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Tuffley RH, Folke F, Ersbøll AK, Blomberg SNF, Linderoth G. Is dispatcher-assisted cardiopulmonary resuscitation affected by a bystander's emotional stress state in out-of-hospital cardiac arrest? Scand J Trauma Resusc Emerg Med 2023; 31:82. [PMID: 37978562 PMCID: PMC10656878 DOI: 10.1186/s13049-023-01117-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/06/2023] [Indexed: 11/19/2023] Open
Abstract
AIM The study aimed to investigate whether a bystander's emotional stress state affects dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) in out-of-hospital cardiac arrest (OHCA). The primary outcome was initiation of chest compressions (Yes/No). Secondarily we analysed time until chest compressions were initiated and assessed how dispatchers instructed CPR. METHOD The study was a retrospective, observational study of OHCA emergency calls from the Capital Region of Denmark. Recorded calls were evaluated by five observers using a pre-defined code catalogue regarding the variables wished investigated. RESULTS Included were 655 OHCA emergency calls, of which 211 callers were defined as emotionally stressed. When cardiac arrest was recognized, chest compressions were initiated in, respectively, 76.8% of cases with an emotionally stressed caller and 73.9% in cases with a not emotionally stressed caller (2.18 (0.80-7.64)). Cases with an emotionally stressed caller had a longer time until chest compressions were initiated compared to cases with a not emotionally stressed caller, however non-significant (164 s. vs. 146 s.; P = 0.145). The dispatchers were significantly more likely to be encouraging and motivating, and to instruct on speed and depth of chest compressions in cases with an emotionally stressed caller compared to cases with a not emotionally stressed caller (1.64 (1.07-2.56); 1.78 (1.13-2.88)). Barriers to CPR were significantly more often reported in cases with an emotionally stressed caller compared to cases with a not emotionally stressed caller (1.83 (1.32-2.56)). CONCLUSION There was no significant difference in initiation of chest compressions or in time until initiation of chest compressions in the two groups. However, the dispatchers were overall more encouraging and motivating, and likely to instruct on speed and depth of chest compressions when the caller was emotionally stressed. Furthermore, barriers to CPR were more often reported in cases with an emotionally stressed caller compared to cases with a not emotionally stressed caller. TRIAL REGISTRATION We applied for ethical approval from The Danish National Committee on Health Research Ethics, but formal approval was waived. We received permission for storage of data and to use these for research of OHCAs in the Capital Region of Denmark by Danish Data Protection Agency (P-2021-670) and Danish Health Authorities (R-2,005,114). The study is registered at ClinicalTrials (NTC05113706).
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Affiliation(s)
- Rebecca Hvidt Tuffley
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, Ballerup, 2750, Denmark.
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, Ballerup, 2750, Denmark
- Dept. of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, Herlev, 2730, Denmark
- Dept. of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, Copenhagen, 2200, Denmark
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, Copenhagen, 1455, Denmark
| | | | - Gitte Linderoth
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, Ballerup, 2750, Denmark
- Dept. of Anesthesiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Copenhagen, 2400, Denmark
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Binhotan M, Turnbull J, Petley G, Aljerian N, Altuwaijri M. Evaluation of Telephone Cardiopulmonary Resuscitation Performance in Current Practice in Saudi Arabia. J Saudi Heart Assoc 2023; 35:244-253. [PMID: 37881593 PMCID: PMC10597598 DOI: 10.37616/2212-5043.1353] [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: 04/04/2023] [Revised: 09/10/2023] [Accepted: 09/13/2023] [Indexed: 10/27/2023] Open
Abstract
Objectives Out-of-hospital cardiac arrest (OHCA) is a global health problem with a low survival rate. Telephone cardiopulmonary resuscitation (T-CPR) guidance by emergency medical services (EMS) dispatchers can improve CPR performance and, consequently, survival rates. Accordingly, the American Heart Association (AHA) has released performance standards for T-CPR in current practice to improve its quality. However, no study has examined T-CPR performance in Saudi Arabia. Therefore, this study aims to evaluate T-CPR performance in the Saudi Arabian EMS system. Methods A retrospective observation of OHCA calls in current practice was conducted in Riyadh, Saudi Arabia. OHCA calls were reviewed to identify those that met the selection criteria. Variables collected included return of spontaneous circulation (ROSC), OHCA recognition rate, time from EMS call receipt to location acquisition, to OHCA recognition and to commencement of CPR. Results A total of 308 OHCA cases were reviewed, and 100 calls were included. ROSC was identified in 10% of the included calls. OHCA was correctly recognized in 62% of the calls. The time to OHCA identification and CPR performance from EMS call receipt were found to be 303 s and 367 s, respectively. Conclusion T-CPR performance in Saudi Arabia is below AHA standards. However, this is similar to what has been reported in the literature. Avoiding any unnecessary call transfer during OHCA calls and prompt identification of callers' locations could improve T-CPR performance.
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Affiliation(s)
- Meshary Binhotan
- School of Health Sciences, University of Southampton, Southampton,
United Kingdom
- Department of Emergency Medical Services, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh,
Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh,
Saudi Arabia
| | - Joanne Turnbull
- School of Health Sciences, University of Southampton, Southampton,
United Kingdom
| | - Graham Petley
- School of Health Sciences, University of Southampton, Southampton,
United Kingdom
| | - Nawfal Aljerian
- Medical Referrals Center, Ministry of Health, Riyadh,
Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh,
Saudi Arabia
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Hölzing CR, Brinkrolf P, Metelmann C, Metelmann B, Hahnenkamp K, Baumgarten M. Potential to enhance telephone cardiopulmonary resuscitation with improved instructions - findings from a simulation-based manikin study with lay rescuers. BMC Emerg Med 2023; 23:36. [PMID: 37003971 PMCID: PMC10067171 DOI: 10.1186/s12873-023-00810-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 03/23/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Telephone-Cardiopulmonary Resuscitation (T-CPR) significantly increases rate of bystander resuscitation and improves patient outcomes after out-of-hospital cardiac arrest (OHCA). Nevertheless, securing correct execution of instructions remains a difficulty. ERC Guidelines 2021 recommend standardised instructions with continuous evaluation. Yet, there are no explicit recommendations on a standardised wording of T-CPR in the German language. We investigated, whether a modified wording regarding check for breathing in a German T-CPR protocol improved performance of T-CPR. METHODS A simulation study with 48 OHCA scenarios was conducted. In a non-randomised trial study lay rescuers were instructed using the real-life-CPR protocol of the regional dispatch centre and as the intervention a modified T-CPR protocol, including specific check for breathing (head tilt-chin lift instructions). Resuscitation parameters were assessed with a manikin and video recordings. RESULTS Check for breathing was performed by 64.3% (n = 14) of the lay rescuers with original wording and by 92.6% (n = 27) in the group with modified wording (p = 0.035). In the original wording group the head tilt-chin manoeuvre was executed by 0.0% of the lay rescuers compared to 70.3% in the group with modified wording (p < 0.001). The average duration of check for breathing was 1 ± 1 s in the original wording group and 4 ± 2 s in the group with modified wording (p < 0.001). Other instructions (e.g. check for consciousness and removal of clothing) were well performed and did not differ significantly between groups. Quality of chest compression did not differ significantly between groups, with the exception of mean chest compression depth, which was slightly deeper in the modified wording group. CONCLUSION Correct check for breathing seems to be a problem for lay rescuers, which can be decreased by describing the assessment in more detail. Hence, T-CPR protocols should provide standardised explicit instructions on how to perform airway assessment. Each protocol should be evaluated for practicability.
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Affiliation(s)
- Carlos Ramon Hölzing
- Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch Straße 1, 17475, Greifswald, Germany.
| | - Peter Brinkrolf
- Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch Straße 1, 17475, Greifswald, Germany
| | - Camilla Metelmann
- Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch Straße 1, 17475, Greifswald, Germany
| | - Bibiana Metelmann
- Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch Straße 1, 17475, Greifswald, Germany
| | - Klaus Hahnenkamp
- Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch Straße 1, 17475, Greifswald, Germany
| | - Mina Baumgarten
- Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch Straße 1, 17475, Greifswald, Germany
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Nikolaj Blomberg S, Jensen TW, Porsborg Andersen M, Folke F, Kjær Ersbøll A, Torp-Petersen C, Lippert F, Collatz Christensen H. When the machine is wrong. Characteristics of true and false predictions of Out-of-Hospital Cardiac arrests in emergency calls using a machine-learning model. Resuscitation 2023; 183:109689. [PMID: 36634755 DOI: 10.1016/j.resuscitation.2023.109689] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/29/2022] [Accepted: 01/02/2023] [Indexed: 01/10/2023]
Abstract
BACKGROUND A machine-learning model trained to recognize emergency calls regarding Out-of-Hospital Cardiac Arrest (OHCA) was tested in clinical practice at Copenhagen Emergency Medical Services (EMS) from September 2018 to December 2019. We aimed to investigate emergency call characteristics where the machine-learning model failed to recognize OHCA or misinterpreted a call as being OHCA. METHODS All emergency calls were linked to the dispatch database and verified OHCAs were identified by linkage to the Danish Cardiac Arrest Registry. Calls with either false negative or false positive predictions of OHCA were evaluated by trained auditors. Descriptive analyses were performed with absolute numbers and percentages reported. RESULTS The machine-learning model processed 169,236 calls to Copenhagen EMS and suspected 5,811 (3.4%) of the calls as OHCA, resulting in 84.5% sensitivity and 97.1% specificity. Among OHCAs not recognised by machine-learning model, a condition completely different from OHCA was presented by caller in 31% of the cases. In 28% of unrecognised calls, patient was reported breathing normally, and language barriers were identified in 23% of the cases. Among falsely suspected OHCA, the patient was reported unconscious in 28% of the cases, and in 13% of the false positive cases the machine-learning model interpreted calls regarding dead patients with irreversible signs of death as OHCA. CONCLUSION Continuous optimization of the language model is needed to improve the prediction of OHCA and thereby improve sensitivity and specificity of the machine-learning model on recognising OHCA in emergency telephone calls.
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Affiliation(s)
- Stig Nikolaj Blomberg
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Theo W Jensen
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | - Fredrik Folke
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Cardiology, Herlev Gentofte University Hospital, Copenhagen, Denmark
| | - Annette Kjær Ersbøll
- Copenhagen Emergency Medical Services, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Christian Torp-Petersen
- Department of Cardiology, Nordsjællands Hospital, Denmark; Department of Public Health, University of Copenhagen, Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Falck, Denmark
| | - Helle Collatz Christensen
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Danish Clinical Quality Program (RKKP), National Clinical Registries, Denmark
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Ngo H, Birnie T, Finn J, Ball S, Perera N. Emotions in telephone calls to emergency medical services involving out-of-hospital cardiac arrest: A scoping review. Resusc Plus 2022; 11:100264. [PMID: 35801232 PMCID: PMC9253842 DOI: 10.1016/j.resplu.2022.100264] [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: 04/12/2022] [Revised: 05/25/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022] Open
Abstract
Aims The purpose of this scoping review was to identify and synthesise existing research evidence on emotions in the context of emergency phone calls to emergency medical services (EMS) involving out-of-hospital cardiac arrest (OHCA). The specific objectives were to identify studies that (1) described emotions during emergency OHCA calls; (2) specified an instrument or method for measuring/assessing emotions; and (3) examined the relationship between emotions and call outcomes or patient outcomes. Methods/Data sources Five databases were searched on 18 November 2021: Medline, Embase, PsycInfo, CINAHL, and the Cochrane Review Database. Included studies required the following three concepts to be addressed: emotions in the context of EMS calls that involved OHCA. Calls also needed to be made by a 'second-party' caller; and each study needed to address at least one of the three specific objectives, as outlined above.The review was conducted in accordance with the Joanna Briggs Institute guidelines for evidence synthesis for scoping reviews. Results Thirteen eligible studies were included for synthesis. All studies met Objective 1; six studies met Objective 2; and seven met Objective 3. One study reported patient fatality due to heightened emotions and ensuing ineffective communications between callers and call-takers. Conclusion The review highlights a significant gap in the evidence base of emotions in emergency OHCA-related calls, and the need for a more comprehensive and effective method in assessing and measuring emotions in this context. Relationships between emotions (their expressions and perceptions) and call outcomes (including patient outcomes) also need more rigorous investigation.
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Affiliation(s)
- Hanh Ngo
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Bentley, WA 6102, Australia
- Discipline of Emergency Medicine, Medical School, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Tanya Birnie
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Bentley, WA 6102, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Bentley, WA 6102, Australia
- Discipline of Emergency Medicine, Medical School, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
- St John Western Australia, 209 Great Eastern Highway, Belmont, WA 6104, Australia
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Bentley, WA 6102, Australia
- St John Western Australia, 209 Great Eastern Highway, Belmont, WA 6104, Australia
| | - Nirukshi Perera
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Bentley, WA 6102, Australia
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Jensen B, Vardinghus-Nielsen H, Mills EHA, Møller AL, Gnesin F, Zylyftari N, Kragholm K, Folke F, Christensen HC, Blomberg SN, Torp-Pedersen C, Bøggild H. "Like a rainy weather inside of me": Qualitative content analysis of telephone consultations concerning back pain preceding out-of-hospital cardiac arrest. Int Emerg Nurs 2022; 64:101200. [PMID: 35926318 DOI: 10.1016/j.ienj.2022.101200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/15/2022] [Accepted: 07/09/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Cardiac arrest patients presenting with back pain are at risk of not receiving the appropriate help when calling emergency medical services. In telephone consultations regarding patients with back pain preceding an out-of-hospital cardiac arrest, we investigated how communication between caller and call-taker influenced the call-taker's interpretation of back pain descriptions and decision-making about choice of response. METHOD The study was conducted using 20 recorded phone calls from 17 patients who contacted the Copenhagen Emergency Medical Services (Denmark) reporting back pain up to 24 hours before an out-of-hospital cardiac arrest. Qualitative content analysis was applied. RESULTS Two main categories emerged: (1) reasons, including subcategories: reported conditions, descriptions of conditions, patient's interpretation of condition and patient's own remedial actions; and (2) considerations, including subcategories: assessment of the severity, call-taker's interpretation of the condition, arguments for chosen response and conditions not facilitating further communication by the call-taker. CONCLUSION In telephone consultations regarding patients with back pain preceding an out-of-hospital cardiac arrest the communication was influenced by the communicative preconditions of the call-taker. Communication in consultations where ambulances were not dispatched was characterized by complex descriptions of symptoms not easily fitting into the health system's interpretations of conditions warranting an urgent response.
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Affiliation(s)
- Britta Jensen
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220 Aalborg, Denmark.
| | - Henrik Vardinghus-Nielsen
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220 Aalborg, Denmark
| | | | | | - Filip Gnesin
- Department of Cardiology, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Nertila Zylyftari
- Department of Cardiology, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Kristian Kragholm
- Unit of Clinical Biostatistics and Epidemiology, Department of Cardiology, Aalborg University Hospital, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark; Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, 2750 Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Helle Collatz Christensen
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, 2750 Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark; Danish Clinical Quality Program (RKKP), National Clinical Registries, Denmark
| | - Stig Nikolaj Blomberg
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, 2750 Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark; Department of Cardiology, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark; Department of Public Health, University of Copenhagen, Denmark
| | - Henrik Bøggild
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220 Aalborg, Denmark
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Kirby K, Voss S, Bird E, Benger J. Features of Emergency Medical System calls that facilitate or inhibit Emergency Medical Dispatcher recognition that a patient is in, or at imminent risk of, cardiac arrest: A systematic mixed studies review. Resusc Plus 2021; 8:100173. [PMID: 34841368 PMCID: PMC8605417 DOI: 10.1016/j.resplu.2021.100173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/19/2022] Open
Abstract
Aim To identify and appraise evidence relating to the features of an Emergency Medicine System call interaction that enable, or inhibit, an Emergency Medical Dispatcher’s recognition that a patient is in out-of-hospital cardiac arrest, or at imminent risk of out-of-hospital cardiac arrest. Methods All study designs were eligible for inclusion. Data sources included Medline, BNI, CINAHL, EMBASE, PubMed, Cochrane Database of Systematic Reviews, AMED and OpenGrey. Stakeholder resources were screened and experts in resuscitation were asked to review the studies identified. Studies were appraised using the Mixed Methods Appraisal Tool. Synthesis was completed using a segregated mixed research synthesis approach. Results Thirty-two studies were included in the review. Three main themes were identified: Key features of the Emergency Medical Service call interaction; Managing the Emergency Medical Service call; Emotional distress. Conclusion A dominant finding is the difficulty in recognising abnormal/agonal breathing during the Emergency Medical Service call. The interaction between the caller and the Emergency Medical Dispatcher is critical in the recognition of patients who suffer an out-of-hospital cardiac arrest. Emergency Medical Dispatchers adapt their approach to the Emergency Medical Service call, and regular training for Emergency Medical Dispatchers is recommended to optimise out-of-hospital cardiac arrest recognition. Further research is required with a focus on the Emergency Medical Service call interaction of patients who are alive at the time of the Emergency Medical Service call and who later deteriorate into OHCA. PROSPERO registration: CRD42019155458.
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Affiliation(s)
- Kim Kirby
- South Western Ambulance Service NHS Foundation Trust, Eagle Way, Exeter EX2 7HY, United Kingdom
- University of the West of England, Blackberry Hill, Stapleton, Bristol BS16 1DD, United Kingdom
- Corresponding author at: South Western Ambulance Service NHS Foundation Trust, Eagle Way, Exeter EX2 7HY, United Kingdom.
| | - Sarah Voss
- University of the West of England, Blackberry Hill, Stapleton, Bristol BS16 1DD, United Kingdom
| | - Emma Bird
- University of the West of England, Blackberry Hill, Stapleton, Bristol BS16 1DD, United Kingdom
| | - Jonathan Benger
- University of the West of England, Blackberry Hill, Stapleton, Bristol BS16 1DD, United Kingdom
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Early recognition of a caller's emotion in out-of-hospital cardiac arrest dispatching: An artificial intelligence approach. Resuscitation 2021; 167:144-150. [PMID: 34461203 DOI: 10.1016/j.resuscitation.2021.08.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 08/11/2021] [Accepted: 08/18/2021] [Indexed: 11/23/2022]
Abstract
AIM This study aimed to develop an AI model for detecting a caller's emotional state during out-of-hospital cardiac arrest calls by processing audio recordings of dispatch communications. METHODS Audio recordings of 337 out-of-hospital cardiac arrest calls from March-April 2011 were retrieved. The callers' emotional state was classified based on the emotional content and cooperative scores. Mel-frequency cepstral coefficients extracted essential information from the voice signals. A support vector machine was utilised for the automatic judgement, and repeated random sub-sampling cross validation (RRS-CV) was applied to evaluate robustness. The results from the artificial intelligence classifier were compared with the consensus of expert reviewers. RESULTS The audio recordings were classified into five emotional content and cooperative score levels. The proposed model had an average positive predictive value of 72.97%, a negative predictive value of 93.47%, sensitivity of 38.76%, and specificity of 98.29%. If only the first 10 seconds of the recordings were considered, it had an average positive predictive value of 84.62%, a negative predictive value of 93.57%, sensitivity of 52.38%, and specificity of 98.64%. The artificial intelligence model's performance maintained preferable results for emotionally stable cases. CONCLUSION Artificial intelligence models can possibly facilitate the judgement of callers' emotional states during dispatch conversations. This model has the potential to be utilised in practice, by pre-screening emotionally stable callers, thus allowing dispatchers to focus on cases that are judged to be emotionally unstable. Further research and validation are required to improve the model's performance and make it suitable for the general population.
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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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Fukushima H, Bolstad F. Telephone CPR: Current Status, Challenges, and Future Perspectives. Open Access Emerg Med 2020; 12:193-200. [PMID: 32982493 PMCID: PMC7490094 DOI: 10.2147/oaem.s259700] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/12/2020] [Indexed: 12/16/2022] Open
Abstract
With each successive update of the cardiopulmonary resuscitation (CPR) guidelines, the role of dispatchers in sudden cardiac arrest (CA) has grown. Dispatchers instruct callers in how to perform CPR until the arrival of emergency medical service (EMS) professionals. This is widely known as telephone CPR (TCPR) or dispatch-assisted CPR (DACPR). Studies have shown the efficacy of TCPR in increasing the survival rate of sudden CA. The TCPR process, however, is challenging and needs to be constantly evaluated and refined in order to improve the survival rate of sudden CA victims throughout the world. In this review article, the current status, challenges, and future perspectives of TCPR are discussed with a view to providing a research foundation from which to launch further studies into the effective role of dispatchers in sudden CA.
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Affiliation(s)
- Hidetada Fukushima
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara City, Nara, Japan
| | - Francesco Bolstad
- Department of Clinical English, Nara Medical University, Kashihara City, Nara, Japan
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Kim TH, Sohn Y, Hong W, Song KJ, Shin SD. Association between hourly call volume in the emergency medical dispatch center and dispatcher-assisted cardiopulmonary resuscitation instruction time in out-of-hospital cardiac arrest. Resuscitation 2020; 153:136-142. [DOI: 10.1016/j.resuscitation.2020.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/17/2020] [Accepted: 05/20/2020] [Indexed: 11/27/2022]
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12
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Leong PWK, Leong BSH, Arulanandam S, Ng MXR, Ng YY, Ong MEH, Mao DRH. Simplified instructional phrasing in dispatcher-assisted cardiopulmonary resuscitation - when 'less is more'. Singapore Med J 2020; 62:647-652. [PMID: 32460451 DOI: 10.11622/smedj.2020080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In our national emergency dispatch centre, the standard protocol for dispatcher-assisted cardiopulmonary resuscitation (DACPR) in out-of-hospital cardiac arrests (OHCAs) involves the instruction "push 100 times a minute 5 cm deep". As part of quality improvement, the instruction was simplified to "push hard and fast". METHODS We analysed all dispatcher-diagnosed OHCAs over four months in 2018: January to February ("push 100 times a minute 5 cm deep") and August to September ("push hard and fast"). We also performed secondary per-protocol analysis based on the protocol used: (a) standard (n = 48); (b) simplified (n = 227); and (c) own words (n = 231). RESULTS 506 cases were included, 282 in the 'before' group and 224 in the 'after' group. Adherence to the protocol was 15.2% in the 'before' phase and 72.8% in the 'after' phase (p < 0.001). The mean time between instruction and first compression for the 'before' and 'after' groups was 34.36 seconds and 26.83 seconds, respectively (p < 0.001). Time to first compression was 238.62 seconds and 218.83 seconds in the 'before' and 'after' groups, respectively (p = 0.016). In the per-protocol analysis, the interval between instruction and compression was 37.19 seconds, 28.31 seconds and 32.40 seconds in the standard protocol, simplified protocol and 'own words' groups, respectively (p = 0.005). The need for paraphrasing was 60.4% in the standard protocol group and 81.5% in the simplified group (p < 0.001). CONCLUSION Simplified instructions were associated with a shorter interval between instruction and first compression. Efforts should be directed at simplifying DACPR instructions.
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Affiliation(s)
| | | | - Shalini Arulanandam
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore
| | - Marie Xin Ru Ng
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore
| | - Yih Yng Ng
- Home Team Medical Services, Ministry of Home Affairs, Singapore.,Emergency Department, Tan Tock Seng Hospital, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore.,Health Service and Systems Research, Duke-NUS Medical School, Singapore
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De Silva T, Hodges PW, Costa N, Setchell J. Potential Unintended Effects of Standardized Pain Questionnaires: A Qualitative Study. PAIN MEDICINE 2020; 21:e22-e33. [PMID: 31617917 DOI: 10.1093/pm/pnz252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Low back pain is a common musculoskeletal condition with substantial individual and societal costs. Standardized self-report questionnaires are commonly used in clinical practice to identify prognostic risk factors and tailor interventions for low back pain. However, most of these low back pain questionnaires have been developed in Western cultures and may not be clinically applicable to other cultures. These cultural aspects have not been explored. This study aimed to investigate the cultural assumptions underlying back pain questionnaires and the potential implications of using standardized questionnaires with non-Western populations. DESIGN An interpretive qualitative design was employed. SUBJECTS Participants (N = 16) self-identified as coming from culturally and linguistically diverse backgrounds. METHODS Data collection and analysis were guided by thematic analysis. Four focus groups of three to five participants were conducted during which participants discussed two questionnaires commonly used in low back pain settings: the Fear-Avoidance Beliefs Questionnaire and Örebro Musculoskeletal Pain Questionnaire. RESULTS Analysis identified four themes: questionnaires affect the patient-clinician encounter; results are not only about back pain; questionnaires affect people's understanding of their back pain; and results potentially affect people's lives beyond their back condition. CONCLUSIONS Findings suggest that questionnaires could potentially negatively affect the patient-clinician rapport and lead to inaccurate and unanticipated results when used with culturally and linguistically diverse populations. Findings are also likely to be applicable to people with low back pain more broadly, regardless of culture. Implications include a need for cultural sensitivity when using questionnaires, greater consideration of when to use these measures, and adaptations to the use/design of standardized questionnaires.
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Affiliation(s)
- Theresa De Silva
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Nathalia Costa
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Jenny Setchell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Lu CH, Fang PH, Lin CH. Dispatcher-assisted cardiopulmonary resuscitation for traumatic patients with out-of-hospital cardiac arrest. Scand J Trauma Resusc Emerg Med 2019; 27:97. [PMID: 31675978 PMCID: PMC6824105 DOI: 10.1186/s13049-019-0679-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/17/2019] [Indexed: 12/24/2022] Open
Abstract
Background Resuscitation efforts for traumatic patients with out-of-hospital cardiac arrest (OHCA) are not always futile. Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) during emergency calls could increase the rate of bystander cardiopulmonary resuscitation (CPR) and thus may enhance survival and neurologic outcomes of non-traumatic OHCA. This study aimed to examine the effectiveness of DA-CPR for traumatic OHCA. Methods A retrospective cohort study was conducted using an Utstein-style population database with data from January 1, 2014, to December 31, 2016, in Tainan City, Taiwan. Voice recordings of emergency calls were retrospectively retrieved and reviewed. The primary outcome was an achievement of sustained (≥2 h) return of spontaneous circulation (ROSC); the secondary outcomes were prehospital ROSC, ever ROSC, survival at discharge and favourable neurologic status at discharge. Statistical significance was set at a p-value of less than 0.05. Results A total of 4526 OHCA cases were enrolled. Traumatic OHCA cases (n = 560, 12.4%), compared to medical OHCA cases (n = 3966, 87.6%), were less likely to have bystander CPR (10.7% vs. 31.7%, p < 0.001) and initially shockable rhythms (7.1% vs. 12.5%, p < 0.001). Regarding DA-CPR performance, traumatic OHCA cases were less likely to have dispatcher recognition of cardiac arrest (6.3% vs. 42.0%, p < 0.001), dispatcher initiation of bystander CPR (5.4% vs. 37.6%, p < 0.001), or any dispatcher delivery of CPR instructions (2.7% vs. 20.3%, p < 0.001). Stepwise logistic regression analysis showed that witnessed cardiac arrests (aOR 1.70, 95% CI 1.10–2.62; p = 0.017) and transportation to level 1 centers (aOR 1.99, 95% CI 1.27–3.13; p = 0.003) were significantly associated with achievement of sustained ROSC in traumatic OHCA cases, while DA-CPR-related variables were not (All p > 0.05). Conclusions DA-CPR was not associated with better outcomes for traumatic OHCA in achieving a sustained ROSC. The DA-CPR program for traumatic OHCAs needs further studies to validate its effectiveness and practicability, especially in the communities where rules for the termination of resuscitation in prehospital settings do not exist.
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Affiliation(s)
- Chien-Hsin Lu
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 70403, No.138, Shengli Rd., North District, Tainan, Taiwan
| | - Pin-Hui Fang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 70403, No.138, Shengli Rd., North District, Tainan, Taiwan
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 70403, No.138, Shengli Rd., North District, Tainan, Taiwan.
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Chien CY, Chien WC, Tsai LH, Tsai SL, Chen CB, Seak CJ, Chou YS, Ma M, Weng YM, Ng CJ, Lin CY, Tzeng IS, Lin CC, Huang CH. Impact of the caller’s emotional state and cooperation on out-of-hospital cardiac arrest recognition and dispatcher-assisted cardiopulmonary resuscitation. Emerg Med J 2019; 36:595-600. [PMID: 31439715 DOI: 10.1136/emermed-2018-208353] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 07/24/2019] [Accepted: 08/02/2019] [Indexed: 11/04/2022]
Abstract
ObjectiveThis study determined the impact of the caller’s emotional state and cooperation on out-of-hospital cardiac arrest (OHCA) recognition and dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) performance metrics.MethodsThis was a retrospective study using data from November 2015 to October 2016 from the emergency medical service dispatching centre in northern Taiwan. Audio recordings of callers contacting the centre regarding adult patients with non-traumatic OHCA were reviewed. The reviewers assigned an emotional content and cooperation score (ECCS) to the callers. ECCS 1–3 callers were graded as cooperative and ECCS 4–5 callers as uncooperative and highly emotional. The relation between ECCS and OHCA recognition, time to key events and DA-CPR delivery were investigated.ResultsOf the 367 cases, 336 (91.6%) callers were assigned ECCS 1–3 with a good inter-rater reliability (k=0.63). Dispatchers recognised OHCA in 251 (68.4%) cases. Compared with callers with ECCS 1, callers with ECCS 2 and 3 were more likely to give unambiguous responses about the patient’s breathing status (adjusted OR (AOR)=2.6, 95% CI 1.1 to 6.4), leading to a significantly higher rate of OHCA recognition (AOR=2.3, 95% CI 1.1 to 5.0). Thirty-one callers were rated uncooperative (ECCS 4–5) but had shorter median times to OHCA recognition and chest compression (29 and 122 s, respectively) compared with the cooperative caller group (38 and 170 s, respectively). Nevertheless, those with ECCS 4–5 had a significantly lower DA-CPR delivery rate (54.2% vs 85.9%) due to ‘caller refused’ or ‘overly distraught’ factors.ConclusionsThe caller’s high emotional state is not a barrier to OHCA recognition by dispatchers but may prevent delivery of DA-CPR instruction. However, DA-CPR instruction followed by first chest compression is possible despite the caller’s emotional state if dispatchers are able to skilfully reassure the emotional callers.
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Temporal variations in dispatcher-assisted and bystander-initiated resuscitation efforts. Am J Emerg Med 2018; 36:2203-2210. [DOI: 10.1016/j.ajem.2018.03.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/26/2018] [Accepted: 03/30/2018] [Indexed: 11/21/2022] Open
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Prentice C, Jeyanathan J, De Coverly R, Williams J, Lyon R. Emergency medical dispatch recognition, clinical intervention and outcome of patients in traumatic cardiac arrest from major trauma: an observational study. BMJ Open 2018; 8:e022464. [PMID: 30185576 PMCID: PMC6129099 DOI: 10.1136/bmjopen-2018-022464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES The aim of this study is to describe the demographics of reported traumatic cardiac arrest (TCA) victims, prehospital resuscitation and survival to hospital rate. SETTING Helicopter Emergency Medical Service (HEMS) in south-east England, covering a resident population of 4.5 million and a transient population of up to 8 million people. PARTICIPANTS Patients reported on the initial 999 call to be in suspected traumatic cardiac arrest between 1 July 2016 and 31 December 2016 within the trust's geographical region were identified. The inclusion criteria were all cases of reported TCA on receipt of the initial emergency call. Patients were subsequently excluded if a medical cause of cardiac arrest was suspected. OUTCOME MEASURES Patient records were analysed for actual presence of cardiac arrest, prehospital resuscitation procedures undertaken and for survival to hospital rates. RESULTS 112 patients were reported to be in TCA on receipt of the 999/112 call. 51 (46%) were found not to be in TCA on arrival of emergency medical services. Of the 'not in TCA cohort', 34 (67%) received at least one advanced prehospital medical intervention (defined as emergency anaesthesia, thoracostomy, blood product transfusion or resuscitative thoracotomy). Of the 61 patients in actual TCA, 10 (16%) achieved return-of-spontaneous circulation. In 45 (88%) patients, the HEMS team escorted the patient to hospital. CONCLUSION A significant proportion of patients reported to be in TCA on receipt of the emergency call are not in actual cardiac arrest but are critically unwell requiring advanced prehospital medical intervention. Early activation of an enhanced care team to a reported TCA call allows appropriate advanced resuscitation. Further research is warranted to determine which interventions contribute to improved TCA survival.
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Affiliation(s)
- Craig Prentice
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill, UK
| | - Jeyasankar Jeyanathan
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill, UK
- Academic Department of Military Anaesthesia and Critical Care, Defence Medical Services, Birmingham, UK
| | | | - Julia Williams
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill, UK
- University of Hertfordshire, Hertfordshire, UK
- South East Coast Ambulance Service, Crawley, UK
| | - Richard Lyon
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill, UK
- University of Surrey, Guildford, UK
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Lee SY, Ro YS, Shin SD, Song KJ, Hong KJ, Park JH, Kong SY. Recognition of out-of-hospital cardiac arrest during emergency calls and public awareness of cardiopulmonary resuscitation in communities: A multilevel analysis. Resuscitation 2018; 128:106-111. [DOI: 10.1016/j.resuscitation.2018.05.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 04/30/2018] [Accepted: 05/05/2018] [Indexed: 10/17/2022]
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Syväoja S, Salo A, Uusaro A, Jäntti H, Kuisma M. Witnessed out-of-hospital cardiac arrest- effects of emergency dispatch recognition. Acta Anaesthesiol Scand 2018; 62:558-567. [PMID: 29266165 DOI: 10.1111/aas.13051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 10/24/2017] [Accepted: 11/24/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Survival from an out-of-hospital cardiac arrest (OHCA) depends on the sequence of interventions in "the chain of survival". If OHCA is recognized in the emergency medical communication centre (EMCC), the proper emergency medical service (EMS) should be dispatched and cardiopulmonary resuscitation (CPR) instructions should be given to a bystander. The study aimed to examine the impact of OHCA recognition in the EMCC on survival rates and the main elements of the chain of survival. METHODS Data from the Helsinki University Hospital's registry of OHCA patients between 1997 and 2013 were studied. Altogether, 2054 EMCC-handled and bystander-witnessed OHCA proven events of cardiac origin were analysed. RESULTS In 80.5% of the victims, two EMS units were correctly dispatched and the OHCA was classified as recognized. Achieved return of spontaneous circulation (ROSC) and survival to hospital discharge were 49% and 23%, respectively, if cardiac arrest was recognized by the EMCC and 40% and 16% when it was not (P = 0.003 and 0.002). Dispatchers gave CPR instructions in 60% of the recognized OHCA cases. Bystander-performed CPR increased over time and was given in 58% of the recognized OHCAs and also in 17% of the unrecognized events. EMS delays were shorter if OHCA was recognized as opposed to unrecognized (8 min with an IQR 6.5-10 min vs. 9 min with an IQR 6.5-11 min; P = 0.001). CONCLUSIONS Recognition of OHCA by the EMCC was significantly associated with an increased rate of bystander-performed CPR, reduced EMS response time, and increased OHCA patient ROSC and survival rates.
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Affiliation(s)
- S. Syväoja
- Department of Anaesthesia and Intensive Care; North Karelia Central Hospital; Joensuu Finland
| | - A. Salo
- Department of Emergency Medicine; Section of EMS; Helsinki University Central Hospital; Helsinki Finland
| | - A. Uusaro
- Department of Intensive Care; Kuopio University Hospital, KYS; Kuopio Finland
| | - H. Jäntti
- Centre for Prehospital Emergency Care; Kuopio University Hospital, KYS; Kuopio Finland
| | - M. Kuisma
- Department of Emergency Medicine; Section of EMS; Helsinki University Central Hospital; Helsinki Finland
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How Does a Caller’s Anger, Fear and Sadness Affect Operators’ Decisions in Emergency Calls? INTERNATIONAL REVIEW OF SOCIAL PSYCHOLOGY 2018. [DOI: 10.5334/irsp.89] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Riou M, Ball S, Williams TA, Whiteside A, Cameron P, Fatovich DM, Perkins GD, Smith K, Bray J, Inoue M, O'Halloran KL, Bailey P, Brink D, Finn J. 'She's sort of breathing': What linguistic factors determine call-taker recognition of agonal breathing in emergency calls for cardiac arrest? Resuscitation 2017; 122:92-98. [PMID: 29183831 DOI: 10.1016/j.resuscitation.2017.11.058] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 10/27/2017] [Accepted: 11/24/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND In emergency ambulance calls, agonal breathing remains a barrier to the recognition of out-of-hospital cardiac arrest (OHCA), initiation of cardiopulmonary resuscitation, and rapid dispatch. We aimed to explore whether the language used by callers to describe breathing had an impact on call-taker recognition of agonal breathing and hence cardiac arrest. METHODS We analysed 176 calls of paramedic-confirmed OHCA, stratified by recognition of OHCA (89 cases recognised, 87 cases not recognised). We investigated the linguistic features of callers' response to the question "is s/he breathing?" and examined the impact on subsequent coding by call-takers. RESULTS Among all cases (recognised and non-recognised), 64% (113/176) of callers said that the patients were breathing (yes-answers). We identified two categories of yes-answers: 56% (63/113) were plain answers, confirming that the patient was breathing ("he's breathing"); and 44% (50/113) were qualified answers, containing additional information ("yes but gasping"). Qualified yes-answers were suggestive of agonal breathing. Yet these answers were often not pursued and most (32/50) of these calls were not recognised as OHCA at dispatch. CONCLUSION There is potential for improved recognition of agonal breathing if call-takers are trained to be alert to any qualification following a confirmation that the patient is breathing.
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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
| | - Teresa A Williams
- 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; Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia; Emergency Medicine, Royal Perth Hospital, Perth, WA 6001, Australia
| | | | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3004, 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
| | - Gavin D Perkins
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Karen Smith
- Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3004, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria 3004, Australia; Ambulance Victoria, Blackburn North, Victoria 3130, 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
| | - Madoka Inoue
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia
| | - Kay L O'Halloran
- School of Education, 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
| | - 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; Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3004, Australia
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Debaty G, Labarere J, Frascone RJ, Wayne MA, Swor RA, Mahoney BD, Domeier RM, Olinger ML, O'Neil BJ, Yannopoulos D, Aufderheide TP, Lurie KG. Long-Term Prognostic Value of Gasping During Out-of-Hospital Cardiac Arrest. J Am Coll Cardiol 2017; 70:1467-1476. [PMID: 28911510 DOI: 10.1016/j.jacc.2017.07.782] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 07/18/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Gasping is a natural reflex that enhances oxygenation and circulation during cardiopulmonary resuscitation (CPR). OBJECTIVES This study sought to assess the relationship between gasping during out-of-hospital cardiac arrest and 1-year survival with favorable neurological outcomes. METHODS The authors prospectively collected incidence of gasping on all evaluable subjects in a multicenter, randomized, controlled, National Institutes of Health-funded out-of-hospital cardiac arrest clinical trial from August 2007 to July 2009. The association between gasping and 1-year survival with favorable neurological function, defined as a Cerebral Performance Category (CPC) score ≤2 was estimated using multivariable logistic regression. RESULTS The rates of 1-year survival with a CPC score of ≤2 were 5.4% (98 of 1,827) overall, and 20% (36 of 177) and 3.7% (61 of 1,643) for individuals with and without spontaneous gasping or agonal respiration during CPR, respectively. In multivariable analysis, 1-year survival with CPC ≤2 was independently associated with younger age (odds ratio [OR] for 1 SD increment 0.57; 95% confidence interval [CI]: 0.43 to 0.76), gasping during CPR (OR: 3.94; 95% CI: 2.09 to 7.44), shockable initial recorded rhythm (OR: 16.50; 95% CI: 7.40 to 36.81), shorter CPR duration (OR: 0.31; 95% CI: 0.19 to 0.51), lower epinephrine dosage (OR: 0.47; 95% CI: 0.25 to 0.87), and pulmonary edema (OR: 3.41; 95% CI: 1.53 to 7.60). Gasping combined with a shockable initial recorded rhythm had a 57-fold higher OR (95% CI: 23.49 to 136.92) of 1-year survival with CPC ≤2 versus no gasping and no shockable rhythm. CONCLUSIONS Gasping during CPR was independently associated with increased 1-year survival with CPC ≤2, regardless of the first recorded rhythm. These findings underscore the importance of not terminating resuscitation prematurely in gasping patients and the need to routinely recognize, monitor, and record data on gasping in all future cardiac arrest trials and registries.
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Affiliation(s)
- Guillaume Debaty
- University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525, Grenoble, France; Department of Emergency Medicine, University Hospital of Grenoble Alps, Grenoble, France.
| | - Jose Labarere
- University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525, Grenoble, France; Quality of Care Unit, CIC 1406, INSERM, University Hospital of Grenoble Alps, Grenoble, France
| | - Ralph J Frascone
- Department of Emergency Medicine, Regions Hospital, St. Paul, Minnesota
| | - Marvin A Wayne
- Whatcom County Emergency Medical Services, Department of Emergency Medicine, PeaceHealth St. Joseph Medical Center, Bellingham, Washington
| | - Robert A Swor
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Brian D Mahoney
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Robert M Domeier
- Department of Emergency Medicine, St. Joseph Hospital, Ann Arbor, Michigan
| | - Michael L Olinger
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan
| | - Demetris Yannopoulos
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Tom P Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Keith G Lurie
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan
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23
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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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24
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Riou M, Ball S, Williams TA, Whiteside A, O'Halloran KL, Bray J, Perkins GD, Smith K, Cameron P, Fatovich DM, Inoue M, Bailey P, Brink D, Finn J. 'Tell me exactly what's happened': When linguistic choices affect the efficiency of emergency calls for cardiac arrest. Resuscitation 2017; 117:58-65. [PMID: 28599999 DOI: 10.1016/j.resuscitation.2017.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/18/2017] [Accepted: 06/05/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clear and efficient communication between emergency caller and call-taker is crucial to timely ambulance dispatch. We aimed to explore the impact of linguistic variation in the delivery of the prompt "okay, tell me exactly what happened" on the way callers describe the emergency in the Medical Priority Dispatch System®. METHODS We analysed 188 emergency calls for cases of paramedic-confirmed out-of-hospital cardiac arrest. We investigated the linguistic features of the prompt "okay, tell me exactly what happened" in relation to the format (report vs. narrative) of the caller's response. In addition, we compared calls with report vs. narrative responses in the length of response and time to dispatch. RESULTS Callers were more likely to respond with a report format when call-takers used the present perfect ("what's happened") rather than the simple past ("what happened") (Adjusted Odds Ratio [AOR] 4.07; 95% Confidence Interval [95%CI] 2.05-8.28, p<0.001). Reports were significantly shorter than narrative responses (9s vs. 18s, p<0.001), and were associated with less time to dispatch (50s vs. 58s, p=0.002). CONCLUSION These results suggest that linguistic variations in the way the scripted sentences of a protocol are delivered can have an impact on the efficiency with which call-takers process emergency calls. A better understanding of interactional dynamics between caller and call-taker may translate into improvements of dispatch performance.
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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
| | - Teresa A Williams
- 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; Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia; Royal Perth Hospital, Perth, WA 6001, Australia
| | | | - Kay L O'Halloran
- School of Education, 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
- Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3004, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria 3004, Australia; Ambulance Victoria, Blackburn North, Victoria 3130, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3004, 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; Royal Perth Hospital, Perth, WA 6001, Australia; Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Nedlands, WA 6009, 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
| | - 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; Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3004, Australia
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Møller TP, Kjærulff TM, Viereck S, Østergaard D, Folke F, Ersbøll AK, Lippert FK. The difficult medical emergency call: A register-based study of predictors and outcomes. Scand J Trauma Resusc Emerg Med 2017; 25:22. [PMID: 28249588 PMCID: PMC5333377 DOI: 10.1186/s13049-017-0366-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pre-hospital emergency care requires proper categorization of emergency calls and assessment of emergency priority levels by the medical dispatchers. We investigated predictors for emergency call categorization as "unclear problem" in contrast to "symptom-specific" categories and the effect of categorization on mortality. METHODS Register-based study in a 2-year period based on emergency call data from the emergency medical dispatch center in Copenhagen combined with nationwide register data. Logistic regression analysis (N = 78,040 individuals) was used for identification of predictors of emergency call categorization as "unclear problem". Poisson regression analysis (N = 97,293 calls) was used for examining the effect of categorization as "unclear problem" on mortality. RESULTS "Unclear problem" was the registered category in 18% of calls. Significant predictors for "unclear problem" categorization were: age (odds ratio (OR) 1.34 for age group 76+ versus 18-30 years), ethnicity (OR 1.27 for non-Danish vs. Danish), day of week (OR 0.92 for weekend vs. weekday), and time of day (OR 0.79 for night vs. day). Emergency call categorization had no effect on mortality for emergency priority level A calls, incidence rate ratio (IRR) 0.99 (95% confidence interval (CI) 0.90-1.09). For emergency priority level B calls, an association was observed, IRR 1.26 (95% CI 1.18-1.36). DISCUSSIONS The results shed light on the complexity of emergency call handling, but also implicate a need for further improvement. Educational interventions at the dispatch centers may improve the call handling, but also the underlying supportive tools are modifiable. The higher mortality rate for patients with emergency priority level B calls with "unclear problem categorization" could imply lowering the threshold for dispatching a high level ambulance response when the call is considered unclear. On the other hand a "benefit of the doubt" approach could hinder the adequate response to other patients in need for an ambulance as there is an increasing demand and limited resources for ambulance services. CONCLUSIONS Age, ethnicity, day of week and time of day were significant predictors of emergency call categorization as "unclear problem". "Unclear problem" categorization was not associated with mortality for emergency priority level A calls, but a higher mortality was observed for emergency priority level B calls.
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Affiliation(s)
- Thea Palsgaard Møller
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, 2750, Ballerup, Denmark.
| | - Thora Majlund Kjærulff
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 1353, København K, Denmark
| | - Søren Viereck
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, 2750, Ballerup, Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Fredrik Folke
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, 2750, Ballerup, Denmark
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 1353, København K, Denmark
| | - Freddy K Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, 2750, Ballerup, Denmark
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26
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Viereck S, Palsgaard Møller T, Kjær Ersbøll A, Folke F, Lippert F. Effect of bystander CPR initiation prior to the emergency call on ROSC and 30day survival-An evaluation of 548 emergency calls. Resuscitation 2016; 111:55-61. [PMID: 27923114 DOI: 10.1016/j.resuscitation.2016.11.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 11/13/2016] [Accepted: 11/18/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed at evaluating if time for initiation of bystander cardiopulmonary resuscitation (CPR) - prior to the emergency call (CPRprior) versus during the emergency call following dispatcher-assisted CPR (CPRduring) - was associated with return of spontaneous circulation (ROSC) and 30-day survival. The secondary aim was to identify predictors of CPRprior. METHODS This observational study evaluated out-of-hospital cardiac arrests (OHCA) occurring in the Capital Region of Denmark from 01.01.2013 to 31.12.2013. OHCAs were linked to emergency medical dispatch centre records and corresponding emergency calls were evaluated. Multivariable logistic regression analyses were applied to evaluate the association between time for initiation of bystander CPR, ROSC, and 30-day survival. Univariable logistic regression analyses were applied to identify predictors of CPRprior. RESULTS The study included 548 emergency calls for OHCA patients receiving bystander CPR, 34.9% (n=191) in the CPRprior group and 65.1% (n=357) in the CPRduring group. Multivariable analyses showed no difference in ROSC (OR=0.88, 95% CI: 0.56-1.38) or 30-day survival (OR=1.14, 95% CI: 0.68-1.92) between CPRprior and CPRduring. Predictors positively associated with CPRprior included witnessed OHCA and healthcare professional bystanders. Predictors negatively associated with CPRprior included residential location, solitary bystanders, and bystanders related to the patient. CONCLUSIONS The majority of bystander CPR (65%) was initiated during the emergency call, following dispatcher-assisted CPR instructions. Whether bystander CPR was initiated prior to emergency call versus during the emergency call following dispatcher-assisted CPR was not associated with ROSC or 30-day survival. Dispatcher-assisted CPR was especially beneficial for the initiation of bystander CPR in residential areas.
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Affiliation(s)
- Søren Viereck
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, Building 2, 3rd Floor, DK-2750 Copenhagen, Denmark.
| | - Thea Palsgaard Møller
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, Building 2, 3rd Floor, DK-2750 Copenhagen, Denmark
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353 Copenhagen, Denmark
| | - Fredrik Folke
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, Building 2, 3rd Floor, DK-2750 Copenhagen, Denmark
| | - Freddy Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, Building 2, 3rd Floor, DK-2750 Copenhagen, Denmark
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Møller TP, Andréll C, Viereck S, Todorova L, Friberg H, Lippert FK. Recognition of out-of-hospital cardiac arrest by medical dispatchers in emergency medical dispatch centres in two countries. Resuscitation 2016; 109:1-8. [PMID: 27658652 DOI: 10.1016/j.resuscitation.2016.09.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/21/2016] [Accepted: 09/09/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Survival after out-of-hospital cardiac arrest (OHCA) remains low. Early recognition by emergency medical dispatchers is essential for an effective chain of actions, leading to early cardiopulmonary resuscitation, use of an automated external defibrillator and rapid dispatching of the emergency medical services. AIM To analyse and compare the accuracy of OHCA recognition by medical dispatchers in two countries. METHOD An observational register-based study collecting data from national cardiac arrest registers in Denmark and Sweden during a six-month period in 2013. Data were analysed in two steps; registry data were merged with electronically registered emergency call data from the emergency medical dispatch centres in the two regions. Cases with missing or non-OHCA dispatch codes were analysed further by auditing emergency call recordings using a uniform data collection template. RESULTS The sensitivity for recognition of OHCA was 40.9% (95% CI: 37.1-44.7%) in the Capital Region of Denmark and 78.4% (95% CI: 73.2-83.0%) in the Skåne Region in Sweden (p<0.001). With additional data from the emergency call recordings, the sensitivity was 80.7% (95% CI: 77.7-84.3%) and 86.0% (95% CI: 81.3-89.8%) for the two regions (p=0.06). The majority of the non-recognised OHCA were dispatched with the highest priority. CONCLUSION The accuracy of OHCA recognition was high and comparable. We identified large differences in data registration practices despite the use of similar dispatch tools. This raises a discussion of definitions and transparency in general in scientific reporting of OHCA recognition, which is essential if used as quality indicator in emergency medical services.
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Affiliation(s)
- Thea Palsgaard Møller
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, 2750 Ballerup, Denmark.
| | - Cecilia Andréll
- Center for Cardiac Arrest, Lund University, Barngatan 2A, S-221 85 Lund, Sweden; Anesthesiology and Intensive Care, Skåne University Hospital, Lund, Sweden
| | - Søren Viereck
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, 2750 Ballerup, Denmark
| | - Lizbet Todorova
- Center for Cardiac Arrest, Lund University, Barngatan 2A, S-221 85 Lund, Sweden; Section of Ambulance, Crisis Management and Security, Region Skane Prehospital Unit, Lund, Sweden
| | - Hans Friberg
- Center for Cardiac Arrest, Lund University, Barngatan 2A, S-221 85 Lund, Sweden; Anesthesiology and Intensive Care, Skåne University Hospital, Lund, Sweden
| | - Freddy K Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, 2750 Ballerup, Denmark
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