Disparities in telephone CPR access and timing during out-of-hospital cardiac arrest

Abstract

Aim Spanish-only speaking residents in the United States face barriers to receiving potentially life-saving 911 interventions such as Telephone -cardiopulmonary resuscitation (TCPR) instructions. Since 2015, 911 dispatchers have placed an increased emphasis on rapid identification of potential cardiac arrest. The purpose of this study was to describe the utilization and timing of the 911 system during suspected OHCA by Spanish-speaking callers in Metropolitan Phoenix, Arizona. Methods The dataset consisted of suspected OHCA from 911 centers from October 10, 2010 through December 31, 2013. Review of audio TCPR process data included whether the need for CPR was recognized by telecommunicators, whether CPR instructions were provided, and the time elements from call receipt to initiation of compressions. Results A total of 3,398 calls were made to 911 for suspected OHCA where CPR was indicated. A total of 39 (1.2%) were determined to have a Spanish language barrier. This averages to 18 calls per year with a Spanish language barrier during the study period, compared with 286 OHCAs expected per year among this population. The average time until telecommunicators recognized CPR need was 87.4 seconds for the no language barrier group compared to 160.6 seconds for the Spanish-language barrier group (p<0.001).Time to CPR instructions started was significantly different between these groups (144.4 seconds vs 231.3 seconds, respectively) (p<0.001), as was time to first compression, (174.4 seconds vs. 290.9 seconds, respectively) (p<0.001). Conclusions Our study suggests that Hispanic callers under-utilize the 911 system, and when they do call 911, there are significant delays in initiating CPR.

The present and future of cardiac arrest care: international experts reach out to caregivers and healthcare authorities

“…Language barriers for comprehension and implementation of telephone-CPR were also identified. In a recent US study that focused on Spanish-speaking callers, the average time for the dispatcher to recognize need for CPR was two times longer than with English-speaking callers, and this resulted in longer delays to first compression [24].…”

‘We’re going to do CPR’: A linguistic study of the words used to initiate dispatcher-assisted CPR and their association with caller agreement

“…There is significant room for improvement in uptake of DA-CPR instructions by callers. Two important foci of research on DA-CPR during emergency calls have been: the delays and barriers to bystanders performing CPR [3][4][5][6][7][8][9][10][11][12][13] and the specific protocol for DA-CPR. [14][15][16][17][18][19][20] Whether callers agree to attempt CPR is an issue which is distinct from, though closely connected to, whether bystander-CPR occurs.…”

The barriers and facilitators to the telephonic application of the FAST assessment for stroke in a private emergency dispatch centre in South Africa

“…With increasing migration and asylum-seeking, it is expected that language discordance between caller and call-taker may occur more commonly. Providing telephonic instructions in a caller's native language has been shown to improve compliance in the application of telephonic cardiopulmonary resuscitation [ 25 ]. It is recommended that culturally appropriate screening algorithms be developed and translated to allow for improved understanding and application.…”