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Aldridge ES, Perera N, Ball S, Finn J, Bray J. A scoping review to determine the barriers and facilitators to initiation and performance of bystander cardiopulmonary resuscitation during emergency calls. Resusc Plus 2022; 11:100290. [PMID: 36034637 PMCID: PMC9403560 DOI: 10.1016/j.resplu.2022.100290] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/02/2022] [Accepted: 08/02/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Emogene S. Aldridge
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia
- Corresponding author.
| | - Nirukshi Perera
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia
- St John Western Australia, Western Australia, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia
- St John Western Australia, Western Australia, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Janet Bray
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
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Michiels C, Clinckaert C, Wauters L, Dewolf P. Phone CPR and barriers affecting life-saving seconds. Acta Clin Belg 2021; 76:427-432. [PMID: 32306856 DOI: 10.1080/17843286.2020.1752454] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: Phone cardiopulmonary resuscitation (CPR) increases the rate of bystander CPR to patients suffering from an out-of-hospital cardiac arrest (OHCA). This study analyzed the effectiveness of the ALERT protocol for instructing laypeople in bystander CPR.Methods: All 244 phone CPR calls to the emergency medical communication center in Leuven during a one-year period were analyzed. Time to recognition of OHCA and to start of phone CPR was evaluated and compared to the recommendations set up by the American Heart Association (AHA). Barriers that delayed or prevented phone CPR were identified.Results: Time to recognition of OHCA and to start of chest compressions was below the benchmark set by the AHA in 37% and 32% of the calls, respectively. The most common barriers that delayed the start of phone CPR were irrelevant questioning by the dispatcher and difficulties moving the patient.In 52 calls, phone CPR was not initiated. In 54% of these calls, this was due to the bystander's inability to move the patient to the floor or to perform CPR. In 44% the bystander's lack of motivation hindered the start of CPR.Conclusions: The ALERT protocol plays a key role in bystander-CPR. Despite the increased CPR rates and reduced time to start chest compressions since its implementation, further improvement is required. Based on the barriers detected, intensive training of dispatchers is an important next step. Furthermore, adding an alternative track to the protocol for immovable patients might be worth considering.
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Affiliation(s)
- Charlotte Michiels
- Department of Emergency Medicine, University Hospital of Leuven, Leuven, Belgium
| | - Carol Clinckaert
- Department of Emergency Medicine, University Hospital of Brussels, Jette, Belgium
| | - Lina Wauters
- Department of Emergency Medicine, University Hospital of Leuven, Leuven, Belgium
| | - Philippe Dewolf
- Department of Emergency Medicine, University Hospital of Leuven, Leuven, Belgium
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Hampton L, Brindley P, Kirkpatrick A, McKee J, Regehr J, Martin D, LaPorta A, Park J, Vergis A, Gillman L. Strategies to improve communication in telementoring in acute care coordination: a scoping review. Can J Surg 2020; 63:E569-E577. [PMID: 33253511 DOI: 10.1503/cjs.015519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background Telementoring facilitates the coordination of advanced medical care in rural, remote or austere environments. Because the interpersonal element of telementoring has been relatively underexplored, we conducted a scoping review to identify strategies to improve communication in telementoring. Methods Two independent reviewers searched all English-language articles in MEDLINE and Scopus from 1964 to 2017, as well as reference lists of relevant articles to identify articles addressing telementored interactions between health care providers. Search results were gathered in June 2017 and updated in January 2018. Identified articles were categorized by theme. Results We identified 144 articles, of which 56 met our inclusion criteria. Forty-one articles focused on improving dispatcher-directed cardiopulmonary resuscitation (CPR). Major themes included the importance of language in identifying out-of-hospital cardiac arrest and how to provide instructions to enable administration of effective CPR. A standardized approach with scripted questions was associated with improved detection of out-of-hospital cardiac arrest, and a concise script was associated with improved CPR quality compared to no mentoring, unscripted mentoring or more complex instructions. Six articles focused on physician-physician consultation. Use of a handover tool that highlighted critical information outperformed an unstructured approach regarding transmission of vital information. Nine articles examined telementoring in trauma resuscitation. A common theme was the need to establish an understanding between mentor and provider regarding the limitations of the provider and his or her environment. Conclusion The available data suggest that standardization coupled with short, concise validated scripts could improve efficacy, safety and engagement. Improvements will require multidisciplinary input, practice and deliberate efforts to address barriers.
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Affiliation(s)
- Lauren Hampton
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Peter Brindley
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Andrew Kirkpatrick
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Jessica McKee
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Julian Regehr
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Douglas Martin
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Anthony LaPorta
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Jason Park
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Ashley Vergis
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Lawrence Gillman
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
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Using a Mobile Phone Application Versus Telephone Assistance During Cardiopulmonary Resuscitation: A Randomized Comparative Study. J Emerg Nurs 2020; 46:460-467.e2. [PMID: 32444161 DOI: 10.1016/j.jen.2020.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/22/2020] [Accepted: 03/16/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION In recent years, the way CPR instructions are given has changed because of the development of new technology that allows bystanders who witness a cardiac arrest to be guided in performing CPR. This study aimed to compare the effectiveness of using a mobile phone application (app) versus telephone operator assistance in performing cardiopulmonary resuscitation (CPR) techniques in simulated settings. METHODS A comparative study was performed with 2 intervention groups: (1) mobile phone app and (2) telephone assistance. A total of 128 students participated and were distributed randomly into each intervention group. A CPR observation checklist and standard CPR quality parameter measurements were used for data collection. RESULTS The group that used the app obtained better results than the group that had telephone assistance on 5 items during CPR observation: checking if the area is secure (X2(1) = 26.81; P < 0.05), asking for help (X2(1) = 66.07; P < 0.05), opening of airways (X2(1) = 12.03; P < 0.05), checking for breathing (X2(1) = 6.10; P < 0.05), and contacting emergency services (X2(1) = 12.41; P < 0.05). Regarding the skill level of CPR, no statistically significant differences were found when comparing the 2 intervention groups (X2(1) = 0.91; P = 0.33). As for the parameters measured, there were only statistically significant differences found in the item compression fraction (U = 1,593.00; Z = -2.16; P < 0.05), with the group that used the app obtaining better results. DISCUSSION Better outcomes were observed in recognizing if the area was safe, asking for help, opening up the airways, checking for breathing, and calling emergency services in the mobile phone app group. However, the results indicated that there were no differences in the CPR parameters, except compression fraction, when the app was used as opposed to being guided by telephone.
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Abstract
Prehospital emergency telephone triages are mechanisms to verify the appropriate need for care in an emergency call by telephone. Considering the high rates of trauma and clinical cases that need prehospital care, the importance of knowing how the services that send rescue teams can guarantee improved care is highlighted. The objective of this study was to characterize the services that support effective telephone triage. Literature review was conducted in 6 phases to answer the following question: How can prehospital emergency telephone triage be performed? To search for primary studies, we used specific search strategies in the databases: LILaCs, PubMed, CINAHL, LISA, ISTA, and SCOPUS. The sample consisted of 23 studies whose information was extracted using a validated tool. Among the selected studies, 2 come from CINAHL, 2 from LISA, 4 from PubMed, 1 from ISTA, and 14 from SCOPUS, which were published between 2006 and 2016 in 17 different journals with varying types of scopes and originated from 13 countries on 3 distinct continents. The articles were nonexperimental and indicated the broad use of software constructed to support the telephone triage. The prehospital emergency telephone triages are frequently performed to identify the event, deduct the need for support, and prioritize those calls that require a rescue team. They should take place with the support of institutional protocols and technological support to guarantee dynamic data and constant training of the ambulance dispatchers.
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Riou M, Ball S, Whiteside A, Bray J, Perkins GD, Smith K, O'Halloran KL, Fatovich DM, Inoue M, Bailey P, Cameron P, Brink D, Finn J. 'We're going to do CPR': A linguistic study of the words used to initiate dispatcher-assisted CPR and their association with caller agreement. Resuscitation 2018; 133:95-100. [PMID: 30316951 DOI: 10.1016/j.resuscitation.2018.10.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 09/27/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND In emergency ambulance calls for out-of-hospital cardiac arrest (OHCA), dispatcher-assisted cardiopulmonary resuscitation (CPR) plays a crucial role in patient survival. We examined whether the language used by dispatchers to initiate CPR had an impact on callers' agreement to perform CPR. METHODS We analysed 424 emergency calls relating to cases of paramedic-confirmed OHCA where OHCA was recognised by the dispatcher, the caller was with the patient, and resuscitation was attempted by paramedics. We investigated the linguistic choices used by dispatchers to initiate CPR, and the impact of those choices on caller agreement to perform CPR. RESULTS Overall, CPR occurred in 85% of calls. Caller agreement was low (43%) when dispatchers used terms of willingness ("do you want to do CPR?"). Caller agreement was high (97% and 84% respectively) when dispatchers talked about CPR in terms of futurity ("we are going to do CPR") or obligation ("we need to do CPR"). In 38% (25/66) of calls where the caller initially declined CPR, the dispatcher eventually secured their agreement by making several attempts at initiating CPR. CONCLUSION There is potential for increased agreement to perform CPR if dispatchers are trained to initiate CPR with words of futurity and/or obligation.
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Affiliation(s)
- Marine Riou
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, 6102, Australia.
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, 6102, Australia
| | | | - Janet Bray
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, 6102, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria, 3004, Australia
| | - Gavin D Perkins
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, 3004, Australia; Emergency Medicine, The University of Western Australia, Crawley, WA, 6009, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, 3004, Australia; Ambulance Victoria, Blackburn North, Victoria, 3130, Australia
| | - Kay L O'Halloran
- School of Education, Curtin University, Bentley, WA, 6102, Australia
| | - Daniel M Fatovich
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, 6102, Australia; Emergency Medicine, The University of Western Australia, Crawley, WA, 6009, Australia; Emergency Medicine, Royal Perth Hospital, Perth, WA, 6001, Australia; Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, WA, 6847, Australia
| | - Madoka Inoue
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, 6102, Australia
| | - Paul Bailey
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, 6102, Australia; St John Ambulance (WA), Belmont, WA, 6104, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, 3004, Australia
| | - Deon Brink
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, 6102, Australia; St John Ambulance (WA), Belmont, WA, 6104, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, 6102, Australia; St John Ambulance (WA), Belmont, WA, 6104, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria, 3004, Australia; Emergency Medicine, The University of Western Australia, Crawley, WA, 6009, Australia
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Nebsbjerg MA, Rasmussen SE, Bomholt KB, Krogh LQ, Krogh K, Povlsen JA, Riddervold IS, Grøfte T, Kirkegaard H, Løfgren B. Skills among young and elderly laypersons during simulated dispatcher assisted CPR and after CPR training. Acta Anaesthesiol Scand 2018; 62:125-133. [PMID: 29143314 DOI: 10.1111/aas.13027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 09/06/2017] [Accepted: 10/13/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Dispatcher assisted cardiopulmonary resuscitation (DA-CPR) increase the rate of bystander CPR. The aim of the study was to compare the performance of DA-CPR and attainable skills following CPR training between young and elderly laypersons. METHODS Volunteer laypersons (young: 18-40 years; elderly: > 65 years) participated. Single rescuer CPR was performed in a simulated DA-CPR cardiac arrest scenario and after CPR training. Data were obtained from a manikin and from video recordings. The primary endpoint was chest compression depth. RESULTS Overall, 56 young (median age: 26, years since last CPR training: 6) and 58 elderly (median age: 72, years since last CPR training: 26.5) participated. Young laypersons performed deeper (mean (SD): 56 (14) mm vs. 39 (19) mm, P < 0.001) and faster (median (25th-75th percentile): 107 (97-112) per min vs. 84 (74-107) per min, P < 0.001) chest compressions compared to elderly. Young laypersons had shorter time to first compression (mean (SD): 71 (11) seconds vs. 104 (38) seconds, P < 0.001) and less hands-off time (median (25th-75th percentile): 0 (0-1) seconds vs. 5 (2-10) seconds, P < 0.001) than elderly. After CPR training chest compressions were performed with a depth (mean (SD): 64 (8) mm vs. 50 (14) mm, P < 0.001) and rate (mean (SD): 111 (11) per min vs. 93 (18) per min, P < 0.001) for young and elderly laypersons respectively. CONCLUSION Despite long CPR retention time for both groups, elderly laypersons had longer retention time, and performed inadequate DA-CPR compared to young laypersons. Following CPR training the attainable CPR level was of acceptable quality for both young and elderly laypersons.
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Affiliation(s)
- M. A. Nebsbjerg
- Research Center for Emergency Medicine; Aarhus University Hospital; Aarhus C Denmark
- Emergency Department; Aarhus University Hospital; Aarhus C Denmark
| | - S. E. Rasmussen
- Research Center for Emergency Medicine; Aarhus University Hospital; Aarhus C Denmark
- Department of Respiratory Diseases and Allergy; Aarhus University Hospital; Aarhus C Denmark
| | - K. B. Bomholt
- Research Center for Emergency Medicine; Aarhus University Hospital; Aarhus C Denmark
| | - L. Q. Krogh
- Research Center for Emergency Medicine; Aarhus University Hospital; Aarhus C Denmark
- Psychiatric Department; Regional Hospital of Herning; Herning Denmark
| | - K. Krogh
- Centre for Health Sciences Education; Aarhus University; Aarhus N Denmark
- Department of Anaesthesiology and Intensive Care; Aarhus University Hospital; Aarhus N Denmark
| | - J. A. Povlsen
- Institute of Clinical Medicine; Aarhus University; Aarhus N Denmark
- Department of Cardiology; Aarhus University Hospital; Aarhus N Denmark
| | - I. S. Riddervold
- Prehospital Emergency Medical Services; Central Denmark Region; Aarhus N Denmark
| | - T. Grøfte
- Prehospital Emergency Medical Services; Central Denmark Region; Aarhus N Denmark
- Department of Anaesthesiology and Intensive Care; Regional Hospital of Randers; Randers Denmark
| | - H. Kirkegaard
- Research Center for Emergency Medicine; Aarhus University Hospital; Aarhus C Denmark
- Prehospital Emergency Medical Services; Central Denmark Region; Aarhus N Denmark
| | - B. Løfgren
- Research Center for Emergency Medicine; Aarhus University Hospital; Aarhus C Denmark
- Institute of Clinical Medicine; Aarhus University; Aarhus N Denmark
- Department of Internal Medicine; Regional Hospital of Randers; Randers Denmark
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Riou M, Ball S, Williams TA, Whiteside A, O’Halloran KL, Bray J, Perkins GD, Cameron P, Fatovich DM, Inoue M, Bailey P, Brink D, Smith K, Della P, Finn J. The linguistic and interactional factors impacting recognition and dispatch in emergency calls for out-of-hospital cardiac arrest: a mixed-method linguistic analysis study protocol. BMJ Open 2017; 7:e016510. [PMID: 28694349 PMCID: PMC5541602 DOI: 10.1136/bmjopen-2017-016510] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Emergency telephone calls placed by bystanders are crucial to the recognition of out-of-hospital cardiac arrest (OHCA), fast ambulance dispatch and initiation of early basic life support. Clear and efficient communication between caller and call-taker is essential to this time-critical emergency, yet few studies have investigated the impact that linguistic factors may have on the nature of the interaction and the resulting trajectory of the call. This research aims to provide a better understanding of communication factors impacting on the accuracy and timeliness of ambulance dispatch. METHODS AND ANALYSIS A dataset of OHCA calls and their corresponding metadata will be analysed from an interdisciplinary perspective, combining linguistic analysis and health services research. The calls will be transcribed and coded for linguistic and interactional variables and then used to answer a series of research questions about the recognition of OHCA and the delivery of basic life-support instructions to bystanders. Linguistic analysis of calls will provide a deeper understanding of the interactional dynamics between caller and call-taker which may affect recognition and dispatch for OHCA. Findings from this research will translate into recommendations for modifications of the protocols for ambulance dispatch and provide directions for further research. ETHICS AND DISSEMINATION The study has been approved by the Curtin University Human Research Ethics Committee (HR128/2013) and the St John Ambulance Western Australia Research Advisory Group. Findings will be published in peer-reviewed journals and communicated to key audiences, including ambulance dispatch professionals.
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Affiliation(s)
- Marine Riou
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Australia
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Australia
| | - Teresa A Williams
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Australia
- St John Ambulance (WA), Belmont, Australia
| | | | | | - Janet Bray
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Gavin D Perkins
- Out of Hospital Cardiac Arrest Outcomes, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Daniel M Fatovich
- Emergency Medicine, The University of Western Australia, Crawley, Australia
- Emergency Medicine, Royal Perth Hospital, Perth, Australia
| | - Madoka Inoue
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Australia
| | - Paul Bailey
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Australia
- St John Ambulance (WA), Belmont, Australia
| | - Deon Brink
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Australia
- St John Ambulance (WA), Belmont, Australia
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
- Ambulance Victoria, Blackburn North, Victoria, Australia
| | - Phillip Della
- School of Nursing and Midwifery, Curtin University, Bentley, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Australia
- St John Ambulance (WA), Belmont, Australia
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Deakin CD, England S, Diffey D. Ambulance telephone triage using 'NHS Pathways' to identify adult cardiac arrest. Heart 2016; 103:738-744. [PMID: 28011758 DOI: 10.1136/heartjnl-2016-310651] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/26/2016] [Accepted: 11/29/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND UK ambulance services are called to 30 000 cardiac arrests (CAs) annually where resuscitation is attempted. Correct identification by the ambulance service trebles survival by facilitating bystander-cardiopulmonary resuscitation (CPR) and immediate ambulance dispatch. Identification of CA by telephone is challenging and involves algorithms to identify key features. 'NHS Pathways' is now used for triage by six of 12 UK ambulance services, covering a population of 20 million. With the significant improvements in survival when CA is accurately identified, it is vital that 'NHS Pathways' is able to identify CA correctly. METHODS All '999' emergency calls to South Central Ambulance Service (SCAS) over a 12-month period screened by NHS Pathways v9.04 were identified. All actual or presumed CAs identified by the emergency call taker were cross-referenced with the ambulance crew's Patient Report Form to identify all confirmed CAs. RESULTS A total of 469 400 emergency (999) calls were received by SCAS. Of the 3119 CA identified by ambulance crew, 753 were not initially classified as CA by NHS Pathways (24.1%). Overall, sensitivity=0.759 (95% CI 0.743 to 0.773); specificity=0.986 (95% CI 0.9858 to 0.98647); and positive predictive value=26.80% (95% CI 25.88 to 27.73%). CONCLUSIONS NHS Pathways accurately identifies 75.9% of adult CAs. The remainder represents approximately 7500 treatable CAs in the UK annually where the diagnosis is missed, with significant implications for patient outcome. Further work is required to improve this first link in the chain of survival.
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Affiliation(s)
- Charles D Deakin
- NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK.,South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK
| | - Simon England
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK
| | - Debbie Diffey
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK
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Rasmussen SE, Nebsbjerg MA, Krogh LQ, Bjørnshave K, Krogh K, Povlsen JA, Riddervold IS, Grøfte T, Kirkegaard H, Løfgren B. A novel protocol for dispatcher assisted CPR improves CPR quality and motivation among rescuers-A randomized controlled simulation study. Resuscitation 2016; 110:74-80. [PMID: 27658651 DOI: 10.1016/j.resuscitation.2016.09.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/14/2016] [Accepted: 09/09/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Emergency dispatchers use protocols to instruct bystanders in cardiopulmonary resuscitation (CPR). Studies changing one element in the dispatcher's protocol report improved CPR quality. Whether several changes interact is unknown and the effect of combining multiple changes previously reported to improve CPR quality into one protocol remains to be investigated. We hypothesize that a novel dispatch protocol, combining multiple beneficial elements improves CPR quality compared with a standard protocol. METHODS A novel dispatch protocol was designed including wording on chest compressions, using a metronome, regular encouragements and a 10-s rest each minute. In a simulated cardiac arrest scenario, laypersons were randomized to perform single-rescuer CPR guided with the novel or the standard protocol. PRIMARY OUTCOME a composite endpoint of time to first compression, hand position, compression depth and rate and hands-off time (maximum score: 22 points). Afterwards participants answered a questionnaire evaluating the dispatcher assistance. RESULTS The novel protocol (n=61) improved CPR quality score compared with the standard protocol (n=64) (mean (SD): 18.6 (1.4)) points vs. 17.5 (1.7) points, p<0.001. The novel protocol resulted in deeper chest compressions (mean (SD): 58 (12)mm vs. 52 (13)mm, p=0.02) and improved rate of correct hand position (61% vs. 36%, p=0.01) compared with the standard protocol. In both protocols hands-off time was short. The novel protocol improved motivation among rescuers compared with the standard protocol (p=0.002). CONCLUSIONS Participants guided with a standard dispatch protocol performed high quality CPR. A novel bundle of care protocol improved CPR quality score and motivation among rescuers.
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Affiliation(s)
- Stinne Eika Rasmussen
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark
| | - Mette Amalie Nebsbjerg
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark
| | - Lise Qvirin Krogh
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark
| | - Katrine Bjørnshave
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark
| | - Kristian Krogh
- Center for Health Sciences Education, Aarhus University, Palle Juul-Jensens Boulevard 82, Building B, 8200 Aarhus N, Denmark; Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Jonas Agerlund Povlsen
- Institute of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 9, 8200 Aarhus N, Denmark
| | - Ingunn Skogstad Riddervold
- Prehospital Emergency Medical Services, Central Denmark Region, Olof Palmes Allé 34, 1st floor, 8200 Aarhus N, Denmark
| | - Thorbjørn Grøfte
- Department of Anaesthesiology and Intensive Care, Regional Hospital of Randers, Skovlyvej 1, 8930 Randers, Denmark
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark
| | - Bo Løfgren
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark; Institute of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Department of Internal Medicine, Regional Hospital of Randers, Skovlyvej 1, 8930 Randers, Denmark.
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Nishi T, Kamikura T, Funada A, Myojo Y, Ishida T, Inaba H. Are regional variations in activity of dispatcher-assisted cardiopulmonary resuscitation associated with out-of-hospital cardiac arrests outcomes? A nation-wide population-based cohort study. Resuscitation 2015; 98:27-34. [PMID: 26525273 DOI: 10.1016/j.resuscitation.2015.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 08/06/2015] [Accepted: 10/11/2015] [Indexed: 11/19/2022]
Abstract
AIM Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) impacts the rates of bystander CPR (BCPR) and survival after out-of-hospital cardiac arrests (OHCAs). This study aimed to elucidate whether regional variations in indexes for BCPR and emergency medical service (EMS) may be associated with OHCA outcomes. METHODS We conducted a population-based observational study involving 157,093 bystander-witnessed, resuscitation-attempted OHCAs without physician involvement between 2007 and 2011. For each index of BCPR and EMS, we classified the 47 prefectures into the following three groups: advanced, intermediate, and developing regions. Nominal logit analysis followed by multivariable logistic regression including OHCA backgrounds was employed to examine the association between neurologically favourable 1-month survival, and regional classifications based on BCPR- and EMS-related indexes. RESULTS Logit analysis including all regional classifications revealed that the number of BLS training course participants per population or bystander's own performance of BCPR without DA-CPR was not associated with the survival. Multivariable logistic regression including the OHCA backgrounds known to be associated with survival (BCPR provision, arrest aetiology, initial rhythm, patient age, time intervals of witness-to-call and call-to-arrival at patient), the following regional classifications based on DA-CPR but not on EMS were associated with survival: sensitivity of DA-CPR [adjusted odds ratio (95% confidence intervals) for advanced region; those for intermediate region, with developing region as reference, 1.277 (1.131-1.441); 1.162 (1.058-1.277)]; the proportion of bystanders to follow DA-CPR [1.749 (1.554-1.967); 1.280 (1.188-1.380)]. CONCLUSIONS Good outcomes of bystander-witnessed OHCAs correlate with regions having higher sensitivity of DA-CPR and larger proportion of bystanders to follow DA-CPR.
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Affiliation(s)
- Taiki Nishi
- Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan.
| | - Takahisa Kamikura
- Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan.
| | - Akira Funada
- Emergency Medical Centre, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan.
| | - Yasuhiro Myojo
- Emergency Medical Centre, Ishikawa Prefectural Central Hospital, 2-1 Kuratsuki-Higashi, Kanazawa, Ishikawa 920-8201, Japan.
| | - Tetsuya Ishida
- Emergency Department, Kaga Citizen's Hospital, 65 Hachikenmichi, Daishoji, Kaga 922-0057, Japan.
| | - Hideo Inaba
- Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan.
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Besnier E, Damm C, Jardel B, Veber B, Compere V, Dureuil B. Dispatcher-assisted cardiopulmonary resuscitation protocol improves diagnosis and resuscitation recommendations for out-of-hospital cardiac arrest. Emerg Med Australas 2015; 27:590-596. [DOI: 10.1111/1742-6723.12493] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Emmanuel Besnier
- Department of Anaesthesiology and Intensive Care; Rouen University Hospital; Rouen Cedex France
| | - Cedric Damm
- Department of Anaesthesiology and Intensive Care; Rouen University Hospital; Rouen Cedex France
| | - Benoit Jardel
- Department of Anaesthesiology and Intensive Care; Rouen University Hospital; Rouen Cedex France
| | - Benoit Veber
- Department of Anaesthesiology and Intensive Care; Rouen University Hospital; Rouen Cedex France
| | - Vincent Compere
- Department of Anaesthesiology and Intensive Care; Rouen University Hospital; Rouen Cedex France
| | - Bertrand Dureuil
- Department of Anaesthesiology and Intensive Care; Rouen University Hospital; Rouen Cedex France
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13
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How effectively can young people perform dispatcher-instructed cardiopulmonary resuscitation without training? Resuscitation 2015; 90:138-42. [DOI: 10.1016/j.resuscitation.2015.02.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/13/2015] [Accepted: 02/27/2015] [Indexed: 11/19/2022]
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14
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Le massage cardiaque externe. ANNALES FRANCAISES DE MEDECINE D URGENCE 2015. [DOI: 10.1007/s13341-015-0524-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Out-of-hospital cardiac arrest phone detection: Those who most need chest compressions are the most difficult to recognize. Resuscitation 2014; 85:1720-5. [DOI: 10.1016/j.resuscitation.2014.09.020] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/21/2014] [Accepted: 09/19/2014] [Indexed: 11/19/2022]
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16
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Lyon RM. Pre-hospital resuscitation exposure – When is enough, enough? Resuscitation 2014; 85:1121-2. [DOI: 10.1016/j.resuscitation.2014.06.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 06/26/2014] [Indexed: 12/01/2022]
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17
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Hirose K, Enami M, Matsubara H, Kamikura T, Takei Y, Inaba H. Basic life support training for single rescuers efficiently augments their willingness to make early emergency calls with no available help: a cross-over questionnaire survey. J Intensive Care 2014; 2:28. [PMID: 25520840 PMCID: PMC4267597 DOI: 10.1186/2052-0492-2-28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 03/27/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate effects of basic life support (BLS) training on willingness of single rescuers to make emergency calls during out-of-hospital cardiac arrests (OHCAs) with no available help from others. METHODS A cross-over questionnaire survey was conducted with two questionnaires. Questionnaires were administered before and after two BLS courses in fire departments. One questionnaire included two scenarios which simulate OHCAs occurring in situations where help from other rescuers is available (Scenario-M) and not available (Scenario-S). The conventional BLS course was designed for multiple rescuers (Course-M), and the other was designed for single rescuers (Course-S). RESULTS Of 2,312 respondents, 2,218 (95.9%) answered all questions and were included in the analysis. Although both Course-M and Course-S significantly augmented willingness to make early emergency calls not only in Scenario-M but also in Scenario-S, the willingness for Scenario-M after training course was significantly higher in respondents of Course-S than in those of Course-M (odds ratio 1.706, 95% confidential interval 1.301-2.237). Multiple logistic regression analysis for Scenario-M disclosed that post training (adjusted odds ratio 11.6, 95% confidence interval 7.84-18.0), age (0.99, 0.98-0.99), male gender (1.77, 1.39-2.24), prior BLS experience of at least three times (1.46, 1.25-2.59), and time passed since most recent training during 3 years or less (1.80, 1.25-2.59) were independently associated with willingness to make early emergency calls and that type of BLS course was not independently associated with willingness. Therefore, both Course-M and Course-S similarly augmented willingness in Scenario-M. However, in multiple logistic regression analyses for Scenario-S, Course-S was independently associated with willingness to make early emergency calls in Scenario-S (1.26, 1.00-1.57), indicating that Course-S more efficiently augmented willingness. Moreover, post training (2.30, 1.86-2.83) and male gender (1.26, 1.02-1.57) were other independent factors associated with willingness in Scenario-S. CONCLUSIONS BLS courses designed for single rescuers with no help available from others are likely to augment willingness to make early emergency calls more efficiently than conventional BLS courses designed for multiple rescuers.
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Affiliation(s)
- Keiko Hirose
- />Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, 13-1 Takaramachi, Kanazawa, 920-8641 Japan
| | - Miki Enami
- />Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, 13-1 Takaramachi, Kanazawa, 920-8641 Japan
| | - Hiroki Matsubara
- />Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, 13-1 Takaramachi, Kanazawa, 920-8641 Japan
| | - Takahisa Kamikura
- />Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, 13-1 Takaramachi, Kanazawa, 920-8641 Japan
| | - Yutaka Takei
- />Department of Medical Science and Technology, Hiroshima International University, Hiroshima, Japan
| | - Hideo Inaba
- />Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, 13-1 Takaramachi, Kanazawa, 920-8641 Japan
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Goh ES, Liang B, Fook-Chong S, Shahidah N, Soon SS, Yap S, Leong B, Gan HN, Foo D, Tham LP, Charles R, Ong MEH. Effect of Location of Out-of-Hospital Cardiac Arrest on Survival Outcomes. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2013. [DOI: 10.47102/annals-acadmedsg.v42n9p437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: This study aims to study how the effect of the location of patient collapses from cardiac arrest, in the residential and non-residential areas within Singapore, relates to certain survival outcomes. Materials and Methods: A retrospective cohort study of data were done from the Cardiac Arrest and Resuscitation Epidemiology (CARE) project. Out-of-hospital cardiac arrest (OHCA) data from October 2001 to October 2004 (CARE) were used. All patients with OHCA as confirmed by the absence of a pulse, unresponsiveness and apnoea were included. All events had occurred in Singapore. Analysis was performed and expressed in terms of the odds ratio (OR) and the corresponding 95% confidence interval (CI). Results: A total of 2375 cases were used for this analysis. Outcomes for OHCA in residential areas were poorer than in non-residential areas—1638 (68.9%) patients collapsed in residential areas, and 14 (0.9%) survived to discharge. This was significantly less than the 2.7% of patients who survived after collapsing in a non-residential area (OR 0.31 [0.16 – 0.62]). Multivariate logistic regression analysis showed that location alone had no independent effect on survival (adjusted OR 1.13 [0.32 – 4.05]); instead, underlying factors such as bystander CPR (OR 3.67 [1.13 – 11.97]) and initial shockable rhythms (OR 6.78 [1.95 – 23.53]) gave rise to better outcomes. Conclusion: Efforts to improve survival from OHCA in residential areas should include increasing CPR by family members, and reducing ambulance response times.
Key words: Emergency Medical Services, Non-residential, Prehospital, Residential
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Affiliation(s)
| | - Benjamin Liang
- Yong Loo Lin School of Medicine, National University Health System, Singapore
| | | | | | | | - Susan Yap
- Singapore General Hospital, Singapore
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The continuous quality improvement project for telephone-assisted instruction of cardiopulmonary resuscitation increased the incidence of bystander CPR and improved the outcomes of out-of-hospital cardiac arrests. Resuscitation 2012; 83:1235-41. [DOI: 10.1016/j.resuscitation.2012.02.013] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 02/13/2012] [Accepted: 02/18/2012] [Indexed: 12/16/2022]
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Park SO, Hong CK, Shin DH, Lee JH, Hwang SY. Efficacy of metronome sound guidance via a phone speaker during dispatcher-assisted compression-only cardiopulmonary resuscitation by an untrained layperson: a randomised controlled simulation study using a manikin. Emerg Med J 2012; 30:657-61. [PMID: 23018287 DOI: 10.1136/emermed-2012-201612] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM Untrained laypersons should perform compression-only cardiopulmonary resuscitation (COCPR) under a dispatcher's guidance, but the quality of the chest compressions may be suboptimal. We hypothesised that providing metronome sounds via a phone speaker may improve the quality of chest compressions during dispatcher-assisted COCPR (DA-COCPR). METHODS Untrained laypersons were allocated to either the metronome sound-guided group (MG), who performed DA-COCPR with metronome sounds (110 ticks/min), or the control group (CG), who performed conventional DA-COCPR. The participants of each group performed DA-COCPR for 4 min using a manikin with Skill-Reporter, and the data regarding chest compression quality were collected. RESULTS The data from 33 cases of DA-COCPR in the MG and 34 cases in the CG were compared. The MG showed a faster compression rate than the CG (111.9 vs 96.7/min; p=0.018). A significantly higher proportion of subjects in the MG performed the DA-COCPR with an accurate chest compression rate (100-120/min) compared with the subjects in the CG (32/33 (97.0%) vs 5/34 (14.7%); p<0.0001). The mean compression depth was not different between the MG and the CG (45.9 vs 46.8 mm; p=0.692). However, a higher proportion of subjects in the MG performed shallow compressions (compression depth <38 mm) compared with subjects in the CG (median % was 69.2 vs 15.7; p=0.035). CONCLUSIONS Metronome sound guidance during DA-COCPR for the untrained bystanders improved the chest compression rates, but was associated more with shallow compressions than the conventional DA-COCPR in a manikin model.
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Affiliation(s)
- Sang O Park
- Department of Emergency Medicine, Konkuk University School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Republic of Korea
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21
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Impact of telephone dispatcher assistance on the outcomes of pediatric out-of-hospital cardiac arrest*. Crit Care Med 2012; 40:1410-6. [DOI: 10.1097/ccm.0b013e31823e99ae] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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23
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Van Vleet LM, Hubble MW. Time to first compression using Medical Priority Dispatch System compression-first dispatcher-assisted cardiopulmonary resuscitation protocols. PREHOSP EMERG CARE 2011; 16:242-50. [PMID: 22150694 DOI: 10.3109/10903127.2011.616259] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Without bystander cardiopulmonary resuscitation (CPR), cardiac arrest survival decreases 7%-10% for every minute of delay until defibrillation. Dispatcher-assisted CPR (D-CPR) has been shown to increase the rates of bystander CPR and cardiac arrest survival. Other reports suggest that the most critical component of bystander CPR is chest compressions with minimal interruption. Beginning with version 11.2 of the Medical Priority Dispatch System (MPDS) protocols, instructions for mouth-to-mouth ventilation (MTMV) and pulse check were removed and a compression-first pathway was introduced to facilitate rapid delivery of compressions. Additionally, unconscious choking and third-trimester pregnancy decision-making criteria were added in versions 11.3 and 12.0, respectively. However, the effects of these changes on time to first compression (TTFC) have not been evaluated. OBJECTIVE We sought to quantify the TTFC of MPDS versions 11.2, 11.3, and 12.0 for all calls identified as cardiac arrest on call intake that did not require MTMV instruction. METHODS Audio recordings of all D-CPR events for October 2005 through May 2010 were analyzed for TTFC. Differences in TTFC across versions were compared using the Kruskal-Wallis test. RESULTS A total of 778 cases received D-CPR. Of these, 259 were excluded because they met criteria for MTMV (pediatric patients, allergic reaction, etc.), were missing data, or were not initially identified as cardiac arrest. Of the remaining 519 calls, the mean TTFC was 240 seconds, with no significant variation across the MPDS versions (p = 0.08). CONCLUSIONS Following the removal of instructions for pulse check and MTMV, as well as other minor changes in the MPDS protocols, we found the overall TTFC to be 240 seconds with little variation across the three versions evaluated. This represents an improvement in TTFC compared with reports of an earlier version of MPDS that included pulse checks and MTMV instructions (315 seconds). However, the MPDS TTFC does not compare favorably with reports of older, non-MPDS protocols that included pulse checks and MTMV. Efforts should continue to focus on improving this key, and modifiable, determinant of cardiac arrest survival.
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Affiliation(s)
- Jerry P Nolan
- Department of Anaesthesia, Royal United Hospital NHS Trust, Bath BA1 3NG, UK.
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25
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Elektrotherapie: automatisierte externe Defibrillatoren, Defibrillation, Kardioversion und Schrittmachertherapie. Notf Rett Med 2010. [DOI: 10.1007/s10049-010-1369-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dispatcher-assisted telephone cardiopulmonary resuscitation using a French-language compression-only protocol in volunteers with or without prior life support training: A randomized trial. Resuscitation 2010; 82:57-63. [PMID: 21036454 DOI: 10.1016/j.resuscitation.2010.09.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 09/06/2010] [Accepted: 09/19/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Due to the recent interest in hands-only protocols for dispatcher-assisted cardiopulmonary resuscitation (CPR) and the lack of any validated algorithms in French, our primary objective was to evaluate a new French-language protocol in terms of its efficacy to help previously untrained volunteers in performing basic life support efforts of appropriate quality, and secondarily to investigate its potential utility in subjects with previous training. METHODS Untrained volunteers were recruited among adults in a public movie centre and previously trained volunteers among undergraduate nursing students. Participants were randomly assigned to 'phone CPR' versus 'no phone CPR' by drawing sets of envelopes. Primary outcome measures were the results of the Cardiff evaluation test; the secondary measures were global scoring of a complete 5min period of CPR, in a manikin model of cardiac arrest. RESULTS Out of 146 volunteers assessed for eligibility, 36 previously untrained candidates declined participation. 110 participants, distributed into four groups, completed the study: the previously untrained non-guided group (group A, n=30), the previously untrained guided group (group B, n=30), the previously trained non-guided group (group C, n=25) and the previously trained guided group (group D, n=25). Results of the Cardiff test and global evaluation of CPR performance revealed a significant improvement in group B as compared with group A, approaching the level of the group C. Previously trained guided bystanders had the best CPR scores, notably because of an improvement in the quality of airway management. CONCLUSION When used by dispatchers, this new French-language algorithm offers the opportunity to help previously untrained bystanders initiate CPR. The same protocol may serve to guide volunteers with prior basic life support training to reach their best CPR performance.
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Deakin CD, Nolan JP, Sunde K, Koster RW. European Resuscitation Council Guidelines for Resuscitation 2010 Section 3. Electrical therapies: Automated external defibrillators, defibrillation, cardioversion and pacing. Resuscitation 2010; 81:1293-304. [DOI: 10.1016/j.resuscitation.2010.08.008] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Dami F, Carron PN, Praz L, Fuchs V, Yersin B. Why bystanders decline telephone cardiac resuscitation advice. Acad Emerg Med 2010; 17:1012-5. [PMID: 20836786 DOI: 10.1111/j.1553-2712.2010.00851.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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.
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Affiliation(s)
- Fabrice Dami
- Emergency Medical Services Dispatch Center, State of Vaud, Lausanne, Switzerland.
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Poynton MR, Bennett HK, Ellington L, Crouch BI, Caravati EM, Jasti S. Specialist discrimination of toxic exposure severity at a poison control center. Clin Toxicol (Phila) 2009; 47:678-82. [DOI: 10.1080/15563650903140407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bolle SR, Scholl J, Gilbert M. Can video mobile phones improve CPR quality when used for dispatcher assistance during simulated cardiac arrest? Acta Anaesthesiol Scand 2009; 53:116-20. [PMID: 19032569 PMCID: PMC2659378 DOI: 10.1111/j.1399-6576.2008.01779.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Because mobile telephones may support video calls, emergency medical dispatchers may now connect visually with bystanders during pre-hospital cardio-pulmonary resuscitation (CPR). We studied the quality of simulated dispatcher-assisted CPR when guidance was delivered to rescuers by video calls or audio calls from mobile phones. METHODS One hundred and eighty high school students were randomly assigned in groups of three to communicate via video calls or audio calls with experienced nurse dispatchers at a Hospital Emergency Medical Dispatch Center. CPR was performed on a recording resuscitation manikin during simulated cardiac arrest. Quality of CPR and time factors were compared depending on the type of communication used. RESULTS The median CPR time without chest compression ('hands-off time') was shorter in the video-call group vs. the audio-call group (303 vs. 331 s; P=0.048), but the median time to first compression was not shorter (104 vs. 102 s; P=0.29). The median time to first ventilation was insignificantly shorter in the video-call group (176 vs. 205 s; P=0.16). This group also had a slightly higher proportion of ventiliations without error (0.11 vs. 0.06; P=0.30). CONCLUSION Video communication is unlikely to improve telephone CPR (t-CPR) significantly without proper training of dispatchers and when using dispatch protocols written for audio-only calls. Improved dispatch procedures and training for handling video calls require further investigation.
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Affiliation(s)
- S R Bolle
- Norwegian Centre for Telemedicine, University Hospital of North Norway, Tromsø, Norway.
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Cardiac arrest patients rarely receive chest compressions before ambulance arrival despite the availability of pre-arrival CPR instructions. Resuscitation 2008; 77:51-6. [DOI: 10.1016/j.resuscitation.2007.10.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2007] [Revised: 10/18/2007] [Accepted: 10/26/2007] [Indexed: 11/20/2022]
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In this issue. Resuscitation 2007. [DOI: 10.1016/j.resuscitation.2007.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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