Dispatcher-Assisted Cardiopulmonary Resuscitation

Abstract

Background-Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR), in which 9-1-1 dispatchers provide CPR instructions over the telephone, has been shown to nearly double the rate of bystander CPR. We sought to identify factors that hampered the identification of cardiac arrest by 9-1-1 dispatchers and prevented or delayed the provision of dispatcher-assisted CPR chest compressions. Methods and Results-We reviewed dispatch recordings for 476 out-of-hospital cardiac arrests occurring between January 1, 2011, and December 31, 2011. We found that the dispatcher correctly identified cardiac arrest in 80% of reviewed cases and 92% of cases in which they were able to assess patient consciousness and breathing. The median time to recognition of the arrest was 75 seconds. Chest compressions following dispatcher-assisted CPR instructions occurred in 62% of cases when the dispatcher had the opportunity to asses for consciousness and breathing and bystander CPR was not already started. The median time to first dispatcher-assisted CPR chest compression was 176 seconds. Conclusions-Dispatchers are able to accurately diagnose cardiac arrest over the telephone, but recognition is likely not possible in all circumstances. In some cases, recognition of cardiac arrest may be improved through training in the detection of agonal respirations. Delays in the delivery of dispatcher-assisted CPR chest compressions are common and are attributable to a mixture of dispatcher behavior and factors beyond the control of the dispatcher. Performance standards for the successful and quick recognition of cardiac arrest and delivery of first chest compressions should be adopted as metrics against which emergency medical services systems can measure their performance. Lewis et alTimeliness of Dispatcher-Assisted CPR 1523 CPR program in 1982. 11 Dispatchers undergo 32 hours of emergency medical training, with 6 hours dedicated to the recognition of cardiac arrest and delivery of CPR instructions over the telephone. Dispatchers receive 8 hours of continuing education each year and undergo regular performance evaluations to ensure that quality assurance standards are met. For the purposes of this study, we use the term dispatcher to refer to the person responsible for questioning and giving instructions to the 9-1-1 caller, although this term may not be used in all emergency response systems. In the 2 communications centers participating in this study, the dispatcher handles only 1 call at a time and stays on the line until the call is terminated.Dispatchers are trained to approach every call with a high index of suspicion for cardiac arrest and to assertively provide CPR instructions in cases of suspected arrest. After the incident address is confirmed, protocol dictates that dispatchers ask every caller 2 questions: "Is the patient conscious?" and "Is the patient breathing normally?" If the caller answers no to both questions, then the patient is presumed to be in cardiac arrest and CPR instructions are provided. The protocol allows dispatc...

Performance review of regional emergency medical service pre‐arrival cardiopulmonary resuscitation with or without dispatcher instruction: a population‐based observational study

“…The success of DACPR in getting bystander CPR started has not been well investigated. Recent studies showed that success rates are reported to be 40% and 50% 15, 16. Although the success rate of DACPR was less than 50% in this study, dispatcher instructions for CPR was effective for ongoing CPR (128/162 [79.0%]).…”

“…Dispatch‐assisted CPR is not a straightforward procedure and there can be many obstacles that prevent CPR instruction. Studies that reviewed the performance of DACPR have revealed that a certain proportion of CA cases were not eligible for CPR instruction because of callers’ refusal or physical factors 15, 16. In this current study, these were the major barriers to CPR instruction.…”

“…Dispatchers chose barriers described on the sheet when they encountered obstacles to provision of CPR instruction. These barriers were: the caller rejected CPR instruction, the caller was emotionally distressed, the caller left or hung up the phone, the caller was not with the patient, the caller had difficulty accessing the patient, the caller had physical limitations preventing CPR, the caller was unable to move the patient to a hard, flat surface, the caller knew how to perform CPR, and rigor mortis 14, 15, 16…”

Effectiveness of dispatcher training in increasing bystander chest compression for out‐of‐hospital cardiac arrest patients in Japan

“…Since Carter et al 8. proposed that a CPR instruction to give five ventilations and chest compressions for 5 min should be given to a bystander by telephone in 1984, many reports have suggested that dispatchers are able to diagnose cardiac arrest over the telephone accurately, and dispatchers’ oral guidance may increase chest compressions by bystanders and improve patients’ outcomes 9, 10, 11, 12, 13, 14, 15…”

Resuscitation in the dental practice

“…Agonal breathing is common in the first few minutes following a cardiac arrest and, if correctly identified as a sign of cardiac arrest, is associated with higher survival rates. 1 Always be suspicious of cardiac arrest in a patient who presents with seizures: carefully check if the patient is breathing normally Immediately following cardiac arrest, because cerebral blood flow is reduced to almost zero, a short seizure-like episode may be witnessed that could be confused with epilepsy. Dental staff should be suspicious of cardiac arrest in any patient presenting with seizures.…”