Abstract 18631: Delayed Recognition of Cardiac Arrest in Emergency Medical Dispatch - Best Source of Key Information for System Improvement?
Background: Measuring emergency medical dispatch performance is important for both quality control and clinical outcome. Recognition of cardiac arrest is one of the key metrics when evaluating performance as it is essential for initiation of bystander CPR. It is commonly reported as either recognized or not recognized without any benchmarked definition or time limit. Little is known about the extent of delayed recognition, and if these initial delays lead to clinically relevant delays in CPR.
Methods: Prospective, observational study of cardiac arrest calls during a 1 year period in Oslo and Akershus Emergency Services. Dispatch logs, ambulance records and audio files were analyzed. Recognition of cardiac arrest was reported as (1) recognized, (2) not recognized and (3) delayed recognition. Delayed recognition was defined as failure to initially clarify consciousness or abnormal breathing before moving on to further questioning regarding other symptoms or patient history. Calls across all three groups were purposefully selected, and respective dispatchers invited for interviews based on the calls they had experienced.
Results: 500 cardiac arrest calls were processed of which 289 calls were included for further analysis as the dispatcher had the opportunity to recognize cardiac arrest and initiate CPR instructions. 74% of cases were recognized, 13% were not recognized and in 13% recognition was delayed. Median time to bystander CPR (first compression performed) was 2,6 (range 0.9,12.3) minutes when cardiac arrest was recognized and 5,1 (range 2.9,9.7) minutes when recognition was delayed. Interviews after calls where cardiac arrest was not recognized or delayed in recognition yielded insight into challenging areas for the dispatchers such as agonal breathing, handling health care workers as callers and non-compliance with protocol that have impacted future training and education.
Conclusion: Delayed dispatch recognition of cardiac arrest is common and leads to significant delays in chest compressions. Emergency medical dispatch systems committed to improving cardiac arrest outcomes need to identify and explore all calls that challenge the system, not only those where cardiac arrest is not recognized.
Author Disclosures: C. Hardeland: None. L. Soilammi: None. A.E. Hansen: None. T.M. Olasveengen: None.
- © 2014 by American Heart Association, Inc.