ObjectiveThis study determined the impact of the caller’s emotional state and cooperation on out-of-hospital cardiac arrest (OHCA) recognition and dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) performance metrics.MethodsThis was a retrospective study using data from November 2015 to October 2016 from the emergency medical service dispatching centre in northern Taiwan. Audio recordings of callers contacting the centre regarding adult patients with non-traumatic OHCA were reviewed. The reviewers assigned an emotional content and cooperation score (ECCS) to the callers. ECCS 1–3 callers were graded as cooperative and ECCS 4–5 callers as uncooperative and highly emotional. The relation between ECCS and OHCA recognition, time to key events and DA-CPR delivery were investigated.ResultsOf the 367 cases, 336 (91.6%) callers were assigned ECCS 1–3 with a good inter-rater reliability (k=0.63). Dispatchers recognised OHCA in 251 (68.4%) cases. Compared with callers with ECCS 1, callers with ECCS 2 and 3 were more likely to give unambiguous responses about the patient’s breathing status (adjusted OR (AOR)=2.6, 95% CI 1.1 to 6.4), leading to a significantly higher rate of OHCA recognition (AOR=2.3, 95% CI 1.1 to 5.0). Thirty-one callers were rated uncooperative (ECCS 4–5) but had shorter median times to OHCA recognition and chest compression (29 and 122 s, respectively) compared with the cooperative caller group (38 and 170 s, respectively). Nevertheless, those with ECCS 4–5 had a significantly lower DA-CPR delivery rate (54.2% vs 85.9%) due to ‘caller refused’ or ‘overly distraught’ factors.ConclusionsThe caller’s high emotional state is not a barrier to OHCA recognition by dispatchers but may prevent delivery of DA-CPR instruction. However, DA-CPR instruction followed by first chest compression is possible despite the caller’s emotional state if dispatchers are able to skilfully reassure the emotional callers.

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Introduction: Abdominal pain is a common cause of emergency department (ED) visits, and non-specific abdominal pain (NSAP) accounts for a large proportion of diagnoses. Patients with severe mental illness (SMI) are particularly vulnerable due to their atypical disease presentation and high comorbidity rates. Previous studies have reported higher ED revisit rates and delayed diagnoses in patients with SMI and NSAP. This study aimed to evaluate ED management, unscheduled ED revisit rates, and short-term adverse outcomes in patients with SMI and NSAP.Methods: Relying on the Chang Gung Research Database (CGRD), we selectively used data from January 1, 2007, to December 31, 2017. Diagnoses of NSAP and SMI were confirmed by combining the ICD codes with relevant medical records. The non-SMI group was matched at a ratio of 1:3 using a Greedy algorithm. The outcomes were ED management, 72-hour unscheduled ED revisits, and 7-day adverse events.Results: A total of 233,671 patients from seven hospitals over a span of 11 years were recruited; among them, 98,722 were excluded based on the inclusion criteria, leaving 134,949 patients for analysis. The SMI group had more comorbidities, a higher rate of 72-hour unscheduled ED revisits, and was more likely to receive analgesics, but less likely to undergo laboratory tests and CT scans. Patients without SMI were more likely to be admitted to the ward and undergo invasive abdominal procedures within seven days after index ED discharge. No significant differences were found in ICU admission, abdominal surgery, or in-hospital mortality between the two groups.Conclusion: Our study demonstrated that patients with SMI and NSAP had a higher rate of 72-hour unscheduled ED revisits, but this did not lead to higher short-term adverse outcomes. Although NSAP is considered a safe diagnosis for both the general population and patients with SMI, the higher rate of unscheduled ED revisits suggests the need for better healthcare interventions to eliminate health disparities in this vulnerable group.