnership allows the foundation to focus on current and future versions of the app and associated products while offering PulsePoint agencies the broad and comprehensive services of a leading developer of emergency response tools.
Does the app raise any HIPAA or other privacy concerns?
The Health Insurance Portability and Accountability Act (HIPAA) protects the privacy of individually identifiable health information. On a ‘CPR Needed’ notification, the app reports only an address (in a public place) and a business name, if available. Individually identifiable health information, such as name, birth date, or Social Security Number are not reported or known to the PulsePoint application. In addition, PulsePoint has retained Page, Wolfberg & Wirth, LLC to assist agencies understand legal issues related to the implementation of PulsePoint. PWW is well respected EMS law firm specializing in dispatch liability and HIPAA issues.
The PulsePoint app is a Location-Based Service (LBS) with the ability to make use of the geographical position of your mobile device. The LBS capabilities of the app allow you to see your current location relative to the incidents occurring around you. This is an optional feature that is not enabled by default – you must specially opt-in to utilize this functionality. In addition, if you opt-in to the CPR/AED notification, the PulsePoint server will store your current location for immediate reference during an emergency where you may be nearby. In this case, only the current location of your device is stored (no movement history is maintained) and your identity is never known to the PulsePoint application.
How do you know if people subscribing to the CPR/AED notification are really trained and qualified?
CPR today is very easy to perform and can be learned quickly in informal settings such as community street fairs, group training sessions, take-home DVD-based courses, or even by watching brief online videos. These types of training environments do not provide certificates of other forms of skill documentation. Automated External Defibrillators (AEDs) actually require no training to use. Therefore, there is no ability or even reason to verify that someone volunteering to help others with CPR or an AED has been formally trained. Learn how you can help save a life in this one-minute American Heart Association video showing Hands-Only CPR in action.
What does a CPR notification look and sound like?
A CPR notification arrives as a normal push notification similar to the one shown in the lefthand image below. This push notification will be accompanied by a distinctive alert tone. Opening the notification will load the PulsePoint app to the screen shown below on the right. This screen will display your current location, the general reported location of the cardiac arrest victim, and any nearby Automated External Defibrillators (AEDs). You can tap an AED icon for a text description of its precise location. To receive a CPR Needed activation you must have the CPR notification type selected in the Settings Menu and you must be in the immediate vicinity of a reported cardiac arrest. Notification radiuses vary by jurisdiction.
Is there a risk that the app will draw too many bystanders to the emergency medical scene?
Only about a third of Sudden Cardiac Arrest victims receive bystander CPR, and public access Automated External Defibrillators (AEDs) are used less than 3% of the time when needed and available. The current situation is far too few bystander rescuers – not too many. The goal of the app is to engage additional bystanders in these lifesaving acts. If this situation was to truly materialize in the future it would be a major success and the footprint of the notification could be reduced.
How do you prevent someone from using the CPR/AED notification to steal from or otherwise take advantage of a cardiac arrest victim?
For the app to be activated someone must first call the local emergency number (such as 911) to begin a normal public safety response. This means that the victim is likely not alone when the CPR/AED notifications are made. In addition, the app is only activated for incidents occurring in public places (not at someone’s home for example) furthering the likelihood that others will be present. Also, since the app is only activated on devices in the immediate vicinity of the victim, a “Bad Samaritan” has little opportunity to be in the right place at the right time.
How big is the notification radius for CPR/AED events?
The app aims to notify those essentially within walking distance of the event location. However, this distance is configurable on an agency by agency basis. Higher population densities usually warrant a smaller notification radius. Likewise, a rural area with longer local government response times may choose to notify over a broader area.
Is it possible to miss a notification?
The push notification services used by PulsePoint are provided by Apple on iOS devices and Google on Android devices. While these services are quite reliable they do not guarantee that every message will be delivered. Several factors beyond their control can also effect message delivery. Below are the primary factors that exclude a device from receiving an alert.
Delivery of a notification is attempted but the device is offline (turned off, momentarily outside of cellular or Wi-Fi coverage, etc.). The notification will be stored for a limited period of time and delivered to the device when it becomes available. However, on iOS devices only one recent notification for PulsePoint is stored. If multiple notifications are sent while the device is offline, each new notification will cause the prior notification to be discarded. If the device remains offline for a long period any notifications that were being stored for it are discarded.
Devices don’t always report an accurate location to PulsePoint. If a GPS fix is not possible, the device will report a location based on a cell tower triangulation fix or a derived location of a Wi-Fi access point. These methods can place the device outside of the agency’s designated CPR responder radius.
Gathering location data is a power-intensive operation. It involves powering up the onboard radios and querying the available cell towers, Wi-Fi hotspots, or GPS satellites, which can take several seconds. On iOS devices PulsePoint drastically reduces battery drain by monitoring only for significant location changes (change in cell tower, transitioning from cellular to Wi-Fi, etc.). This method is usually sufficient to establish and maintain a reasonable position fix. While this method is very battery efficient the device may not have triggered a significant location change to the current location before an alert was sent. PulsePoint does not use a significant location change method on Android devices. This usually results in more accurate location data at some expense of battery life.
Devices can be set on silent or have notifications turned off completely. Typically applications cannot override these settings.
Can I be successfully sued if I voluntarily help a victim in distress?
The purpose of the Good Samaritan Law is to protect individuals that assist a victim during a medical emergency. Most Good Samaritan laws are created specifically for the general public. The law assumes that there is no medically trained person available to assist the victim. Since the Good Samaritan typically does not have medical training, the law protects him or her from being liable from injury or death caused to the victim during a medical emergency. A general layperson is protected under the Good Samaritan laws as long as he or she has good intentions to aid the victim to the best of his or her ability during a medical emergency. Since each state law has specific guidelines, and this text does not provide a worldwide view of this matter, you should familiarize yourself with the laws or acts applicable to you. A typical example of the wording appears below.
“…a person, who, in good faith, lends emergency care or assistance without compensation at the place of an emergency or accident, and who was acting as a reasonable and prudent person would have acted under the circumstances present at the scene at the time the services were rendered, shall not be liable for any civil damages for acts or omissions performed in good faith.”
Could the app make a CPR/AED notification when CPR isn’t needed?
Yes. With dispatchers making rapid over-the-telephone assessments of patients based on the observations of untrained callers, an incorrect determination can be made. For example, such a situation could occur with someone who has just had a grand mal seizure, passed out from too much alcohol, or has a very high blood sugar. However, if you tried to do CPR on such an individual he or she would probably moan and possibly even try to push you away. Also, an AED would not deliver a shock to a person in any condition where an effective heartbeat was present.
How does PulsePoint determine if a location is Public?
The application first checks with the originating agency, as this is the most accurate source of local information of this nature. It does this by checking the value of the “Public” field sent in the interface (API) record for the incident. An agency can set this value to True if it is able to determine this through the computer-aided dispatch (CAD) system, a GIS layer, local database, etc. For example, if the CAD system of the local agency knows that the incident address is at a local park, it can inform PulsePoint, through the interface, to consider the location as public. Likewise, if CAD can determine that the address is an apartment building, it can set the value of “Public” in the interface to False. If the value of “Public” is left blank, PulsePoint will query public data sources such as the Residential/Commercial Indicator (RDI) from the USPS (PulsePoint uses the USPS address validation API from SmartyStreets) along with other sources such as the Google Places API to make this determination.
Where does the radio channel audio in the app originate from?
Each agency supplies their own audio feed for use in the app (or can choose to use an existing public feed if available). Originating an official agency feed requires about $700 in hardware and a free account on RadioReference.com. See complete setup instructions on our Streaming Radio Channel page. Streaming radio feeds are optional.
How do we get our incident pictures to appear on the Photos tab?
The profile page allows PulsePoint agencies to easily display incident, event, station, apparatus, and other photo albums from within the app. See complete setup instructions on our In-App Agency Photos page. Including photos on the profile page is optional.
How is the PulsePoint Foundation funded?
The PulsePoint Foundation is a 501(c)(3) nonprofit organization funded through a combination of license fees paid by adopting agencies and donations from private individuals and charitable foundations. Learn more about the foundation.
"This is one of the best things I've ever written about. It's so important. Watch the video, get behind it."
Jason Kincaid | Techcrunch
"This may be the most important development in the treatment of out-of-hospital cardiac arrest since the automatic external defibrillator! Simply awesome."
TOM BOUTHILLET | WIRELESS HEALTH
"There are smart phone apps, and then there are apps for your phone - that are truly genius."
SCOTT BUDMAN | NBC BAY AREA
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KYM MCNICHOLAS | FORBES
"Making it easier that ever for CPR-trained Good Samaritans to save lives."
KI MAE HEUSSNER | ABC NEWS
"If this CPR iPhone app does not save lives, well we're doomed."
KAT HANNAFORD | GIZMODO
"With the creative environment of a Silicon Valley start up, this fire department has accomplished a feat previously unthinkable."
PETROS DERMETZIS | WORKDAY
"The iPhone app with a noble mission: provide fast rescue to victims of Sudden Cardiac Arrest (SCA)."
ISABEL BONFATTI | YAHOO
"The moment I tried it I knew I needed to retake CPR and that I really want this for my city."
BEN PARR | MASHABLE