“Sorry, what did you say?” Communicating defibrillator retrieval and use in OHCA emergency calls

Abstract

Background: The defibrillator prompt, which directs callers to retrieve a defibrillator during out-of-hospital-cardiac arrest, is crucial to the emergency call because it can save lives. We evaluated communicative effectiveness of the prompt instated by the Medical Priority Dispatch System TM version 13, namely: if there is a defibrillator (AED) available, send someone to get it now, and tell me when you have it.Methods: Using Conversation Analysis and descriptive statistics, we examined linguistic features of the defibrillator sequences (call-taker prompt and caller response) in 208 emergency calls where non-traumatic out of hospital cardiac arrest was confirmed by the emergency medical services, and they attempted resuscitation, in the first six months of 2019. Defibrillator sequence durations were measured to determine impact on time to CPR prompt. The proportion of cases where bystanders retrieved defibrillators was also assessed.Results: There was low call-taker adoption of the Medical Priority Dispatch System TM version 13 prompt (99/208) compared to alternative prompts (86/208) or no prompt (23/208).Caller responses to the version 13 prompt tended to be longer, more ambiguous or unrelated, and have more instances of repair (utterances to address comprehension trouble). Defibrillators were rarely brought to the scene irrespective of defibrillator prompt utilised. Conclusion:While the version 13 prompt aims to ensure the use of an available automatic external defibrillator, its effectiveness is undermined by the three-clause composition of the prompt and exclusion of a question structure. We recommend testing of a re-phrased defibrillator prompt in order to maximise comprehension and caller action.

“If you miss that first step in the chain of survival, there is no second step”–Emergency ambulance call-takers’ experiences in managing out-of-hospital cardiac arrest calls

“…Such research has helped improve our understanding of how callers answer the critical "is s/he breathing?" question [3], how they comprehend different prompts used in standardised call-handling scripts [4]; and how call-takers encourage caller compliance when they initiate CPR [5]. Research that focuses on the emergency call interaction has also highlighted the influence of critical issues in OHCA emergency calls such as language barriers [6,7] and emotion [8,9].…”

A survey on technologies used during Out of Hospital Cardiac Arrest

“…In a dispatcher assisted AED location system, the dispatcher has access to a particular platform integrated within the existing emergency services system to find the available AEDs near the patient's location 131,62,119 . This system offloads the work of finding an AED from the bystander to the dispatcher.…”

“…The second way of AED delivery is dispatcher assisted, and this method is very similar to the mobile application method of delivery discussed above 131,119,62 . The critical difference between the two methods is that the dispatcher provides the location of the nearest AED in this method.…”

Can emergency dispatch communication research go deeper?

“…Our own group’s research has focussed on a commonly used standardised protocol named the Medical Priority Dispatch System (MPDS) and has identified key barriers to bystanders providing CPR and significant linguistic aspects of OHCA call communication. 10. , 11.…”