key: cord-0979377-pfgmkdgv authors: Jost, Daniel; Derkenne, Clément; Kedzierewicz, Romain; Briche, Frédérique; Frattini, Benoit; Bertho, Kilian; Prunet, Bertrand title: The Need to Adapt the Rescue Chain for Out-of-Hospital Cardiac Arrest during the COVID-19 Pandemic: Experience from the Paris Fire Brigade Basic Life Support and Advanced Life Support Teams date: 2020-06-12 journal: Resuscitation DOI: 10.1016/j.resuscitation.2020.06.005 sha: fea1e17ae1f40d2e6870abbd634a93a9f157e154 doc_id: 979377 cord_uid: pfgmkdgv nan The ILCOR COVID-19 consensus aimed to balance the benefits of early resuscitation with the potential for harm to care providers, stating, notably, that every emergency system should react according to its resources and its region's evolving disease prevalence [1] . The start and end of the lockdown period constituted critical time points when the rescue chain had to be accurately readjusted. The effect of the COVID pandemic on the incidence of out-of-hospital cardiac arrest (OHCA) in Paris has been previously described [2] . Since the start of confinement in France (March 17, 2020), the Paris Fire Brigade prehospital emergency system was faced with the need to adapt its OHCA rescue chain. First, the dispatcher performed phone detection of OHCAs using the "hand over belly" technique, which showed its effectiveness in our system in the recent past [3] Indeed, insofar as this procedure kept the bystander away from the patient's airway, it seemed quite safe. After asking the bystander to open the windows of the room to disperse a potential viral atmosphere, the dispatcher instructed him to perform chest compressions (CCs) [4] . Second, the lockdown resulted in suspending our regional mobile lay-responder application, because mobile-responders had no personal protection equipment (PPE) at this time. Third, the AED-location map from this application failed to be helpful as most public places were closed. Fourth, the dispatch of the Basic Life Support (BLS) teams was limited to one crew per-patient instead of the two provided for in the pre-pandemic period, to limit rescuers' viral exposure and to keep BLS teams available to treat the dramatically increased number of OHCAs that occurred during this period (figure 1) [2] . Before leaving the fire station, the BLS teams equipped themselves with gloves, N95 respirators, eye protection, gowns and overshoes, which took approximately one minute [5] J o u r n a l P r e -p r o o f to replace the manual CCs and limit the teams' viral exposure. The physician performed orotracheal intubation wearing a hooded suit and ski mask and using video laryngoscopy. Breaking out of confinement, which corresponds with the decrease in regional disease prevalence, requires restoring the lay-responder app and easing the BLS teams' protection to save time in their CPR initiation. COVID's decreasing prevalence makes it difficult for the dispatcher and the BLS team to differentiate COVID from non-COVID OHCAs instantly. Unfortunately, for some patients, this may result in inappropriate measures. Finally, the emergency system's responsiveness remains essential for a balanced adaptation of the rescue procedures to the pandemic's evolution, any viral changes, and future scientific advances. In this context, the collection of accurate data remains more essential than ever. (These data have been previously published [2] ). The solid black line represents the number of OHCAs per week since January 1, 2020; The grey dotted line reports the median number of OHCAs per week during the 2016-2019 period and the dark and light grey areas their corresponding interquartile and minimum-tomaximum ranges, respectively. The numbers 1 to 5, along the solid black line, refer to the following events: 1. Brigade Headquarters instructions to the rescue workers to wear the Full Personal Protective Equipment. International Liaison Committee on Resuscitation: COVID-19 Consensus on Science, Treatment Recommendations and Task Force consensus on science, treatment recommendations and task force insights A Population-Based, observational study. The Lancet Public Health Improving emergency call detection of Outof-Hospital Cardiac Arrests in the Greater Paris area: Efficiency of a global system with a new method of detection Roles of sunlight and natural ventilation for controlling infection: historical and current perspectives Provisory suspension of the use of the mobile-responder app ( Paris Lockdown) 3. Limitation to one BLS crew per-patient ILCOR Interim Guidance for Basic and Advanced Life Support in Patients With Suspected or Confirmed COVID-19 Breaking out of confinement DJ reports no conflict of interest CD reports no conflict of interest RK reports no conflict of interest FB reports no conflict of interest BF reports no conflict of interest KB reports no conflict of interest BP reports no conflict of interest Thanks to the Firefighters and BLS Teams for their unfailing determination and daily struggle in this war against disease.