Impact of the caller’s emotional state and cooperation on out-of-hospital cardiac arrest recognition and dispatcher-assisted cardiopulmonary resuscitation

Abstract

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.

When dispatcher assistance is not saving lives: assessment of process compliance, barriers and outcomes in out-of-hospital cardiac arrest in a metropolitan city in China

“…Similar to the other findings, we found that bystander barriers to CPR provision included unstable emotional state, fear of harming the victim, fear of incorrectly performing CPR and caller not with victim. [9][10][11] However, it is important to emphasise that a high proportion of callers disconnected the call during the dispatcher instructions in our study. From audio recordings, although the dispatcher explained the importance of bystander CPR, callers were unwilling to follow the instructions, perhaps believing that only medical professionals can help the victim.…”

Adult Basic Life Support

“…Negative likelihood ratio = the likelihood of a patient with confirmed cardiac arrest to be labeled negative compared with a person without cardiac arrest (the smaller the likelihood ratio, the better the test to rule out cardiac arrest). * 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 . †Patients strictly with confirmed OHCA.…”

Prognostic factors for adults with cardiac arrest in the emergency department: a retrospective cohort study

“…OHCA has been explored in terms of the steps involved in treatment: from EMS dispatch, dispatcher-assisted or bystander cardiopulmonary resuscitation (CPR) [4], public access defibrillation, and prehospital management by emergency medical services (EMSs) to survival analysis [5]. In contrast to OHCA, primary EDCA is a critical situation, but it has yet to be fully understood.…”