Impact of a 9-1-1-Integrated Mobile App on Bystander CPR - Implementation of PulsePoint in an Urban County

Sep 30, 2026

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Early bystander CPR improves perfusion and increases the odds of favorable survival and neurological outcomes after out-of-hospital cardiac arrest (OHCA). PulsePoint, a crowd-sourcing mobile CPR app that alerts trained citizens to nearby OHCA, was deployed in an urban county in 2019. Using SQUIRE 2.0 in a retrospective observational review of all activations from June 2020 to September 2023, the study analyzes bystander intervention, responder characteristics, activation circumstances, and patient care.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages16

Reading Time40 min

AccessFree to download

Abstract

Background/Objectives

Methods

Results

Conclusions

Introduction

OHCA burden and time-critical resuscitation

Role of bystanders and smartphone notifications

PulsePoint features and prior experience

Materials and Methods

Setting

Article Impact of a 9-1-1-Integrated Mobile App on Bystander CPR: Implementation of PulsePoint in an Urban County Charles W. Hwang 1, *, Anthony J. Meyer 2, Ira Harmon 3, Brandon P. Climenhage 1, Eric M. Nordhues 2 and Torben K. Becker 2 Academic Editor: Andrea Fabbri Received: 6 November 2025 Revised: 12 December 2025 Accepted: 17 December 2025 Published: 19 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 College of Medicine, University of Florida, Gainesville, FL 32610, USA; [bclimenhage@ufl.edu](bclimenhage@ufl.edu) 2 Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA; [t.becker@ufl.edu](t.becker@ufl.edu) (T.K.B.) 3 Center for Data Solutions, College of Medicine, University of Florida, 655 W 8th St., Jacksonville, FL 32209, USA * [Correspondence: hwang.c@ufl.edu](Correspondence: hwang.c@ufl.edu); Tel.: +1-352-265-5911 Abstract Background/Objectives: Early bystander CPR helps to restore perfusion and improves the likelihood of favorable survival and neurological outcome after out-of-hospital cardiac arrest (OHCA) . One strategy to improve bystander CPR is the use of crowd-sourcing mobile CPR applications such as PulsePoint, which notifies bystanders of nearby OHCA. In 2019, PulsePoint was deployed in an urban county. Prior to its deployment, bystander CPR rates were 42.9% in this county. This descriptive analysis seeks to analyze bystander intervention after PulsePoint implementation in an urban county. Methods: This retrospective observational study included all PulsePoint activations in Alachua County from June 2020 to September 2023 . Patient characteristics and survey data were extracted from EMS patient care reports, hospital electronic medical records, and Pulsepoint dispatch and responder data. Descriptive statistics were used to analyze patient and responder characteristics, PulsePoint activation circumstances, and patient care. Results: Of 225 PulsePoint activations, 95 (42.2%) were confirmed OHCA. Among these, 54 (56.8%) received bystander CPR prior to EMS arrival. Out of 15 prehospital defibrillations, laypersons defibrillated 9 patients (60.0%) . There was an average of 3.3 eligible PulsePoint responders within a 0.25-mile radius of the OHCA victim. A majority of PulsePoint survey respondents were formally trained in CPR and automated defibrillator use. Conclusions: The data from our urban EMS experience demonstrate that bystander CPR rates were higher after PulsePoint deployment (56.8%) than before. Our bystander CPR rate was also higher than the national average. Keywords: out-of-hospital cardiac arrest; emergency medical services; mobile applications 1. Introduction Out-of-hospital cardiac arrest (OHCA) is a major cause of morbidity and mortality in the US. The American Heart Association (AHA) estimates 356,000 OHCA cases occur annually in the US [1] . The likelihood of survival after OHCA is highest when cardiopulmonary resuscitation (CPR) and defibrillation is initiated within 3 to 5 min after cardiac arrest [2] . After cardiac arrest, the probability of neurologically intact survival decreases by 7–10% for every minute without CPR; with early CPR, this decline may be reduced to as little as 3% per minute [3,4] . Moreover, early defibrillation increases the likelihood of restoring a perfusing rhythm [5] . Therefore, early, timely CPR after OHCA is crucial for survival. The average EMS response interval after OHCA is approximately 8 min [6] . Consequently, the role of bystanders has been recognized as an essential link in the Chain of Survival for OHCA resuscitation. Bystander intervention can shave critical minutes from the initiation of life-saving interventions and improve the likelihood of return of spontaneous circulation (ROSC) and survival [

FAQs

What is the main goal of the study on PulsePoint and bystander CPR?

To analyze bystander intervention following PulsePoint implementation in an urban county, including how CPR and defibrillation were carried out before EMS arrival.

What study design and time period were used?

A retrospective observational study included all PulsePoint activations in Alachua County from June 2020 to September 2023.

What were the key findings regarding bystander CPR after PulsePoint deployment?

Among 225 activations, 95 were confirmed OHCA, and 56.8% of those received bystander CPR prior to EMS arrival. The bystander CPR rate after deployment was higher than before.

Sep 30, 2026

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