Telephone CPR Instructions in Emergency Dispatch Systems: Qualitative Survey of 911 Call Centers

Abstract

IntroductionOut-of-hospital cardiac arrest (OHCA) is a leading cause of death. The 2010 American Heart Association Emergency Cardiovascular Care (ECC) Guidelines recognize emergency dispatch as an integral component of emergency medical service response to OHCA and call for all dispatchers to be trained to provide telephone cardiopulmonary resuscitation (T-CPR) pre-arrival instructions. To begin to measure and improve this critical intervention, this study describes a nationwide survey of public safety answering points (PSAPs) focusing on the current practices and resources available to provide T-CPR to callers with the overall goal of improving survival from OHCA.MethodsWe conducted this survey in 2010, identifying 5,686 PSAPs; 3,555 had valid e-mail addresses and were contacted. Each received a preliminary e-mail announcing the survey, an e-mail with a link to the survey, and up to three follow-up e-mails for non-responders. The survey contained 23 primary questions with sub-questions depending on the response selected.ResultsOf the 5,686 identified PSAPs in the United States, 3,555 (63%) received the survey, with 1,924/3,555 (54%) responding. Nearly all were public agencies (n=1,888, 98%). Eight hundred seventy-eight (46%) responding agencies reported that they provide no instructions for medical emergencies, and 273 (14%) reported that they are unable to transfer callers to another facility to provide T-CPR. Of the 1,924 respondents, 975 (51%) reported that they provide pre-arrival instructions for OHCA: 67 (3%) provide compression-only CPR instructions, 699 (36%) reported traditional CPR instructions (chest compressions with rescue breathing), 166 (9%) reported some other instructions incorporating ventilations and compressions, and 92 (5%) did not specify the type of instructions provided. A validation follow up showed no substantial difference in the provision of instructions for OHCA by non-responders to the survey.ConclusionThis is the first large-scale, nationwide assessment of the practices of PSAPs in the United States regarding T-CPR for OHCA. These data showing that nearly half of the nation’s PSAPs do not provide T-CPR for OHCA, and very few PSAPs provide compression-only instructions, suggest that there is significant potential to improve the implementation of this critical link in the chain of survival for OHCA.

Parents’ experiences of the caring encounter in the ambulance service—A qualitative study

“…Dispatchers who gave parents information on how to prepare while waiting also helped the parents to feel needed, and the prearrival information helped the parents to become more composed while waiting. These findings confirm the importance of dispatchers giving instructions before the ambulance arrives, as shown in previous studies (Billittier, Lerner, Tucker, & Lee, ; O’Cathain, Turner, & Nicholl, ; Sutter et al, ). When the ambulance arrived, some of the parents actively handed over the responsibility of the care for their child and they described a sense of relief when they could go back to being just a parent.…”

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

“…The delivery of CPR instructions to callers by telecommunicators can have a significant impact on both CPR use and survival. 27, 28 However, its effectiveness declines rapidly with each minute after a patient collapses. 29 …”

Mobile phone-based alerting of CPR-trained volunteers simultaneously with the ambulance can reduce the resuscitation-free interval and improve outcome after out-of-hospital cardiac arrest: A German, population-based cohort study

“…Bystander-CPR for witnessed OHCA is believed to strongly influence survival to hospital discharge. 25 Hasselqvist-Ax et al analysed more than 30,000 witnessed OHCA in Sweden. They showed that CPR performed before EMS arrival was associated with a 30-day survival rate after an OHCA that was more than twice as high as that associated with no CPR before EMS arrival.…”