EIT 6312 Terminology for individuals or teams attending patients in cardiac arrest – A scoping review: TF ScR

Conflict of Interest Declaration

The ILCOR Continuous Evidence Evaluation process is guided by a rigorous ILCOR Conflict of Interest policy. No Task Force members or other authors were recused from the discussion as they declared a conflict of interest.

The following Task Force members and other authors declared an intellectual conflict of interest and this was acknowledged and managed by the Task Force Chairs and Conflict of Interest committees: Bibiana Metelmann, Camilla Metelmann, Sebastian Schnaubelt, and Robert Greif are authors of one of the analyzed publications. Robert Greif is the ERC Director of Guidelines and ILCOR; the ILCOR Task force Education, Implementation, and Teams chair, and member of the editorial board of Resuscitation Plus.

Task Force Synthesis Citation

Sebastian Schnaubelt, Sabine Nabecker, Alexander Olaussen, Andrea Cortegiani, Cristian Abelairas-Gomez, Kathryn Eastwood, Robert Greif. Terminology for individuals or teams attending patients in cardiac arrest Force Synthesis of a Scoping Review [Internet] Brussels, Belgium: International Liaison Committee on Resuscitation (ILCOR) Education, Implementation and Teams Task Force, 2025 September 15.  Available from: http://ilcor.org

Methodological Preamble

The continuous evidence evaluation process started with a scoping review on the terminology used to describe individuals or teams attending patients in cardiac arrest. The review was conducted by the ILCOR Education, Implementation and Teams Task Force, supported by external experts. Evidence for all settings (out-of-hospital and in-hospital, adult and pediatric) was sought and synthesized in accordance with ILCOR guidance and PRISMA-ScR methodology.

Scoping Review

Webmaster to insert the Scoping Review citation and link to Pubmed using this format when/if it is available.

PICOST

The PICOST (Population, Intervention, Comparator, Outcome, Study Designs and Timeframe) 

Population:  All individuals and teams attending patients with cardiac arrest of any age in any setting (lay persons or healthcare professionals, witnesses or dispatched responders).

Intervention: Terms and definitions used to describe such individuals or teams.

Comparators:  Not applicable (descriptive scoping review).

Outcomes: Terms and definitions

Study Designs:  All types of published peer-reviewed literature (RCTs, observational studies, reviews, consensus papers, commentaries, editorials). Excluded were articles without explicit definitions, other emergencies than resuscitation, or the simple use of terms without explanation.

Timeframe: All from inception until 06/2025.

Search Strategies

We searched MEDLINE (Ovid), Embase (Ovid), Web of Science (Clarivate), and Scopus (Elsevier) from inception to last updated on 5 June 2025. The search strategy was developed using input from an ILCOR Task Force survey including the Task Forces BLS, ALS, PLS, NLS, FA, and EIT (21 responses, yielding 48 terms: AED provider, ALS provider, Ambulance, Associate ambulance practitioner, Attendee, BLS provider, British Association for Immediate Care (BASICS), Bystander, Caretaker, Co-responder, Code blue team, Combat Medic, Community first responder (CFR), Do-gooder, Doctor / Physician, Emergency care assistant, Emergency care practitioner, Emergency Care Response Unit (ECRU), Emergency medical service (EMS), Emergency medical team, Emergency medical technician (EMT), Emergency medicine specialist, Firefighter / fire fighter / fire officer, First aid responder, First aider, First responder (FR), Hazardous area response team (HART), Helicopter EMS (HEMS), Helper, Lay rescuer, Layperson, Layperson rescuer, Life saver, Medic, Medical responder, Nurse, Paramedic, Police / Policeman, Professional first responder, Provider, Rescue squad, Rescue Squad Member, Rescuer, Responder, Resuscitation team, Resuscitationist, Samaritan, Witness).

A custom-built ChatGPT 4.0 model (programmed by AO) generated a draft search strategy, which was refined by an information specialist at the Medical University of Vienna. The strategy combined terminology-related keywords with descriptors of individuals attending cardiac arrest (e.g. “bystander”, “first responder”, “layperson”). The full strategy is provided in Supplement 1.

Inclusion and Exclusion criteria

Inclusion: Peer-reviewed articles in English (as translation of terms from other languages into English would not reflect their cultural-linguistic background) providing definitions or structured terminology for individuals or teams attending a cardiac arrest (any age, setting, role, or affiliation).

Exclusion: Articles without definitions or explanations of used terms, describing individuals or teams attending other emergencies, or merely using terms without further explanation. Grey literature was not included.

Supplement 1: Search Strategy

First Responders Concept:

(("Emergency Responders"[MeSH] OR "First Responders"[MeSH] OR "Health Personnel"[MeSH] OR "Paramedics"[MeSH] OR "Emergency Medical Technicians"[MeSH]) OR (layperson OR "lay person" OR "lay-person" OR "lay rescuer" OR "lay-rescuer" OR "layperson rescuer" OR "lay person rescuer"
OR bystander OR attendee OR "do-gooder" OR witness OR provider OR helper OR samaritan OR rescuer OR "first aider" OR "first aid responder" OR "life saver" OR "medical responder" OR responder OR "co-responder" OR "first responder" OR FR OR "community first responder" OR CFR OR "professional first responder" OR "BLS-provider" OR "BLS provider" OR "ALS-provider" OR "ALS provider" OR "AED-provider" OR "AED provider" OR "emergency medical service" OR EMS OR paramedic OR ambulance OR "emergency medical technician" OR EMT OR "rescue squad" OR medic OR "emergency care assistant" OR "associate ambulance practitioner" OR "emergency care practitioner" OR police OR policeman OR firefighter OR "fire fighter" OR "fire officer" OR nurse OR doctor OR physician OR "emergency medicine specialist" OR resuscitationist OR "emergency medical team" OR "resuscitation team" OR "code blue team" OR BASICS OR "British Association for Immediate Care" OR HART OR "hazardous area response team" OR HEMS OR ECRU OR "emergency care response unit" OR "rescue squad member" OR "combat medics"))

Nomenclature/Definition Concept:

(("Terminology as Topic"[MeSH] OR "Definitions"[MeSH] OR "Nomenclature"[MeSH] OR "Classification"[MeSH] OR "Taxonomy"[MeSH] OR "Semantics"[MeSH] OR "Descriptors"[MeSH])
OR (defin* OR describ* OR discussion* OR terminology* OR nomenclature* OR taxonom* OR term* OR phrase* OR label* OR naming* OR classification* OR semantic* OR descriptor* OR role* OR concept* OR identify OR meaning OR framework OR characterization OR interpretation OR "role definition" OR "role description" OR "conceptual framework" OR "conceptual model" OR glossary OR lexicon OR vocabulary))

Cardiac Arrest Concept:

(("Resuscitation"[MeSH] OR "Cardiopulmonary Resuscitation"[MeSH] OR "Heart Arrest"[MeSH] OR "Cardiopulmonary Arrest"[MeSH] OR "Ventricular Fibrillation"[MeSH] OR "Asystole"[MeSH] OR "Emergency Medical Services"[MeSH]) OR (resuscitat* OR ((cardiac OR heart) adj2 (massag* OR compression*)) OR (chest adj2 compression*) OR CPR OR "basic life support" OR "basic cardiac life support" OR BCLS OR BLS OR "advanced life support" OR ALS OR "advanced cardiac life support" OR ACLS OR "automated external defibrillator*" OR "automatic external defibrillator*" OR AED OR AEDs OR "cardiac arrest" OR "heart arrest" OR "sudden cardiac arrest" OR SCA OR "ventricular fibrillation" OR VF OR asystole OR "cardiopulmonary arrest" OR "cardiovascular arrest" OR "emergency response" OR "prehospital care" OR "emergency medical care" OR "code blue" OR "life-saving care" OR "emergency defibrillation" OR "chest compression-only CPR" OR "hands-only CPR" OR "shockable rhythm" OR defibrillat* OR "out-of-hospital cardiac arrest" OR OHCA OR "community resuscitation" OR "early defibrillation" OR "chain of survival"))

Data Table: Table 1 Summary EIT 6312

Task Force Insights

1. Why this topic was reviewed.

This topic was chosen by the EIT Task Force because terminology to describe individuals or teams attending cardiac arrest was found inconsistent in published articles on resuscitation. The vast majority of resuscitation articles for OHCA and IHCA used such terms but only a few articles defined the terms used. This hampers comparability of registries and studies, and poses challenges for implementation, education, and communication.

2. Narrative summary of evidence identified

After screening of 7,148 records and duplicate removal, 23 full texts were assessed. Nine studies were included, most of them are Utstein updates or consensus documents from high-income countries (Table 1). Six (5, 7, 10, 16, 20, 23) provided structured definitions (e.g., bystander, first responder, volunteer community responder, rapid response team). However, definitions varied widely, especially regarding bystanders (including or excluding off-duty professionals) or are lacking (e.g. lay person, first aider). Three studies highlighted inconsistencies without offering formal definitions (2, 8, 11). Terminology for IHCA remained especially unclear.

3. Narrative Reporting of the task force discussions

Most reports were publications from large multinational authorship groups and it is unknown whether these publications reflect the linguistic or cultural background of the entire group of authors.

The Task Force identified substantial heterogeneity in terminology of individuals or teams responding to cardiac arrest across all settings was found. No studies address terminology in low-resource settings.

Currently, there is no clear set of terminology that is universally accepted covering all aspects of IHCA and OHCA across different contexts. Of note, the survey among the ILCOR Task Forces alone resulted in a multitude of different terms, often only with linguistic differences and sometimes with cultural/ regional aspects (e.g., with different First Responder systems).

The most recent Utstein template (5) represents ILCOR's iterative consensus with international input defining individuals or teams attending OHCA, defining roles primarily from a registry perspective. This scoping review opens the question of whether terminology defined for use in registries can be generalized for use in implementation science, resuscitation education, or legal frameworks. For example, in some contexts, it may be important to define the level of training of responders or health care professionals, as: untrained, BLS-trained, or ALS-trained.

Also, no study was found addressing barriers and facilitators that could influence effective implementation of recently formulated definitions from research and registries, or other definitions for implementation or education.

Future consensus statements should follow the current ILCOR standards of Utstein statements and integrate prior Utstein consensus definitions for OHCA, while addressing gaps in terminology related to IHCA and different kinds of first responders for OHCA. Ideally, such input should include key stakeholders such as healthcare professionals, resuscitation educators, scientists, health policy makers, administrators, patient representatives and lay persons, best from different resource settings and cultural areas.

There was no previous treatment recommendation, and none has been generated.

Knowledge Gaps

• How terminology varies in low-income countries, to enable generalizability of findings to global settings.

• Standard international terminology for in-hospital cardiac arrest responders (e.g., rapid response teams, resuscitation teams).

• Clarification is needed to determine if registry terminology is generalizable to implementation science, resuscitation education or legal frameworks.

References

1. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology. 2005 Feb 1;8(1):19–32.
2. Chamberlain D, Cummins R, Abramson N, Allen M, Baskett P, Becker L, et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest (new abridged version). The ‘Utstein style’. The European Resuscitation Council, American Heart Association, Heart and Stroke Foundation of Canada, and Australian Resuscitation Council. Br Heart J. 1992 Apr;67(4):325–33.
3. Cooke A, Smith D, Booth A. Beyond PICO: The SPIDER Tool for Qualitative Evidence Synthesis. Qual Health Res. 2012 Oct 1;22(10):1435–43.
4. Cummins RO, Chamberlain DA, Abramson NS, Allen M, Baskett PJ, Becker L, et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: The utstein style: A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, and Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation. 1991;84(2):960–75.
5. Gräsner JT, Bray JE, Nolan JP, Iwami T, Ong MEH, Finn J, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: 2024 update of the Utstein Out-of-Hospital Cardiac Arrest Registry template. Resuscitation [Internet]. 2024 Aug 1 [cited 2024 Oct 7];201. Available from: https://www.resuscitationjourn...(24)00182-5/fulltext
6. ILCOR Science Advisory Committee Guidance and Templates [Internet]. [cited 2025 May 4]. International Liaison Committee on Resuscitation. Available from: https://www.ilcor.org/document...;
7. Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa). Resuscitation. 2004 Dec;63(3):233–49.
8. Maurer H, Masterson S, Tjelmeland IB, Gräsner JT, Lefering R, Böttiger BW, et al. When is a bystander not a bystander any more? A European survey. Resuscitation. 2019 Mar;136:78–84.
9. Metelmann C, Metelmann B, Kohnen D, Brinkrolf P, Andelius L, Böttiger BW, et al. Smartphone-based dispatch of community first responders to out-of-hospital cardiac arrest – statements from an international consensus conference. Scand J Trauma Resusc Emerg Med. 2021 Feb 1;29(1):29.
10. Metelmann C, Metelmann B, Müller MP, Scquizzato T, Baldi E, Barry T, et al. Defining the terminology of first responders alerted for out-of-hospital cardiac arrest by medical dispatch centres: An international consensus study on nomenclature. Resusc Plus. 2025 Mar;22:100912.
11. Nolan JP, Berg RA, Andersen LW, Bhanji F, Chan PS, Donnino MW, et al. Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Template for In-Hospital Cardiac Arrest: A Consensus Report From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia). Resuscitation. 2019 Nov;144:166–77.
12. Olasveengen TM, Semeraro F, Ristagno G, Castren M, Handley A, Kuzovlev A, et al. European Resuscitation Council Guidelines 2021: Basic Life Support. Resuscitation. 2021 Apr;161:98–114.
13. Otto Q, Nolan JP, Chamberlain DA, Cummins RO, Soar J. Utstein Style for emergency care — the first 30 years. Resuscitation. 2021 Jun 1;163:16–25.
14. Oving I, Masterson S, Tjelmeland IBM, Jonsson M, Semeraro F, Ringh M, et al. First-response treatment after out-of-hospital cardiac arrest: A survey of current practices across 29 countries in Europe. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2019;27(1).
15. Oving I, de Graaf C, Masterson S, Koster RW, Zwinderman AH, Stieglis R, et al. European first responder systems and differences in return of spontaneous circulation and survival after out-of-hospital cardiac arrest: A study of registry cohorts. Lancet Reg Health Eur. 2020 Nov 20;1:100004.
16. Perkins GD, Jacobs IG, Nadkarni VM, Berg RA, Bhanji F, Biarent D, et al. Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: A Statement for Healthcare Professionals From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Resuscitation. 2015 Nov;96:328–40.
17. Peters DH, Adam T, Alonge O, Agyepong IA, Tran N. Implementation research: what it is and how to do it. BMJ. 2013 Nov 20;347:f6753.
18. Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al. Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda. Adm Policy Ment Health. 2011;38(2):65–76.
19. Semeraro F, Greif R, Böttiger BW, Burkart R, Cimpoesu D, Georgiou M, et al. European Resuscitation Council Guidelines 2021: Systems saving lives. Resuscitation. 2021 Apr;161:80–97.
20. Tirkkonen J, Tamminen T, Skrifvars MB. Outcome of adult patients attended by rapid response teams: A systematic review of the literature. Resuscitation. 2017 Mar;112:43–52.
21. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018 Oct 2;169(7):467–73.
22. World Bank Country and Lending Groups – World Bank Data Help Desk [Internet]. [cited 2022 Nov 6]. Available from: https://datahelpdesk.worldbank...;
23. Zaritsky A, Nadkarni V, Hazinski MF, Foltin G, Quan L, Wright J, et al. Recommended guidelines for uniform reporting of pediatric advanced life support: the pediatric Utstein style. Ann Emerg Med. 1995 Oct;26(4):487–503.