Assessing the Impact of Crowd Tasking Apps on Resuscitation Success: The Case of Sudden Cardiac Arrests in Germany

Introduction

Modern societies are increasingly threatened by a wide range of natural and man-made risks. In this context, ‘mitigation’ is an important concept (Van de Walle & Turoff, 2008). According to Labaka, Hernantes, Laugé & Sarriegi (2013), mitigation/prevention ‘refers to the actions taken to identify risks, avoid their occurrence and reduce possible negative effects on human life and personal property’ (p. 132). Van de Walle & Turoff (2008) consider specific large-scale events with a significant impact on life and property. Labaka et al.’s (2013) definition also allows for referring to large numbers of small risks whose significant impact results from high incidence rates.

Sudden cardiac arrest (SCA) is among the three most prominent causes of death after cancer and other cardiovascular diseases in industrialized nations (see Van Aken & Böttiger, 2015). Consistent with Labaka et al.’s definition of mitigation, ‘actions to … reduce possible negative effects on human life’ are required, in particular because attempts of cardiopulmonary resuscitation are often unsuccessful in those SCA incidents that take place out of hospital.

Helbing (2015) propagates a paradigm shift from power to societal empowerment in disaster risk mitigation. In this context, Neubauer, Nowak, Jager, Kloyber, Flachberger, Foitik & Schimak (2013), identified new processes called ‘crowd tasking,’ ‘dedicated to the improvement of volunteer management applying new media’ (p. 345).

German researchers are developing app-based Early Warning and Alerting System (EWAS) to mobilize registered volunteers. The first such system was “Mobile Retter” (mobile rescuers), which was specifically designed to save lives in case of SCAs, and has been used in practice since 2013 (Stroop, Strickmann, Horstkötter, Kuhlbusch, Hartweg, & Kerner 2015). A similar system which has been designed for a broader range of scenarios beyond SCA, including large-scale incidents and disasters is the ENSURE system which is currently being tested in the city of Berlin (Jendreck, Meissen, Rösler et al., 2016).

Although the positive effects of systems like “Mobile Retter” and ENSURE are unquestioned, implementing such a system, as well as EWAS in general, requires a justification of the costs (see e.g. Klafft & Meissen, 2011). This paper provides a holistic approach to assess EWAS-based SCA risk mitigation activities. It also gives an estimation of the increase in the survival rates in Germany, if volunteers are mobilized by such a service. ¹ The paper is organized as follows: the next section discusses the need for warning apps to alert volunteers in case of sudden cardiac arrests. Thereafter, existing approaches for assessing alerting systems are discussed. These approaches lack a discussion of legal and ethical aspects, which is why specific attention is given to these aspects in a separate section. After having completed the discussion of key success factors, an assessment model is developed, and subsequently applied to the case of Germany. The impact assessment of crowdtasking apps for Germany is based on two scenarios: a conservative one based on what has already been achieved in areas where the “Mobile Retter” system is operational, and an optimistic scenario with increased volunteer participation due to potential changes in the legal framework. Finally, the paper concludes with an evaluation, a summary and outlook.

Need For Warning Apps To Save Lives In Cases Of Sudden Cardiac Arrest

In Europe and the U.S., at least 1.4 million people die each year following SCA with unsuccessful out-of-hospital cardiopulmonary resuscitation (see Van Aken & Böttiger, 2015 and Weber, Bein, Möllenberg, Geldner, Andresen, Bohn, Braun, Ruppert, Scholz, Strauss, Beckers, Frey & Böttiger, 2014). The tragedy of this statistic is increased by the fact that the potential of successful mitigation measures is not fully exploited yet, while the potential benefits of appropriate reaction strategies are overwhelming. Besides saving lives, the probability that successfully treated patients (i.e., long-term survivors) return to work is high. 52.7% of the 530 patients in the study of Smith, Andrew, Lijovic et al. (2014) worked prior to the cardiac arrest. 76.6% returned to work and 65.2% returned to the same role. However, only a small fraction of patients are currently long-term survivors, mostly due to the fact that resuscitation is initiated too late.