Why Bystanders Decline Telephone Cardiac Resuscitation Advice

Abstract

Objectives: The aim of this study was to evaluate the rate and reason for refusal of telephone-based cardiopulmonary resuscitation (CPR) instruction by bystanders after the implementation of the dispatch center's systematic telephone CPR protocol.Methods: Over a 15-month period the authors prospectively collected all case records from the emergency medical services (EMS) dispatch center when CPR had been proposed to the bystander calling in and recorded the reason for declining or not performing that the bystander spontaneously mentioned. All pediatric and adult traumatic and nontraumatic cases were included. Situations when resuscitation had been spontaneously initiated by bystanders were excluded.Results: During the study period, dispatchers proposed CPR on 264 occasions: 232 adult nontraumatic cases, 17 adult traumatic cases, and 15 pediatric (traumatic and nontraumatic) cases. The proposal was accepted in 163 cases (61.7%, 95% confidence interval [CI] = 54.6% to 66.5%), and CPR was eventually performed in 134 cases (51%, 95% CI = 43.2% to 55.3%). In 35 of the cases where resuscitation was not carried out, the condition of the patient or conditions at the scene made this decision medically appropriate. Of the remaining 95 cases, 55 were due to physical limitations of the caller, and 33 were due to emotional distress. Conclusions:The telephone CPR acceptance rate of 62% in this study is comparable to those of other similar studies. Because bystanders' physical condition is one of the keys to success, the rate may not improve as the population ages.

Factors associated with quality of bystander CPR: The presence of multiple rescuers and bystander-initiated CPR without instruction

“…Previous simulation studies reported that the time passed since the most recent BLS training affects CPR quality [19,20]; However, the present analyses revealed no association between BCPR quality and the duration of BLS training of bystanders within the last three years. In reality, bystander initiative may be more predictive of CPR quality than the time passed since BLS training because even trained bystanders suffer physical and emotional stress during OHCAs [21][22][23].…”

Official lay basic life support courses in Germany: is delivered content up to date with the guidelines? An observational study

“…The main focus should lie on the statement that dispatchers will guide the rescuer through every step of action, including specific assistance in CPR. Participants of most observed courses will not be aware of the option of dispatcher-assisted CPR, and will be less likely to accept this support 28. Dispatcher-assisted CPR was explicitly mentioned in the 2010 guidelines, but meaningful communication with dispatch had already been significant before.…”

Survey of a Protocol to Increase Appropriate Implementation of Dispatcher-Assisted Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest

“…Because both the emotional and physical conditions of bystanders have been reported to influence bystander compliance with DA-CPR, 7 it may be very difficult to further improve the acceptance rate of DA-CPR. 23 Because the key words used by dispatchers included specific locations (bathroom, washroom, and bedroom) and because family members were accessible for DA-CPR, at-home cardiac arrest was associated with a high incidence of providing DA-CPR but a low rate of bystander compliance with DA-CPR. These characteristics of at-home arrest suggest that the public perception of DA-CPR in our community should be improved to increase the reliability of this procedure.…”