24-hour Pattern in Lag Time of Response by Firemen to Calls for Urgent Medical Aid

Abstract

The aim of the study was to assess the group 24-h pattern of lag time (LT) in response by regular and volunteer firemen (RFM and VFM) to calls for medical help (CFMH), specifically calls for out-of-hospital cardiac arrest (OHCA). LT, duration in min between a CFMH and departure of service vehicle equipped with a semiautomated defibrillator and generally staffed with four well-trained and ready-to-go FM, represents the integrated duration of several processes, each with separate reaction and decision-making times. The exact time of each CFHM (in min, h, day, month, yr) was recorded electronically, and the exact departure time from the station of the responding FM vehicle was recorded by an on-duty FM. Overall, CFMH made up 53 ± 9% (SEM) of all emergencies calls for aid. To standardize the study methods, the reported findings are based on 568 CFMH specifically regarding OHCA that occurred during the 4-yr study span (January 2005 to December 2008). CFMH exhibited a 24-h pattern with a major peak at 10:00 h (mean ± SEM: n = 9.5 ± 1.6) and major trough at 01:00 h (n = 1.3 ± 0.3; t test, p < .001). From year to year and season to season, a 24-h pattern was detected in the total of CFMH/h with two peaks (∼10:00 and ∼17:00h) and two troughs (∼01:00 and ∼15:00 h) (analysis of variance [ANOVA], p < .01; Cosinor, p < .05 to < .003), with neither season- nor year-related differences (χ², p > .05). In CFMH/h pooled time series, ANOVA-detected differences between the hourly means (p < .01), and Cosinor analysis validated a 24-h rhythm (p < .002). In raw data, the longest LT, indicative of poorest performance, occurred at 05:00 h (8.8 ± 0.7 min) and the trough of LT, indicative of best performance, at 16:00 h (4.3 ± 0.8 min (t test, p < .02). 24-h patterning in LT was validated both by ANOVA of hourly means (p < .0006) and Cosinor analysis (p < .05), with longest LT ∼05:00 h and shortest LT ∼16.00 h for data of the individual yearly time-series data. The 24-h LT rhythm was also validated in the pooled time series by Cosinor (p < .0001), with the 24-h mean ± SEM = 6 ± 0.17 min and acrophase (peak) of 03:00 h ± 88 min (SD). Curve patterns of CFMH/h and LT/h differed widely. As a group phenomenon, the LT 24-h rhythm mimics the 24-h pattern of performance, as demonstrated by many laboratory and field investigations. The stability of the LT rhythm between years and seasons and its weak relationship with the CFMH 24-h pattern favors the hypothesis of an endogenous component or origin. The nighttime trough of performance is presumably linked to the elevated risk of work accidents in the same population of FM.

Keywords:

• Circadian rhythm
• Chute time
• Firemen
• Lag time
• Out-of-hospital cardiac arrest
• Performance rhythms

ACKNOWLEDGMENTS

The study was performed with the help of the Thérèse Tremel Pontremoli donation for Chronobiologic Reseach at The Fondation Adolphe de Rothschild, Paris. Special thanks are due to Didier Pelisse, Stéphane Berrez, Florent Beauchamp, plus the staff members of the SDIS-71, Emmanuel Biard and Thibault Martin of the DRI–CG71 who provided data regarding vehicle traffic on roads of Saône et Loire and Nadim Farés, Director of the National (French) Prevention Program for stimulating discussions and advice.

Declaration of Interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.