Dispatcher assisted CPR: implementation and potential benefit. A 12-year study
Introduction
Despite an extensive program for training citizens in cardiopulmonary resuscitation (CPR) technique [1], [2] only some 50% of the witnessed out-of-hospital cardiac arrests in Seattle and in the adjacent suburban King County area had been attended with bystander-initiated CPR. To address this problem, Eisenberg et al. initiated a program in suburban King County in the early 1980s in which dispatchers were taught to instruct willing callers on how to initiate CPR in cases of suspected cardiac arrest [3], [4]. Building on the work of Eisenberg, we initiated dispatcher assisted CPR in Seattle and studied this in a non-randomized prospective design (instructions were rotated quarterly) from 22 May of 1986 until 20 August of 1988 (Phase I), in a randomized pilot from 1 May 1989 to 15 January 1992 (Phase II), and in a randomized trial from 16 January 1992 to 20 August 1998 (Phase III). The study intervention in all three phases was the type of dispatcher instructions administered: standard airway, breathing, and compression (ABC) instructions versus chest compression only. The major finding of the randomized trial was that the survival rate was 27% higher with the chest compression only instruction set, but the result was only marginally significant (a priori one-sided P=0.09) [5], [6]. During these 12 years of study, extensive data were collected from cases of presumed out-of-hospital cardiac arrest [7], [8]. Much of the data collected was used to address issues of quality control and safety.
Not all episodes of out-of-hospital cardiac arrest can be expected to benefit from dispatcher assisted CPR. For example, episodes occurring in a nursing home or medical facility should have persons available who know CPR and hence not need dispatcher instructions. Arrests which occur in an inaccessible location or in which the caller is relaying information secondhand from another person are also not likely to benefit. Overall, almost half (46%) of all episodes of circulatory arrest were assessed as futile, defined as no emergency medical services (EMS) treatment administered.
The purpose of this paper is to provide an estimate of the proportion of patients that could potentially benefit from dispatcher assisted CPR instruction. Additionally, the limitations and attributes of the dispatcher assisted CPR protocols are described.
Section snippets
Methods
This study was approved by the University of Washington IRB. Consent at the time of the episode was not possible and was not required. Telephone interviews required verbal concurrence with a formal consent statement read at the start of the interview.
The same interrogation protocol (Fig. 1) and CPR instructions (adopted from the work of Eisenberg et al. [4]) were used, except for some wording changes made during the first 3 years. A major and early modification of the interrogation protocol
The potential benefit from dispatcher assisted CPR
During the 12 years a total of 10 533 cardiac arrests were attended by the fire department paramedics and/or emergency medical technicians (EMTs), 6103 of which occurred during the study period (Phase III) and of the latter, 3320 received advanced cardiac life support (ACLS). (ACLS: Precordial shock, medications, I.V. line placement, and/or tracheal intubation.) The remaining 2783 episodes were assessed as futile by the EMT personnel and we excluded them from consideration of potential benefit
Acknowledgements
This study was supported by the Washington State Affiliate of the American Heart Association and Medic I Foundation and by a grant (5 R01 HS08197-04) from the Agency for Healthcare Research and Quality. None of the authors have any financial arrangement that might represent a conflict of interest in this study or the publication of this manuscript.
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Cited by (63)
A centralized system for providing dispatcher assisted CPR instructions to 9-1-1 callers at multiple municipal public safety answering points
2019, ResuscitationCitation Excerpt :Others choose to use locally developed systems for instructing callers in CPR. The most notable of these community-developed systems is the one used in Seattle, Washington, where significant research on dispatcher CPR has been conducted.8–12 Still other communities do not offer any pre-arrival instructions.
Cardiac arrest diagnostic accuracy of 9-1-1 dispatchers: A prospective multi-center study
2015, ResuscitationCitation Excerpt :Providing CPR instructions to a population seemingly in cardiac arrest (unconscious and not breathing, or not breathing normally) is a practice supported by the 2010 International Consensus Guidelines on CPR in that, when in doubt about the presence or absence of signs of life, it is recommended to err on the safe side and initiate CPR.15,16 In 2003, a group from Seattle observed no serious adverse event from dispatch-assisted CPR instructions over a 77-month period.17 In other studies, rib fractures and sternal fractures have respectively been observed in as many as 30% and 15% of cardiac arrest victims during autopsy.18–21