Firefighters around the world have the ability to provide first aid before ambulance staff arrive. In Sweden, this assignment is called ‘While Waiting For the Ambulance’ (WWFA). There is limited knowledge about WWFA in rural environments, therefore the aim of this study was to describe the WWFA assignment in a rural environment from the perspective of the firefighters and the ambulance staff. A descriptive design was used with a reflective lifeworld approach, including 16 telephone interviews with firefighters and ambulance staff. The COREQ checklist was applied. A directed responsibility emerges towards affected persons with a situation-adapted attitude during alarms in a WWFA assignment. The firefighters and ambulance staff are each other’s support with a simultaneous need for support from involved organisations. To strengthen this support, training is required, consisting of interprofessional training, feedback from relevant organisations about first aid efforts and expansion of WWFA assignments. Finally, there is a need for a more coordinated picture in order to provide better conditions for future action by the organisations involved, with increased opportunities to save lives in individual local environments.

Aim

Firefighters perform first aid before the ambulance arrives in areas with a long response time in Sweden; this is called ‘While Waiting for the Ambulance’ (WWFA). The aim was to describe WWFA assignments in rural environments, focusing on frequency, event time, actions and survival >30 days after cardiopulmonary resuscitation (CPR) was performed.

Methods

Retrospective descriptive and comparative design.

Results

Firefighters in the northern part of Sweden were involved in 518 WWFA assignments between 2012 and 2016. From alarm call until ambulance dispatch, median time was 2:20 min; for firefighters, nearly four minutes. Median dispatch time at out-of-hospital cardiac arrests (OHCA) (n = 52) was 1:40 min for ambulance and three minutes for firefighters. Maximal dispatch time was nearly 10 min for ambulance and 44 min for firefighters. Firefighters arrived first at the scene, after 17 min’ median, for 95 % of assignments, while the ambulance took nearly twice the amount of time. In OHCA situations, time for firefighters was over 19 min versus ambulance at nearly twice the time. CPR was terminated by ambulance staff at 83% (n = 43) of 52 when firefighters performed prolonged CPR. Return to spontaneous circulation after OHCA was 17%, and 9% were alive after >30 days.

Conclusion

The efficiency of incident time and utilisation rate for WWFA assignments can be increased for the benefit of affected persons, especially in OHCA.

Background

In a rural environment where distances and access to ambulance resources in people’s immediate area are limited, other responders like firefighters dispatched to perform a first aid before ambulance arrives in areas where a longer response time exists; an assignment called ‘While Waiting for the Ambulance’ (WWFA). Knowledge is limited about the experience from a caller’s perspective when a person has a life‐threatening condition needing emergency help and both firefighters in a WWFA assignment and ambulance staff are involved.

Aim

The aim of the study is to describe the emergency situation involving a WWFA assignment in a rural environment from the caller's perspective.

Method

A descriptive design using qualitative methodology with a reflective lifeworld research (RLR) approach was used for this study, including in‐depth interviews with eight callers.

Results

An emergency situation involving WWFA assignment in a rural environment mean a sense of being lone and lonely with a vulnerability in while waiting to hand over responsibility for the affected person. Ambivalence in several dimensions arises with simultaneous and conflicting emotions. A tension between powerlessness and power of action where the throw between doubt and hope are abrupt with a simultaneous pendulum between being in a chaos and in a calm.

Conclusion

A double ambivalence emerges between, on one hand feeling alone in the situation and having full control, on the other hand, with trust handing over the responsibility, thereby losing control. Contact with the emergency medical dispatcher becomes a saving lifeline to hold onto, and access to emergency help in the immediate area of WWFA is valuable and important. Trust and confidence are experienced when callers are met with empathy, regardless of personal acquaintance with arriving responders.

Aim: The overall aim was to explore and describe experiences from the perspective of different actors in While Waiting for Ambulance (WWFA) assignments in a rural environment. The four studies aimed: to describe WWFA and ambulance assignments in rural environments, focusing on frequency, event time and actions of firefighters before an ambulance arrives at the scene, and to evaluate these actions (I); to describe emergency situations involving  WWFA assignment in a rural environment from the caller´s perspective (II); to describe compliance with the telephone-assisted cardiopulmonary resuscitation (T-CPR) protocol, the performance of the laypersons in a simulated T-CPR situation, and the communication between laypersons and EMDs during these actions (III); to describe WWFA assignment in a rural environment from the firefighters’ and the ambulance staff’s perspective (IV).

Methods: The studies had a descriptive and comparative design. They were analysed with a qualitative and quantitative methods.

Results: In event time showed the process time between ambulance staff and firefighters as significantly statistically different, to firefighters' disadvantage. Nevertheless, firefighters arrived first at the scene for 95 % of assignments after 17 minutes in the median, while ambulance staff took nearly twice the time. Access to help in the immediate area is experienced as valuable to the callers, but there is also a sense of being lone and lonely with vulnerability. Instructions from T-CPR protocol were difficult to comply with both from EMDs and laypersons, especially airway control. Regardless of the quality of communication between EMD and lay people, performance of CPR did not improve. Firefighters and ambulance staff experienced a directedness of responsibility towards affected persons; simultaneously, they were each other’s support. WWFA assignment is, itself, in a gray zone between the involved organisations, and strategies are lacking for the assignment.

Conclusions: WWFA assignments are an underutilized resource in individual’s local environments, where a coordinated picture of identified organisational gray zones provide better conditions for future action by the organisations involved, with increased opportunities to save lives in people's local environments.