BACKGROUND: Over the past decade Smartphone-based activation (SBA) of Community First Responders (CFR) to out-of-hospital cardiac arrests (OHCA) has gained much attention and popularity throughout Europe. Various programmes have been established, and interestingly there are considerable differences in technology, responder spectrum and the degree of integration into the prehospital emergency services. It is unclear whether these dissimilarities affect outcome. This paper reviews the current state in five European countries, reveals similarities and controversies, and presents consensus statements generated in an international conference with the intention to support public decision making on future strategies for SBA of CFR.
METHODS: In a consensus conference a three-step approach was used: (i) presentation of current research from five European countries; (ii) workshops discussing evidence amongst the audience to generate consensus statements; (iii) anonymous real-time voting applying the modified RAND-UCLA Appropriateness method to adopt or reject the statements. The consensus panel aimed to represent all stakeholders involved in this topic.
RESULTS: While 21 of 25 generated statements gained approval, consensus was only found for 5 of them. One statement was rejected but without consensus. Members of the consensus conference confirmed that CFR save lives. They further acknowledged the crucial role of emergency medical control centres and called for nationwide strategies.
CONCLUSIONS: Members of the consensus conference acknowledged that smartphone-based activation of CFR to OHCA saves lives. The statements generated by the consensus conference may assist the public, healthcare services and governments to utilise these systems to their full potential, and direct the research community towards fields that still need to be addressed.

During the past 7th Security Framework Program the European Commission funded a research project called CATO (CBRN Crisis management, Architectures, Technologies and Operational procedures) to develop a prototype decision support system for crisis management in addition to providing a suite of guidelines for first responders and incident commanders when dealing with chemical, biological, radiological or nuclear incidents. In order to derive these guidelines a proof-of-concept experiment was setup during which several passive agent (Stable CsCl) dispersions with improvised explosive devices and vehicle-borne improvised explosive devices were carried out. Each dispersion was thoroughly characterized by a number of monitoring devices, including high-volume air samplers and size-segregated air samplers. All environmental and forensic samples were collected by the UK counter terrorism police, following strict labelling and chain-of-custody protocols. The samples were analyzed at the Belgian Nuclear Research Center suing the k0 method for instrumental neutron activation technique. A full consequence assessment analysis was carried out assuming that the observed concentration of Cs-133 in samples was Cs-137 instead and use was made of the specific activity of Cs-137. Due to the sensitivity of the information the European Commission classified this research. The resulted reported on in this work have been unclassified and are released to assist emergency planners and first responders to take the necessary precautions. The results indicate that, up to distances of 50 m from ground zero radiation levels will be considerable and therefore live-saving actions must be performed by fire/rescue wearing full protective gear. In addition, low-wind conditions will favor a long airborne residence time and therefore the use of full-face protective gear is a must. In order to protect first responders, a radiation protection specialist is to determine how long people can enter and remain in the contaminated area. The recovery of evidence in the case of a car-bomb will be hard or even impossible due to the high level of radioactive material remaining inside the vehicle.