Dispatcher-Assisted CPR: Time to Identify Cardiac Arrest and Deliver Chest Compression Instructions
Background—Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR), in which 911 dispatchers provide CPR instructions over the telephone, has been shown to nearly double the rate of bystander CPR. We sought to identify factors that hampered the identification of cardiac arrest by 911 dispatchers and prevented or delayed the provision of DA-CPR chest compressions.
Methods and Results—We reviewed dispatch recordings for 476 out-of-hospital cardiac arrests occurring between January 1, 2011 and December 31, 2011. We found that the dispatcher correctly identified cardiac arrest in 80% of reviewed cases and 92% of cases in which they were able to assess for patient consciousness and breathing. The median time to recognition of the arrest was 75 seconds. Chest compressions following DA-CPR instructions occurred in 62% of cases where the dispatcher had the opportunity to asses for consciousness and breathing and bystander CPR was not already started. The median time to first DA-CPR chest compression was 176 seconds.
Conclusions—Dispatchers are able to accurately diagnose cardiac arrest over the telephone, but recognition is likely not possible in all circumstances. In some cases, recognition of cardiac arrest may be improved through training in the detection of agonal respirations. Delays in the delivery of DA-CPR chest compressions are common and due to a mixture of dispatcher behavior and factors beyond the control of the dispatcher. Performance standards for the successful and quick recognition of cardiac arrest and delivery of first chest compressions should be adopted as metrics against which EMS systems can measure their performance.
- Received March 15, 2013.
- Revision received July 17, 2013.
- Accepted July 30, 2013.