Impact of lay responder actions on out-of-hospital cardiac arrest outcome.
BACKGROUND
Little peer-reviewed literature exists regarding the actions of the person who recognized and called 911 at the time of an out-of-hospital cardiac arrest (OHCA).


OBJECTIVE
To describe the characteristics of persons who recognized OHCAs and to assess the impact of their actions on survival.


METHODS
Subjects were a convenience sample of individuals who called 911 after a case of home OHCA in which the victim was transported to one of two suburban community teaching hospitals. A retrospective mail survey was conducted asking demographics, including age, race, educational level, prior first aid training, and actions upon recognition of OHCA, including phone calls made and caller estimate from collapse to 911 call. Callers whose initial action was calling 911 were compared with those who made other calls first. Outcomes (discharged alive, DC) were obtained from hospital records. Fisher's exact test and chi-square tests were used for analysis.


RESULTS
Of 378 cases, 173 (45.8%) responded to the mail survey. The lay responders (LRs) who called 911 were younger than the victims (59.9 vs 68.0, p < 0.001) and were most commonly spouses (65.3%) or adult children (22.0%) of the patient. Most (84.7%) called 911 first at the time of recognition of arrest. A first call to 911 tended to predict DC (11.0% vs 0.0%, p = 0.13). When a phone call other than 911 was made first, there were no survivors (0/23). An estimated delay to 911 call of >4 minutes was not associated with an adverse outcome (10.5% vs 6.9%, p = 0.49). There was no difference in demographic variables between immediate and delayed 911 callers.


CONCLUSIONS
Lay responder demographics are similar to those of patients. In this study, an LR call to 911 first appears to be associated with improved OHCA survival. The LR estimates of delay to 911 call were not associated with increased mortality. The authors identified no patient or witness characteristics that were associated with a delay to calling 911 first.
Swor
R A
RA
Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan 48073, USA. raswor@aol.com
Jackson
R E
RE
Walters
B L
BL
Rivera
E J
EJ
Chu
K H
KH
D000328:Adult; D000368:Aged; D000552:Ambulances; D017028:Caregivers / Q000706:statistics & numerical data*; D004631:Emergency Medical Service Communication Systems / Q000706:statistics & numerical data*; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors