title: Dispatcher-assisted telephone CPR: common delays and time standards for delivery.
abstract: OBJECTIVE
  To determine the rate of bystander CPR before and after implementation of a telephone CPR program in King County; to determine the reasons for dispatcher delays in identifying patients in cardiac arrest in delivering CPR instructions over the telephone; and to suggest time standards for delivery of the telephone CPR message.
  
  
  METHODS
  An ongoing cardiac arrest surveillance system to calculate the annual bystander CPR rates from 1976 through 1988. Two hundred sixty-seven taped recordings of calls reporting cardiac arrests to nine emergency dispatch centers during 1988 were reviewed and timed.
  
  
  METHODS
  King County, Washington, excluding the city of Seattle.
  
  
  METHODS
  Two hundred sixty-seven persons with out-of-hospital cardiac arrests receiving emergency medical services. Arrests in doctors' offices, clinics, or nursing homes were excluded.
  
  
  METHODS
  Dispatcher-assisted telephone CPR.
  
  
  RESULTS
  The rate of bystander CPR increased from 32% (1976 through 1981) to 54% (1982 through 1988) after implementation of the dispatcher-assisted telephone CPR program, although an increase in survival could not be demonstrated. The median time for dispatchers to identify the problem was 75 seconds; to deliver the early protocols, 19 seconds; to deliver the ventilation instructions, 25 seconds; and to deliver compression instructions, 30 seconds. The total time to deliver the entire CPR message was 2.3 minutes. The most frequent cause for delay was unnecessary questions (57%) with questions about patient age asked most frequently (32%). Other causes included the caller not being near the patient (29%) and deviations from protocol (22%).
  
  
  CONCLUSIONS
  In a metropolitan emergency medical services system, a dispatcher-assisted telephone CPR program was associated with an increase in bystander CPR. Delays in proper delivery of telephone CPR can be minimized through training.
authors.affiliation: Center for Evaluation of Emergency Medical Services, Emergency Medical Services Division, Seattle, Washington 98104.
authors.forename: L L
authors.initials: LL
authors.lastname: Culley
authors.forename: J J
authors.initials: JJ
authors.lastname: Clark
authors.forename: M S
authors.initials: MS
authors.lastname: Eisenberg
authors.forename: M P
authors.initials: MP
authors.lastname: Larsen
mesh_terms: D004631:Emergency Medical Service Communication Systems / Q000592:standards; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D012151:Resuscitation / Q000379:methods / Q000706:statistics & numerical data; D013689:Telephone; D013997:Time Factors