Volunteer Responder Interventions in Out-of-Hospital Cardiac Arrest in Urban, Suburban, and Rural Areas

Astrid Rolin Kragh*, Mads Tofte Gregers, Linn Andelius, Anne Juul Grabmayr, Louise Kollander, Victor Elnegaard Kjærulf, Julie Samsøe Kjølbye, Annam Pervez Sheikh, Annette Kjær Ersbøll, Fredrik Folke, Carolina Malta Hansen

*Corresponding author for this work

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BACKGROUND: Patients with out-of-hospital cardiac arrest (OHCA) in rural areas experience longer emergency response times and have lower survival rates compared with patients in urban areas. Volunteer responders might improve care and outcomes for patients with OHCA specifically in rural areas. Therefore, we investigated volunteer responder interventions based on the degree of urbanization. METHODS AND RESULTS: We included 1310 OHCAs from 3 different regions in Denmark where volunteer responders had arrived at the OHCA location. The location was classified as urban, suburban, or rural according to the Eurostat Degree of Urbanization Tool. A logistic regression model was used to examine associations between the degree of urbanization and volunteer responder arrival before emergency medical services, cardiopulmonary resuscitation, or defibrillation. We found the odds for volunteer responder arrival before emergency medical services more than doubled in rural areas (odds ratio [OR], 2.60 [95% CI, 1.91–3.53]) and suburban areas (OR, 2.05 [95% CI, 1.56–2.69]) compared with urban areas. In OHCA cases where volunteer responders arrived first, odds for bystander cardiopulmonary resuscitation was tripled in rural areas (OR, 3.83 [95% CI, 1.64–8.93]) and doubled in suburban areas (OR, 2.27 [95% CI, 1.17–4.41]) compared with urban areas. Bystander defibrillation was more common in suburban areas (OR, 1.53 [95% CI, 1.02–2.31]), where almost 1 out of 4 patients received bystander defibrillation, compared with urban areas. CONCLUSIONS: Volunteer responders are significantly more likely to arrive before emergency medical services in rural and suburban areas than in urban areas. Patients with OHCA received more cardiopulmonary resuscitation in rural and suburban areas and more defibrillation in suburban areas than in urban areas.

Original languageEnglish
Article numbere032629
JournalJournal of the American Heart Association
Issue number4
Number of pages9
Publication statusPublished - 2024


  • emergency responders
  • out-of-hospital cardiac arrest
  • volunteers


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