Spontaneous trigger words associated with confirmed out-of-hospital cardiac arrest: a descriptive pilot study of emergency calls

Abstract

BackgroundAccording to the International Liaison Committee on Resuscitation (ILCOR), the trigger words used by callers that are associated with cardiac arrest constitute a scientific knowledge gap. This study was designed to find hypothetical trigger words in emergency calls in order to improve the specificity of out-of-hospital cardiac arrest recognition.MethodsIn this descriptive pilot study conducted in a Finnish hospital district, linguistic contents of 80 emergency calls of dispatcher-suspected or EMS-encountered out-of-hospital cardiac arrests between January 1, 2017 and May 31, 2017 were analysed. Spontaneous trigger words used by callers were transcribed and grouped into 36 categories. The association between the spontaneous trigger words and confirmed true cardiac arrests was tested with logistic regression.ResultsOf the suspected cardiac arrests, 51 (64%) were confirmed as true cardiac arrests when ambulance personnel met the patient. A total of 291 spontaneous trigger words were analysed. ‘Is not breathing’ (n = 9 [18%] in the true cardiac arrest group vs n = 1 [3%] in the non-cardiac arrest group, odds ratio [OR] 6.00, 95% confidence interval [CI] 0.72–50.0), ‘the patient is blue’ (n = 9 [18%] vs n = 1 [3%], OR 6.00, 95% CI 0.72–50.0), ‘collapsed or fallen down’ (n = 12 [24%] vs n = 2 [7%], OR 4.15, 95% CI 0.86–20.1) and ‘is wheezing’ (n = 17 [33%] vs n = 5 [17%], OR 2.40, 95% CI 0.78–7.40) were frequently used to describe true cardiac arrest. ‘Is snoring’ was associated with a false suspicion of cardiac arrest (n = 1 [2%] vs n = 6 [21%], OR 0.08, 95% CI 0.009–0.67).ConclusionsIn our pilot study, no trigger word was associated with confirmed cardiac arrest. ‘Is wheezing’ was a frequently used spontaneous trigger word among later confirmed cardiac arrest victims.

Whole Blood, Fixed Ratio, or Goal-Directed Blood Component Therapy for the Initial Resuscitation of Severely Hemorrhaging Trauma Patients: A Narrative Review

“…Germany, with its centralized system and relatively short transport times, uses prehospital blood products in 6% of trauma centers. Comparatively in France, the rate is 89% [ 16 ]. It is not surprising that the only European RCT for using CSWB in the civilian urban population is in France, where the time spent in the field on resuscitation efforts is longer than the “scoop and run” strategy used in the United States, where physicians are not onboard ambulances [ 107 ].…”

“…Overall, prehospital blood transfusion is safe, but the results of currently ongoing RCTs await to demonstrate a survival benefit.” [ 15 ]. However, the European Society of Anesthesiology recently reported that 48% of responders to an online survey had access to PRBCs, 22% to fresh plasma, and 14% to lyophilized plasma [ 16 ]. It is clear that there were significant dissimilarities in practice among European countries with no consensus regarding the benefit of prehospital blood products [ 16 ].…”

“…However, the European Society of Anesthesiology recently reported that 48% of responders to an online survey had access to PRBCs, 22% to fresh plasma, and 14% to lyophilized plasma [ 16 ]. It is clear that there were significant dissimilarities in practice among European countries with no consensus regarding the benefit of prehospital blood products [ 16 ]. Hence, there is a tremendous need for continued investigation in RCTs.…”

“…A follow-up systematic review of 16 randomized controlled trials (RCTs) stated similar concerns regarding the recommendations of the PROPPR trial. Given the diversity of patients with blunt or penetrating trauma and with or without TBI, additional studies are required to determine the mortality benefit of 1:1:1 vs. 1:1:2 fixed ratios [ 12 , 15 , 16 ]. Due to the concerns about the validity of the PROPPR trial, which set the standard for the fixed 1:1:1 practice, we review the reasons for the widespread adoption of CSWB in the United States for civilian urban trauma.…”

Malpractice claimed calls within the Swedish Healthcare Direct: a descriptive – comparative case study

“…Patient safety in telephone nursing can be enhanced by using a CDSS [ 7 , 8 ], but other aspects may affect the triage process. The gender of the care-seeker [ 3 ], callers self-rated worry [ 21 ] might affect the telephone nurses, and cues of physical dominance (voices with a low fundamental frequency and formant frequencies) have been shown to lead to higher evaluation of medical emergency [ 22 ]. In addition, limiting the time for each call, to increase accessibility, can result in stress [ 23 ] and, thus, negatively affect patient safety.…”