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Missel AL, Dowker SR, Chiola M, Platt J, Tsutsui J, Kasten K, Swor R, Neumar RW, Hunt N, Herbert L, Sams W, Nallamothu BK, Shields T, Coulter-Thompson EI, Friedman CP. Barriers to the Initiation of Telecommunicator-CPR during 9-1-1 Out-of-Hospital Cardiac Arrest Calls: A Qualitative Study. PREHOSP EMERG CARE 2023; 28:118-125. [PMID: 36857489 DOI: 10.1080/10903127.2023.2183533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/15/2023] [Indexed: 03/03/2023]
Abstract
INTRODUCTION Fewer than 10% of individuals who suffer out-of-hospital cardiac arrest (OHCA) survive with good neurologic function. Bystander CPR more than doubles the chance of survival, and telecommunicator-CPR (T-CPR) during a 9-1-1 call substantially improves the frequency of bystander CPR. OBJECTIVE We examined the barriers to initiation of T-CPR. METHODS We analyzed the 9-1-1 call audio from 65 EMS-treated OHCAs from a single US 9-1-1 dispatch center. We initially conducted a thematic analysis aimed at identifying barriers to the initiation of T-CPR. We then conducted a conversation analysis that examined the interactions between telecommunicators and bystanders during the recognition phase (i.e., consciousness and normal breathing). RESULTS We identified six process themes related to barriers, including incomplete or delayed recognition assessment, delayed repositioning, communication gaps, caller emotional distress, nonessential questions and assessments, and caller refusal, hesitation, or inability to act. We identified three suboptimal outcomes related to arrest recognition and delivery of chest compressions, which are missed OHCA identification, delayed OHCA identification and treatment, and compression instructions not provided following OHCA identification. A primary theme observed during missed OHCA calls was incomplete or delayed recognition assessment and included failure to recognize descriptors indicative of agonal breathing (e.g., "snoring", "slow") or to confirm that breathing was effective in an unconscious victim. CONCLUSIONS We observed that modifiable barriers identified during 9-1-1 calls where OHCA was missed, or treatment was delayed, were often related to incomplete or delayed recognition assessment. Repositioning delays were a common barrier to the initiation of chest compressions.
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Affiliation(s)
- Amanda L Missel
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Stephen R Dowker
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Jodyn Platt
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | | | | | - Robert Swor
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Nathaniel Hunt
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Logan Herbert
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Woodrow Sams
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Brahmajee K Nallamothu
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Theresa Shields
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Emilee I Coulter-Thompson
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Charles P Friedman
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
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