by Aris Serrano Santos, RN, MSN, RN
Calero Dela Cruz Fernando Jr., MSN, RN
Ma Ina Hernandez Dela Rosa, MSN, RN
Roison Andro Narvaez, MSN, RN

St. Paul University, Philippines

Citation: Santos, A. S., Fernando, C. D., Dela Rosa, M. I. H. & Narvaez, R. A. (2023). Usability of the PulsePoint app in improving community response efforts. Canadian Journal of Nursing Informatics, 18(3).  https://cjni.net/journal/?p=12217

Abstract

Background: Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of mortality around the world accounting for 50% of all cardiovascular deaths. To increase the chances of survival, mobile health applications like PulsePoint connect potential lay rescuers to respond to OHCA and provide CPR and AED applications.

Aim: To elucidate the usefulness of the PulsePoint app in mobilizing community response in times of emergency in different community settings. 

Design: An integrative review

Results: A synthesis of the nine papers included with major themes identified are: The Responders and their Willingness, Effectiveness of bystander CPR linked to PulsePoint Dispatches and its Impact on Resuscitation of Patients, Challenges and Barriers of PulsePoint App, Benefits of PulsePoint as a Crowdsourcing App, and   User Experience: Feasibility and Acceptability. As a result, the PulsePoint app showed good potential in improving response time to OHCA and increasing survival rates.

Conclusion:  PulsePoint app has the potential to speed up OHCA response times and raise survival rates. PulsePoint offers its users value, education, and the chance to assist members of the community, all of which characterize its functional usability.

Implications for Practice: This platform promotes community participation in OHCA, thus improving outcomes of status post arrest victims. This also implicates the role of health workers as educators in teaching basic life support within the community.

Keywords:  PulsePoint, sudden cardiac arrest, out-of-hospital cardiac arrest, community response

Contribution to Emergency Nursing Practice

What is already known about the topic?

The PulsePoint is a mobile health app created to notify nearby cardiac arrest emergencies in public spaces to CPR-trained local rescuers to respond during out-of-hospital cardiac arrest. This application was developed by Sloan Gaon, a technology company who aims to transform healthcare using real-time data.

What does this paper add to the currently published literature?

The PulsePoint app empowers residents to help victims of sudden cardiac arrest by giving them the tools and training they need to do so. This will help the community develop a culture of action and improve the community’s response to cardiac arrest.

What is the most important implication to clinical emergency nursing?

First responders that provide early CPR and AED application as notified by Pulsepoint, support a higher survivability rate for patients when they arrive in the emergency department. This highlights the importance of educating and encouraging citizens to be CPR trained, as emergency nurses are health educators that can provide training to lay people.

Background

Sudden cardiac arrest (SCA) accounts for approximately 50% of all cardiovascular deaths in the general population, making it one of the leading causes of mortality worldwide; without immediate action, it is always fatal (Ong et al., 2021). The community’s response to OHCA changed during the pandemic, with smaller quantities of bystanders performing CPR, a delay in EMS response times, and decreased OHCA survival rates. These results show that the pandemic harmed OHCA indirectly, even in regions with low rates of COVID-19 infection (Chan et al., 2019). It was found that communities that were hit hard by the COVID-19 pandemic had lower rates of sustained return of spontaneous circulation (ROSC) for out-of-hospital cardiac arrest (Chan et al., 2019).

In every minute a SCA patient awaits intervention, there is a 10 percent drop in the chance of survival (Sayre, 2023). Sudden cardiac arrest is the unexpected cessation of a person’s heartbeat leading to unresponsiveness, which in most cases has catastrophic sequelae caused by arrhythmias and myocardial infarction (Al-Khatib, 2018; Hess et al., 2016; Koivunen, 2023). Cardiac arrest across all settings, whether in a hospital or community setting, remains a public health crisis. In the United States (US), there are more than 356,000 cases of out-of-hospital cardiac arrest (OHCA) reported annually, 90% of which are nearly fatal, with an associated non-traumatic OHCA rate of 100 cases per day (Sudden Cardiac Arrest Foundation, 2023).

Additionally, the true impact of OHCA on public health is unknown because emergency personnel are not present in many cases of OHCA. SCA kills 70%–90% of patients who undergo this medical emergency because, most of the time, CPR and defibrillation are not given to save the person’s life (Welhausen et al., 2019). In lieu of this, in North America, where there is already 911 services and an established EMS delivery system, a volunteer-based network of lay-trained persons is also established who can provide CPR to individuals experiencing SCA to increase their chances of survival (Dainty et al., 2017). To help bridge this gap, the medical community promotes situational awareness to draw skilled individuals into providing basic life support (Graham et al., 2015). A good network to crowdsource this group of CPR providers in communities is the PulsePoint App. In these recent times of the COVID-19 pandemic, there have been significant increases in OCHA incidence in the community setting in different parts of the world, with proven studies in some cities such as New York in the USA, Paris in France, and Lombardy in Italy, which showed significant increases of 223%, 99%, and 52% respectively (Myat et al., 2018).

PulsePoint is a non-profit organization that works with public safety agencies around the United States and Canada to improve survivability for sudden cardiac arrest events as a novel citizen responder health app. 911 centers connect to Pulsepoint by notifying responders present within the six-block radius of the call to provide CPR and AED application. It has been demonstrated that the two determinants of survival during out-of-hospital cardiac arrest are bystander CPR and early defibrillation (Chugh et al., 2020). The emphasis on early CPR initiation by lay rescuers is important, thereby improving lay rescuer response time, raising CPR rates, shortening the time for defibrillation, and increased survival rates (Merchant et al., 2020). Community response is an important part of saving lives, but to give people more power, each community should help people move from being “concerned bystanders” to being “active responders” (Ming Ng et al., 2021).

This current integrative review aims to assess the literature and integrate the usability of the PulsePoint (PP) app into improving community response efforts since serviceability and effectiveness to initiate responses in different communities are still limited. This study aims, to describe the user’s experience and responses and how using the mobile health app can help the community as a whole. This study will be beneficial for all countries to consider and adopt such an app, increasing the number of available responders in the event of an out-of-hospital cardiac arrest.

Method

Design

This study is an integrative review of all available evidence-based literature on the topic, whether quantitative, qualitative, or mixed methods with diverse methodologies (Whittemore & Knafl, 2005). The steps are as follows: clear identification of the clinical subject being studied through the articulation of the usability of the PulsePoint App as the topic being studied, followed by the completion of literature synthesis, analysis, and evaluation of the data collected. The usability of the PulsePoint app in initiating community response efforts will then be summarized and aggregated using themes (Dixon-Woods et al., 2006). Then, the emerging themes will be interpreted to build conceptual understanding and get the most out of the topic being studied.

Search Strategy

This review was conducted from January 2023 to March 2023 utilizing electronic resources such as PubMed, CINAHL, ScienceDirect, PubMed, SAGE, Elsevier, Taylor and Francis, and Springer & Wiley. Published English articles were included in this review. Keywords used were: PulsePoint; PulsePoint AND sudden cardiac arrest; PulsePoint AND out-of-hospital cardiac arrest; PulsePoint AND community response; PulsePoint AND responders; PulsePoint AND sudden cardiac arrest AND community response. As illustrated in Figure 1, utilizing the PRISMA diagram, with the use of the keywords, the initial search resulted in 890 articles based on title, from which 120 abstracts were reviewed. Upon cross-checking if the inclusion criteria were met, 48 articles were fully reviewed, and upon application of the exclusion criteria, nine studies were deemed eligible for this study.

Figure 1

PRISMA Flow Diagram of Usability of PulsePoint App in Improving Community Response

Inclusion and Exclusion Criteria

Table 1 shows the eligibility criteria. The included studies are peer-reviewed empirical studies that utilized the PulsePoint App to determine its usability in improving community response. Qualitative, quantitative, and mixed methods studies were included, while opinion papers, protocols, one-page reviews, letter and abstracts, paper blogs were excluded, as well as studies that did not discuss community response efforts while using the PulsePoint app. Articles included were also written in comprehendible basic English and published during the timeframe of January 2016 to January 2023.

Table 1

Inclusion and Exclusion Criteria

Data Evaluation and Quality Appraisal

The researchers manually and independently analyzed each study with consideration of purpose, methods, and findings. All electronic sources suitable in the inclusion criteria were appended in this integrative review. To a greater extent, each selected study discussed the functionality of PulsePoint app and must explain its usability in improving community effort response. A comprehensive matrix table using Sparbel & Anderson’s (2000) integrative review tool with the following information was collected: author, year of publication, design, method, sample size and participants, sampling technique, aim, and the findings of the study.

As shown in Table 2, to appraise the methodological quality of the studies included, a mixed method appraisal tool (MMAT) was utilized. Each selected study was classified among the five categories of study design, six were quantitative studies, two were qualitative studies and one was a non-randomized quantitative study. The two general screening questions were answered, followed by five screening questions depending on the methodology used for each study (Hong et al, 2018). When the latter five screening questions were answered, each descriptor was given a 20% score and then totaled. All study values were categorized into three levels of quality, seven of the studies scored 80% to 100% and were all considered high quality, and two studies scored 60% and were considered moderate quality (Pluye & Hong, 2014). Furthermore, the level of evidence was established using Melynk and Fineout-Overholt’s (2022) critical appraisal of evidence to guarantee the quality of this integrative review. Experts were invited externally, reviewed, validated and approved the selections. Finally, the researchers gained a consensus after a thorough review of each included study, solving all disagreements that arrived at the inclusion of the nine articles for the study.

Table 2

 Table of Included Studies

Results 

Characteristics of the Study

As presented in Table 3, nine research articles that were conducted from 2016 to 2022 have been studied and synthesized and are included in this integrative review.  The studies were conducted in the USA and Canada, with one study conducted in both countries and eight were conducted in the United States exclusively. Of these nine included articles, six used a quantitative descriptive design, one used a quantitative non-randomized cohort design, and two were qualitative designs. Eight of the studies showed Level VI evidence and one showed Level IV evidence. All study participants were responders with experience in using the PulsePoint app with sample size ranges from 200 to 2912 where data was collected through online surveys, electronic health records of OCHA events and user comments from the mobile health application. All studies aimed to explore the usefulness of the PulsePoint app in initiating community response efforts during OCHA, with discussions on mobilizing community rescuers and their user experience of the app.

From the nine articles included, discussions were provided on the functionality of the PulsePoint app, its usefulness to the general public community and efforts in mobilizing lay rescuers response. The following themes were created from the synthesis of the nine studies to improve the PulsePoint app’s usability in improving community response efforts.

Table 3

Table of Included Studies

The Responders and their Willingness

Five studies discussed that PulsePoint users can download the software for free, and none of the parties involved profited monetarily from it and as to date, it has more than 2.5 million subscribers (Brooks et al., 2016). About 70% of Canadians and 63% of Americans received training in CPR, with this knowledge, it influenced most responders to register as a PulsePoint user (Dainty et al., 2017). Most volunteers viewed the PulsePoint app very positively, 96% and nearly all volunteers planned to continue to be verified responders. They felt confident and prepared during activations, where 95% of the respondents said they were confident in responding (Blackwood et al., 2020).

Most dispatches and rescues occurred in private residences, with only 29.6% occurring in public places (Blackwood et al., 2020; Dainty et al., 2017; Smida et al., 2022). One barrier was the reluctance some responders felt to respond to private homes due to privacy (Blackwood et al., 2020; Smida et al., 2022). Three of the studies profiled their responders (Brooks, 2016; Smida et al., 2022; Welhausen & Bivens, 2021). Two studies classified the responders as experts (29%) and non-experts (69%) (Welhausen & Bivens, 2021) and 42% non-health professionals and 58% health professionals (Brooks, 2016). Two studies showed that most responders belong to the 18-54 age group, which comprised 66% and 70% respectively and many responders have a university degree (39%) (Brooks, 2016; Dainty et al., 2017).

Effectiveness of bystander CPR linked to PulsePoint dispatches and its Impact on Resuscitation of Patients

Five studies were included in the discussion of this theme. Survival rates for cardiac arrest victims depend on a variety of factors, like time of collapse to CPR and the time of initiation of AED. But one contributing factor is the mobilization of rescuers to arrive as soon as possible at the site of the incident. One study discussed that time and distance were factors in responding to OCHA, where the difference in reaction times between deployed bystanders and emergency medical services were calculated using spatial analysis and the estimator with the smallest distance (Srinivasan, 2016). With the PulsePoint app, three studies showed that the response time was reduced to two to three minutes from five minutes leading to increased survival rates from the benchmark (Brooks et al., 2016; Lancaster & Herrmann, 2020; Smida et al, 2020). One study showed that 80% of the responders attempted and performed basic life support when they arrived at the scene prior to EMS arrival (Brooks et al., 2016). On the other hand, one study showed that 35% of OCHA incidents were responded to, with 31% of responders arriving on the scene and providing initial care (Blackwood et al., 2020). In another study, 59.4% of patients received bystander CPR, 20% of patients received application of AED, and 48.4% of patients achieved ROSC in the field Smida et al, 2022). One of the participants stated:

“I was at work [when] the alert went off….CPR is needed…I ran to suite 1100…[she was] unresponsive and pulseless…I started CPR, did two rounds…she had pulses.”

(Welhausen & Bivens, 2021).

PulsePoint dispatch-associated out of hospital cardiac arrests significantly drew more bystander CPR (Blackwood et al., 2020;, Smida et al., 2020). Overall, the use of PulsePoint showed an incremental 10% improvement on the chances of survival, which would result in 4 to 17 additional lives over a 10 year period time (Lancaster & Herrmann, 2020).

Challenges and Barriers of the PulsePoint App

Five studies discussed the presence of barriers during attempted responses like location challenges, time of the day and physical barriers preventing access (Blackwood et al., 2020; Brooks et al., 2016; Smida et al., 2020; Welhausen & Bivens, 2021; Welhausen & Bivens, 2019). In one study, 32.45% of the responders had no impediments to walkability during rescue, still a significant percentage showed barriers on the way to the site of an incident, as 17.3 percent of calls were in an unwalkable area, with identified obstructions such as terrain, water, railroads, unavailable cross walks, and private properties (Smida et al., 2020). The agencies implementing PulsePoint in their communities should provide precise cardiac arrest location information to be transmitted in the app to locate the victim in the quickest time when chances of saving them are maximized (Brooks et al., 2016). One of the participants mentioned:

“The app settings need to allow for a defined area of alerts in relation to location.”

(Welhausen & Bivens, 2019).

On the other hand, challenges were also present in the use of mobile health apps. Two studies mentioned concern about the profile of the responders and if they were really trained in providing CPR (Brooks et al., 2016; Dainty et al., 2017; Welhausen & Bivens, 2019). There is low app penetration on some cardiac arrest incidents due to the lack of nearby users within the 400-meter activation radius (Brooks et al., 2016). From these synthesized studies, most of the concerns raised were the ability of responders, training, lack of necessary information of the nature of incident, and accessibility of proper equipment in public settings (Brooks et al., 2016; Dainty et al., 2017).

Two studies discussed that the system’s notification was not received by PulsePoint users (Blackwood et al., 2020; Brooks et al., 2016). For instance, the reasons given by respondents for not receiving the notification included being away from their device, having it off, and being outside of network range. They either had their phone on “mute” or were in a noisy location and missed the notification. Overall, PulsePoint had good favorability among the public, but trust issues of the app are still present both in Canada (16%) and in the United States (18%) (Dainty et al., 2017).

Benefits of PulsePoint as a Crowdsourcing App

Results from three reviewed studies showed that the use of PulsePoint app provides safety, feasibility, and acceptability that encourages more communities to adapt this novel health app to address OHCA incidents in their respective communities (Blackwood et al., 2020; Dainty et al., 2017; Smida et al., 2022). A respondent stated:

“This app got me motivated to sign up for CPR classes.”

(Welhausen & Bivens, 2021).

The PulsePoint app is a novel citizen responders’ app pioneered in the USA and Canada in 2010: since then it has become more popular in different communities across the two North American countries. 95.39 % of Canadians and 92.44% of Americans had no objections to be crowdsourced to help victims of cardiac arrest in public settings with a mean percentage of 97% in both nations of people had no objection to the implementation of PulsePoint in their community (Dainty et al., 2017).

User Experience: Feasibility and Acceptability

Four of the studies showed favorable experiences among the public safety volunteer responders. These positive user experiences translated to praise when it came to accuracy, decision-making and emergency response which are essential in making specific health-related decisions (Blackwood et al., 2020; Brooks et al., 2016; Welhausen & Bivens, 2021; Welhausen & Bivens, 2019). The app drew a positive user experience since bystanders using the PulsePoint app arrived first on the scene, giving them a chance to save lives in times of emergency (Brooks et al., 2016; Ensan et al., 2018; Smida et al., 2020), where it was measured at 92% according to census tracts in one study (Srinivasan, 2016). In one study, there were no complaints from PulsePoint Dispatch staff members who were alarmed or upset by the unexpected Verified Responder response (Blackwood et al., 2020). One of the participants said:

“Good information. Quick look up to pace if you do chest compressions.”

(Welhausen & Bivens, 2021).

On the other hand, a study mentioned 31. 4% of lay responders expressed that they had some degree of psychological distress following their response to OHCA using the mobile app (Smida et al., 2022). Differences in user experience through the provision of medical service may vary between lay rescuers and professional workers, but both have the potential to decrease mortality due to OHCA (Srinivasan, 2016; Welhausen & Bivens, 2019).

Discussion

According to the World Health Organization (2021), cardiovascular disease (CVD) has been the leading cause of death worldwide since 2019. Specifically, OCHA is one of the leading causes of death worldwide. Health technology has undergone numerous advancements over the years, particularly around health care systems. Bystander recruiting apps for smartphones provide a creative solution to this problem by notifying CPR-trained individuals about area OHCAs concurrently with EMS dispatch and additionally identifying the location of nearby AEDs.

This review was done to determine the usability of the PulsePoint app in improving community response efforts. Furthermore, this study aimed to improve the assembling of lay rescuers to respond during out-of-hospital cardiac arrest. Nine studies were generated in this review based on the inclusion and exclusion criteria indicated. There were three themes that emerged from the results to be discussed.

Usability of the PulsePoint App and its Impact on Community Response

PulsePoint, a citizen first responder app and its crowdsourcing showed obvious advantages to the target people and surrounding communities to perform CPR and AED during out-of-hospital cardiac arrest. Early administration of basic life support increases the chances of survival since the citizen’s first response reduces the time from collapse to the initiation of resuscitation management (Caputo et al, 2017). Also, user performance and user cognition provide human interactions during emergencies. The PulsePoint app initiates integrated coordinated responses with local emergency services and directs first responders to OHCAs to initiate CPR and AED application which shows potential in increasing survival rates (Srinivasan, 2016).

This study has shown that crowdsourcing of lay people within the community is effective in initiating responses in times of OHCA, not only in the study locale of the USA and Canada, but also in other countries like Sweden, Singapore, and Switzerland (Auricchio, 2019; Caputo et al, 2017; Ringh et al., 2011). The results revealed that most of the public population viewed the app positively, and many people showed willingness to help, though it is designed to have a particular purpose, it is used in the context of healthcare to connect citizens who can provide life-saving measures in the event of sudden cardiac arrest Welhausen & Bivens, 2021). This review showed that no studies resulted in more than 80% response rate of lay rescuers arriving at the scene which is a factor in discussing its usability. In conjunction with these, two similar studies also showed less than 80% response rate with other apps like Singapore’s myResponder app only yielded 45.8% (Ming Ng, 2021b) and Sweden’s Emergency Dispatch Center smartphone app only yielded 58% response rates (Berglund et al., 2018). As of this writing, no attempts have been made to improve the apps to mitigate the low deployment rate of any bystander CPR systems. This cross analysis showed that among these countries using a smartphone application for citizen’s response, it is still a personal choice of the lay rescuer to respond in an OCHA: availability and hearing of alert notification systems are among the identified factors of non-response.

PulsePoint, being a citizen responder app used in North America, has its counterparts in different developed countries using the same crowdsourcing and deployment system during OHCA. All of these have shown success and promise, so the generalizability of these apps should be further evaluated to see if they also fit in developing nations. There are places in the world with low educational status, less favorable socioeconomic status, and cultural cohesiveness that may not be able to replicate the results from North America and Europe (Chugh et al., 2020). The mere fact that the aim of PulsePoint is to save lives, grants a good physical and psychological impact on citizens, which in turn provides a good structure for other communities to adapt, raise awareness and mobilize community response during emergencies. As the impact grows, it ensures consistency and longevity through community response efforts.

Solutions to Barriers

Physical barriers can eliminate possible benefits of citizen’s response to OHCA. A larger radius of alerting potential rescuers may increase the number of responders in the alert area, thereby increasing the number of qualified bystanders to respond. Factors like availability and responsiveness of responders, time and location affect the level of response, considering the unpredictability of OCHA incidents. The mere presence of obstacles during attempts to respond, such as geographical obstacles, time constraints, and blockades to road access all affect the delivery of care to the first responders. Real time GPS access of blockades showing on the apps can better provide guidance to the users during their response. The spatial area and its topographical homogeneity must be encoded in the future versions of the app to properly dispatch bystander CPR providers. In addition, an optimal responder group should be drawn and identified from the entire public population of each community (Blackwood et al., 2020). A greater density of responders would lessen the need to expand the radius of capture due to enough CPR trained bystanders.

Social and cultural factors may limit the success of crowdsourcing, but in achieving a meaningful result, the number of CPR trained lay volunteers using the app would always be a key factor to determine its success (Caputo et al, 2017).  Increased awareness plus training initiatives should be implemented within communities to address concerns of public use and the eligibility of volunteers. Findings in this review showed that responding to OCHA was affected by distance and time and according to several studies, the PulsePoint app reduced response time, increasing survival chances compared to the benchmark (Brooks et al., 2016; Lancaster & Herrmann, 2020; Smida et al., 2020). Barriers should be addressed in the future versions of the PulsePoint application. Solutions will provide better usability and applicability among the first responders, as the difficulties in locating the site of the incident will be more accessible, with the inclusion of relevant information about the incident, which will provide better guidance to rescuers in providing basic life support. The most prevalent worry about the use of PulsePoint was that potential crowdsourced responders might not be skilled, knowledgeable, or equipped for a public situation. So therefore, we need to encourage the public to participate in any emergency response systems in their community. In addition, a short retraining course like an instructional video of CPR and AED application plus a short post-test might provide more guarantee that the lay rescuers using the app have the knowledge and skills in becoming a rescuer. This will also provide confidence for both the rescuers and the victims being rescued. A post evaluation of identified rescuers of OCHA should also be an option in the app, to evaluate the experience of the lay rescuers and to better identify challenges and difficulties that brought psychological distress to some volunteers who used it. As the app has proven its effectiveness, it could have a significant influence on assisting developing nations to save more lives in the event of cardiac arrest outside of hospital settings.  In general, the usage of PulsePoint improved survival odds gradually and would save more lives over time.

With the results gathered from this integrative review, we can conclude that although challenges and barriers in using the PulsePoint app exist, we can still consider it to be a useful tool in mobilizing community response efforts to address OHCA due to its benefits as a crowdsourcing app and for its safety, feasibility and acceptability.

Implication for Practice

The use of the PulsePoint app encourages people in different communities to register as responders for out-of-hospital cardiac arrests, thus its major implication in emergency nursing practice is that it increases the number of people who are willing to help in dire times of medical emergencies, resulting in an increase of bystander-initiated CPR. This in turn also increases the chance of survivability for the victims of cardiac arrest arriving in the emergency department.

Another implication is that technology now-a-days plays an important role in providing care and improving patient outcomes. The PulsePoint app, being one of the novel mobile health apps in crowdsourcing responders, shows that society-technology interactions may bring radical changes in the way community rescues of cardiac arrest victims are managed. Mobile health apps can be designed to develop new methods to become a patient/user-center app, targeting the perspective of citizen first responders. On the other hand, society’s dependence on these health apps should only serve as a tool for purposes of immediate response, closely monitoring and examination of patients; human intervention is still the major key in providing optimum care to our patients.

Limitation and Recommendations

Most of the studies included are from web-based surveys or online records. This may create bias for the people who have challenges in computer literacy and for those who have no access to the internet. It does not calculate the traditional response rate that may limit the precision of the measures of association and may not reflect the actual results compared to onsite surveys and observation as methods of data collection. Another limitation is that only one study had Canadian respondents, and only a few states in the USA were included as study locales which may not be a complete representation of all active communities in North America that uses the PulsePoint app. With the impact of the PulsePoint app use during the actual rescues, there is also limitation on long term data collection to fully support the benefits of using the app. Although the research entailed several communities, respondents from the different studies had various kinds of experiences. Finally, the respondents were a mixture of professional and lay rescuers, which are both representations of community people, but different views have been generated depending on their background.

Recommendations are also needed to encourage future research to evaluate the aspect of optimization of community implementation brought about by the PulsePoint app to further justify its usability to the public and overall impact to health management. Another recommendation is for the PulsePoint app to explore collaboration with companies with cell sites for larger coverage for the application to address the issue of connectivity especially in areas in the communities with poor internet coverage. Lastly, this integrative review recommends using the PulsePoint app, or another health app of the same objective in other countries, especially in developing nations where out-of-hospital cardiac arrest remains a public health crisis. Since the app has proven its effective crowdsourcing of responders and has increased chances of survival, it could also have an impact in helping developing nations save more lives in the event of cardiac arrest outside hospital settings. The potentiality of this app should explore possible integration to existing national and local emergency applications worldwide.

Conclusion

The PulsePoint app, as a novel cardiac arrest response system, showed good potential in improving response time to OCHA and increasing survival rates. This is a cost-effective mobile health application that initiates community response through crowdsourcing lay rescuers with efforts to save more lives. Each community will benefit from the PulsePoint application since it encourages more local volunteers to utilize it, increasing the number of rescuers accessible in the case of an out-of-hospital cardiac arrest. Challenges in usability, promoting better privacy and security, and ensuring trained volunteers in this bystander CPR recruitment app should be addressed and encoded in the system for future versions of PulsePoint to properly dispatch responders and manage the medical crisis they are attending to. PulsePoint being a user-friendly app provides value to its users, education, and opportunity to help people within the community. These are important considerations that define its functional usability but there is still a need for significant improvement for the general public to maximize its productive usability to further improve community response efforts.

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Author Notes

• Aris Serrano Santos, RN, MSN, RN is a Registered nurse in the Philippines and an MSN Graduate of St. Paul University Philippines
• Calero Dela Cruz Fernando Jr., MSN, RN is a Registered nurse in the Philippines and an MSN Graduate of St. Paul University Philippines
• Ma Ina Hernandez Dela Rosa, MSN, RN is a Registered nurse in the Philippines and an MSN Graduate of St. Paul University Philippines
• Roison Andro Narvaez, MSN, RN is a Registered nurse in the Philippines and a Professor of Graduate of St. Paul University Philippines

Acknowledgments

This paper is being acknowledged as part of the capstone requirements of St. Paul University Philippines