Effect of a Medical Priority Dispatch System key question addition in the seizure/convulsion/fitting protocol to improve recognition of ineffective (agonal) breathing

Clawson, Jeff; Olola, Christopher; Scott, Greg; Heward, Andy; Patterson, Brett

doi:10.1016/j.resuscitation.2008.06.006

Cited by 45 publications

(37 citation statements)

References 7 publications

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“…This may interfere with a dispatcher's proper recognition of cardiac arrest and may lead to "no further exploration" by the dispatcher because snoring, abnormal motion or convulsions, and emesis are common symptoms of acute illnesses other than cardiac arrest [31,32]. These failures may be minimised by teaching dispatchers that agonal breathing, anoxic convulsions and emesis or regurgitation often occur in OHCA patients [8][9][10][27][28][29]. We also realised that dispatchers frequently fail to attempt telephone-CPR for OHCAs that are witnessed after the emergency call.…”

Section: Discussionmentioning

confidence: 99%

“…Our project was implemented in March 2007 and is presently being continued. The project consists of the following: 1) enforcement of a uniform telephone-CPR manual for CC-only CPR, 2) a standard educational approach on how to detect and recognise OHCAs with agonal breathing [6,7], emesis [8] and anoxic seizure [9,10] as well as an impending cardiac arrest [11] …”

Section: Cqi Project For Telephone-cprmentioning

confidence: 99%

“…The project included the following: 1) a standardized manual for instruction on chest-compression-only CPR (CC-only CPR), 2) education on how to recognise OHCAs with agonal breathing [6,7], emesis [8] and convulsion [9,10], 3) recognition of an impending cardiac arrest [11], 4) recommendations for on-line or redialling instructions for patients with impending cardiac arrest [12,13], 5) instructions on the use of a cellular phone as a communication device at the scene [14], and 6) feedback from emergency physicians and EMT supervisors to dispatchers.…”

Section: Introductionmentioning

confidence: 99%

“…The project included the following: 1) a standardized manual for instruction on chest-compression-only CPR (CC-only CPR), 2) education on how to recognise OHCAs with agonal breathing [6,7], emesis [8] and convulsion [9,10] The purpose of this study was to investigate the effects of the CQI project on the incidences of telephone-CPR and CPR before EMT arrival. This study also investigated the effects of the project on the time factors and outcomes of individuals experiencing an OHCA that was recognised or witnessed by citizens and not witnessed by EMTs.…”

mentioning

confidence: 99%

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The continuous quality improvement project for telephone-assisted instruction of cardiopulmonary resuscitation increased the incidence of bystander CPR and improved the outcomes of out-of-hospital cardiac arrests

et al. 2012

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(CQI) project for telephone-assisted cardiopulmonary resuscitation (telephone-CPR), which included instruction on chest-compression-only CPR, education on how to recognise out-of-hospital cardiac arrests (OHCAs) with agonal breathing, emesis and convulsion, recommendations for on-line or redialling instructions, and feedback from emergency physicians. This study aimed to investigate the effect of this project on the incidence of bystander CPR and the outcomes of OHCAs.Materials and Methods: The baseline data were prospectively collected on 4995 resuscitation-attempted OHCAs, which were recognised or witnessed by citizens rather than emergency medical technicians during the period of February 2004 to March 2010. The incidence of telephone-CPR and bystander CPR, as well as the outcomes of the OHCAs, were compared before and after the project.Results: The incidence of telephone-CPR and bystander CPR significantly increased after the project (from 42% to 62% and from 41% to 56%, respectively). The incidence of failed telephone-CPR due to human factors significantly decreased from 30% to 16%. The outcomes of OHCAs significantly improved after the projects. A multiple logistic regression analysis revealed that the CQI project is one of independent factors associated with one-year (1-Y) survival with favourable neurological outcomes (odds ratio = 1.81, 95% confidence interval = 1.20-2.76).Conclusions: The CQI project for telephone-CPR increased the incidence of bystander CPR and improved the outcome of OHCAs. A CQI project appeared to be essential to augment the effects of telephone-CPR.Keywords: Telephone-CPR; Continuous quality improvement; Cardiopulmonary resuscitation; Dispatcher; Emergency medical service; Out-of-hospital cardiac arrest INTRODUCTION Currently, medical control (MC) for the emergency medical service system (EMS) is active in Japan.However, MC, including education, is mainly targeted to emergency medical technicians (EMTs) and is rarely targeted to dispatchers in Japan. Since February 2004, the Ishikawa MC Council has requested that fire departments collect the reasons why dispatchers failed to provide telephone-assisted instruction on cardiopulmonary resuscitation (telephone-CPR). Telephone-CPR has been shown to increase the incidence of bystander CPR and is expected to improve the outcomes of out-of-hospital cardiac arrests (OHCAs) [1][2][3][4][5].There are no special qualifications or authorisations required for fire department staff to be dispatchers in Japan. Some dispatchers have no experience as EMTs. An educational program for dispatchers has not been established. In some fire departments, the actual condition of the OHCA patient, discovered by EMTs during a post-arrival interview, is not relayed back to the dispatchers.In March of 2007, the Ishikawa MC Council initiated the Continuous Quality Improvement (CQI) project for telephone-CPR. The project included the following: 1) a standardized manual for instruction on chest-compression-only CPR (CC-only CPR), 2) education on how to recognise OH...

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Section: Discussionmentioning

confidence: 99%

Section: Cqi Project For Telephone-cprmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…The project included the following: 1) a standardized manual for instruction on chest-compression-only CPR (CC-only CPR), 2) education on how to recognise OHCAs with agonal breathing [6,7], emesis [8] and convulsion [9,10] The purpose of this study was to investigate the effects of the CQI project on the incidences of telephone-CPR and CPR before EMT arrival. This study also investigated the effects of the project on the time factors and outcomes of individuals experiencing an OHCA that was recognised or witnessed by citizens and not witnessed by EMTs.…”

mentioning

confidence: 99%

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The continuous quality improvement project for telephone-assisted instruction of cardiopulmonary resuscitation increased the incidence of bystander CPR and improved the outcomes of out-of-hospital cardiac arrests

et al. 2012

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“…In addition, dispatchers frequently fail to recognize signs of impending cardiac arrests 9, 16, 17, 18. Thus, skills training to dispatchers is crucial.…”

Section: Introductionmentioning

confidence: 99%

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

Tsunoyama

Nakahara

Yoshida

et al. 2017

Acute Medicine & Surgery

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AimThe Japanese government has developed a standardized training program for emergency call dispatchers to improve their skills in providing oral guidance on chest compression to bystanders who have witnessed out‐of‐hospital cardiac arrests (OHCAs). This study evaluated the effects of such a training program for emergency call dispatchers in Japan.MethodsThe analysis included all consecutive non‐traumatic OHCA patients transported to hospital by eight emergency medical services, where the program was implemented as a pilot project. We compared the provision of oral guidance and the incidence of chest compression applications by bystanders in the 1‐month period before and after the program. Data collection was undertaken from October 2014 to March 2015.ResultsThe 532 non‐traumatic OHCA cases were used for analysis: these included 249 cases before and 283 after the guidance intervention. Most patients were over 75 years old and were men. After the program, provision of oral guidance to callers slightly increased from 63% of cases to 69% (P = 0.13) and implementation of chest compression on patients by bystanders significantly increased from 40% to 52% (P = 0.01). Appropriate chest compression also increased from 34% to 47% (P = 0.01). In analysis stratified by the provision of oral guidance, increased chest compressions were observed only under oral guidance.ConclusionsWe found increased provision of oral guidance by dispatchers and increased appropriate chest compressions by bystanders after the training program for dispatchers had been rolled out. Long‐term observation and further data analysis, including patient outcomes, are needed.

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EMS dispatch

Clawson¹

2015

Emergency Medical Services

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Effect of a Medical Priority Dispatch System key question addition in the seizure/convulsion/fitting protocol to improve recognition of ineffective (agonal) breathing

Cited by 45 publications

References 7 publications

The continuous quality improvement project for telephone-assisted instruction of cardiopulmonary resuscitation increased the incidence of bystander CPR and improved the outcomes of out-of-hospital cardiac arrests

The continuous quality improvement project for telephone-assisted instruction of cardiopulmonary resuscitation increased the incidence of bystander CPR and improved the outcomes of out-of-hospital cardiac arrests

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

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