Abstract 71: Diagnosis of Cardiac Arrest by 911 Call Takers Improved with Education Without Changing Bystander CPR Rates
Context: In most out-of-hospital cardiac arrest (OHCA) events, a telephone call to 911 is the first action by bystanders. Because the 911 call taker cannot see the victim, accurate diagnosis of cardiac arrest depends on the caller's verbal description. If cardiac arrest is not suspected, then no telephone CPR instructions will be given.
Objective: We measured the impact of a change in the EMS call taker question sequence on the accuracy of diagnosis of cardiac arrest by 911 call takers.
Methods: We retrospectively reviewed the Cardiac Arrest Registry to Enhance Survival (CARES) dataset for Jan 1, 2009 through Dec 31, 2010 from a single Midwestern US city, population 750,000 with a longstanding telephone CPR instruction program (APCO). We included OHCA cases of any age who were in arrest prior to the arrival of EMS and for whom resuscitation was attempted. In early 2010, 911 call takers were retrained to follow a revised telephone script that emphasized minimal questioning, assertive control of the callers, and provision of Hands-only telephone CPR instructions. In 2010, call recordings were reviewed regularly with feedback to the call taker. The main outcome measure was sensitivity of the 911 call taker in diagnosing cardiac arrest. We compared 2009 with 2010 using the χ2 test and odds ratio (OR).
Results: There were 509 OHCA cases in 2009 and 447 cases in 2010 (64/100,000 population). The mean age was 59 ± 18 years, and 60% were male. Only 26% of events were witnessed. Before the revision, 40% were identified by 911 dispatchers; and after the revised questioning sequence, 74% were identified (OR 4.3, CI95 3.2 - 5.6, p<0.01). The mean time to question callers was 58 seconds before and 54 seconds after (p=NS). False positive rates changed little (676 before and 861 after). Bystander CPR was performed in 37.5% of events before and 37.4% of events after the training (p=NS).
Conclusion: Emphasis on scripted assessment improved sensitivity without loss of specificity in identifying OHCAs. However, it did not translate to an increase in patients receiving bystander CPR.
- © 2011 by American Heart Association, Inc.