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In a Philadelphia neighbourhood where opioid overdoses are frequent, neighbors used a smartphone app to request and give help for a victim of suspected overdose. A one-year study demonstrated the feasibility of this approach, which empowered the local community to save lives and even respond to overdoses faster than emergency medical services.

Objectives : Patients at risk of anaphylaxis are required to always carry an adrenaline auto-injector (AAI), as the first line of treatment, but their adherence is low. An Emergency Response Community (ERC) is a social network of patients who can potentially help other patients who find themselves without their medication in an emergency. ERC can be mediated by an Emergency Medical Services (EMS) agency or unmediated to provide direct patient-to-patient immediate first aid. The purpose of this research was to study physicians' attitudes towards anaphylaxis ERC (AERC). Methods : A convenience sample of 224 physicians were surveyed using an online questionnaire. Answers were analyzed using ANOVA, t-tests and ordinal regression. Results : Positive attitudes towards an AERC found 88.4% (n=198) see potential in the ERC and 62.9% (n=141) think that ERC is excellent and should be implemented immediately. Fewer respondents (6.25%, n=14) rejected the ERC completely. Respondents showed high willingness to provide patients with solicited or unsolicited advice to join an AERC (78%, n=175 and 50%, n=111 respectively). Physicians' opinion about the minimum age to join an AERC is an average of 15.45 years. Leading concerns are 'being left without AAI' (54.5%, n=122), 'expired AAI' (44.2%, n=99) and 'wrong AAI administration' (41.1%, n=92). High support for mediated AERC (79%, n=177) was found and mediation seems to reduce concerns among the majority (68.3%, n=153) of respondents. Conclusions : Physicians expressed high support for unmediated AERC. EMS mediation is preferred by the respondents and potentially lowers their concerns. Findings support the AERC approach for patients at risk of anaphylaxis. Public Interest Summary : Patients at risk of anaphylaxis are required to always carry an adrenaline auto-injector, as the first line of treatment, but their adherence is low. An Emergency Response Community (ERC) is a social network of patients who can potentially help other patients who find themselves without their medication in an emergency. ERC can be mediated by an Emergency Medical Services (EMS) agency or unmediated to provide direct patient-to-patient immediate first aid. The purpose of this research was to study physicians' attitudes towards anaphylaxis ERC (AERC). A convenience sample of 224 physicians were surveyed using an online questionnaire. Physicians expressed high support for unmediated AERC and high willingness to provide patients with solicited or unsolicited advice to join an AERC. EMS mediation is preferred by the respondents and potentially lowers their concerns. Leading concerns are 'being left without AAI', 'expired AAI', and 'wrong AAI administration'.

Background Rapid naloxone administration is crucial in reversing an opioid overdose. We investigated whether equipping community members, including people who use opioids (PWUO), with a smartphone application enabling them to signal and respond to suspected overdose would support naloxone administration in advance of Emrgency Medical Services (EMS). Methods This observational cohort study of opioid overdose intervention used a dedicated smartphone app, UnityPhilly, activated by volunteers witnessing an overdose to signal other nearby volunteers in Philadelphia (March 2019 - February 2020). Alerted volunteers chose to respond, or declined to respond, or ignored/missed the alert. Witnessing volunteer was connected to 9-1-1 through a semi-automated telephone call. The primary outcome was layperson-initiated overdose reversal before EMS arrival, and a secondary outcome was hospital transfer. This study is registered with ClinicalTrials.gov, NCT03305497. Findings 112 volunteers, including 57 PWUO and 55 community members, signaled 291 suspected opioid overdose alerts. 89 (30⸱6%) were false alarms. For 202 true alerts, the rate of layperson initiated naloxone use was 36⸱6% (74/202 cases). Most naloxone-use cases occurred in the street (58⸱11% (43/74)) and some in home settings (22⸱98% (17/74)). The first naloxone dose was provided by a nearby volunteer responding to the alert in 29⸱73% (22/74) of cases and by the signaling volunteer in 70⸱27% (52/74) of cases. Successful reversal was reported in 95⸱9% (71/74) of cases. Layperson intervention preceded EMS by 5 min or more in 59⸱5% of cases. Recovery without hospital transport was reported in 52⸱7% (39/74) of cases. Interpretation Our findings support the benefits of equipping community members, potentially witnessing suspected opioid overdose, with naloxone and an emergency response community smartphone app, alerting EMS and nearby laypersons to provide additional naloxone. Funding Funding provided by NIH through NIDA , grant number: 5R34DA044758 .

Mobile emergency response applications involving location-based alerts and physical response of networked members increasingly appear on smartphones to address a variety of emergencies. EMS (Emergency Medical Services) administrators, policy makers, and other decision makers need to determine when such systems present an effective addition to traditional Emergency Medical Services. We developed a software tool, the Emergency Response Community Effectiveness Modeler (ERCEM) that accepts parameters and compares the potential smartphone-initiated Samaritan/member response to traditional EMS response for a specific medical condition in a given geographic area. This study uses EMS data from the National EMS Information System (NEMSIS) and analyses geographies based on Rural-Urban Commuting Area (RUCA) and Economic Research Service (ERS) urbanicity codes. To demonstrate ERCEM's capabilities, we input a full year of NEMSIS data documenting EMS response incidents across the USA. We conducted three experiments to explore anaphylaxis, hypoglycemia and opioid overdose events across different population density characteristics, with further permutations to consider a series of potential app adoption levels, Samaritan response behaviors, notification radii, etc. Our model emphasizes how medical condition, prescription adherence levels, community network membership, and population density are key factors in determining the effectiveness of Samaritan-based Emergency Response Communities (ERC). We show how the efficacy of deploying mHealth apps for emergency response by volunteers can be modelled and studied in comparison to EMS. A decision maker can utilize ERCEM to generate a detailed simulation of different emergency response scenarios to assess the efficacy of smartphone-based Samaritan response applications in varying geographic regions for a series of different conditions and treatments.

Background Medical emergencies such as anaphylaxis may require immediate use of emergency medication. Because of the low adherence of chronic patients (ie, carrying anti-anaphylactic medication) and the potentially long response time of emergency medical services (EMSs), alternative approaches to provide immediate first aid are required. A smartphone-based emergency response community (ERC) was established for patients with allergies to enable members to share their automatic adrenaline injector (AAI) with other patients who do not have their AAI at the onset of anaphylactic symptoms. The community is operated by a national EMS. In the first stage of the trial, children with food allergies and their parents were invited to join. Objective This study aimed to identify the factors that influence the willingness to join an ERC for a group of patients at risk of anaphylaxis. Methods The willingness to join an ERC was studied from different perspectives: the willingness of children with severe allergies to join an ERC, the willingness of their parents to join an ERC, the willingness of parents to enroll their children in an ERC, and the opinions of parents and children about the minimum age to join an ERC. Several types of independent variables were used: demographics, medical data, adherence, parenting style, and children's autonomy. A convenience sample of children and their parents who attended an annual meeting of a nonprofit organization for patients with food allergies was used. Results A total of 96 questionnaires, 73 by parents and 23 by children, were collected. Response rates were approximately 95%. Adherence was high: 22 out of 23 children (96%) and 22 out of 52 parents (42%) had their AAI when asked. Willingness to join the community was high among parents (95%) and among children (78%). Willingness of parents to enroll their children was 49% (36/73). The minimum age to join an ERC was 12.27 years (SD 3.02) in the parents’ opinion and 13.15 years (SD 3.44) in the children’s opinion. Conclusions Parents’ willingness to join an ERC was negatively correlated with parents’ age, child’s age, and parents’ adherence. This can be explained by the free-rider effect: parents who carried an AAI for their young child, but had low adherence, wanted to join the ERC to get an additional layer of emergency response. Children’s willingness to join the community was positively correlated with age and negatively correlated with the child’s emotional autonomy. Parents’ willingness to enroll their children in an ERC was positively correlated with child’s age and negatively correlated with parents’ adherence: again, this can be explained by the aforementioned free-rider effect. Parents’ and children’s opinions about the minimum age to join an ERC were negatively correlated with protective parenting style and positively correlated with monitoring parenting style.

BACKGROUND Medical emergencies such as anaphylaxis may require immediate use of emergency medication. Because of the low adherence of chronic patients (ie, carrying anti-anaphylactic medication) and the potentially long response time of emergency medical services (EMSs), alternative approaches to provide immediate first aid are required. A smartphone-based emergency response community (ERC) was established for patients with allergies to enable members to share their automatic adrenaline injector (AAI) with other patients who do not have their AAI at the onset of anaphylactic symptoms. The community is operated by a national EMS. In the first stage of the trial, children with food allergies and their parents were invited to join. OBJECTIVE This study aimed to identify the factors that influence the willingness to join an ERC for a group of patients at risk of anaphylaxis. METHODS The willingness to join an ERC was studied from different perspectives: the willingness of children with severe allergies to join an ERC, the willingness of their parents to join an ERC, the willingness of parents to enroll their children in an ERC, and the opinions of parents and children about the minimum age to join an ERC. Several types of independent variables were used: demographics, medical data, adherence, parenting style, and children's autonomy. A convenience sample of children and their parents who attended an annual meeting of a nonprofit organization for patients with food allergies was used. RESULTS A total of 96 questionnaires, 73 by parents and 23 by children, were collected. Response rates were approximately 95%. Adherence was high: 22 out of 23 children (96%) and 22 out of 52 parents (42%) had their AAI when asked. Willingness to join the community was high among parents (95%) and among children (78%). Willingness of parents to enroll their children was 49% (36/73). The minimum age to join an ERC was 12.27 years (SD 3.02) in the parents’ opinion and 13.15 years (SD 3.44) in the children’s opinion. CONCLUSIONS Parents’ willingness to join an ERC was negatively correlated with parents’ age, child’s age, and parents’ adherence. This can be explained by the free-rider effect: parents who carried an AAI for their young child, but had low adherence, wanted to join the ERC to get an additional layer of emergency response. Children’s willingness to join the community was positively correlated with age and negatively correlated with the child’s emotional autonomy. Parents’ willingness to enroll their children in an ERC was positively correlated with child’s age and negatively correlated with parents’ adherence: again, this can be explained by the aforementioned free-rider effect. Parents’ and children’s opinions about the minimum age to join an ERC were negatively correlated with protective parenting style and positively correlated with monitoring parenting style.