title: Factors impeding dispatcher-assisted telephone cardiopulmonary resuscitation.
abstract: OBJECTIVE
  Dispatcher-assisted telephone cardiopulmonary resuscitation (CPR) instruction can increase the proportion of sudden cardiac arrest victims who receive bystander CPR and has been associated with improved survival. Most sudden cardiac arrest victims, however, do not receive bystander CPR. The study objective was to examine factors that may impede implementation of telephone CPR.
  
  
  METHODS
  We reviewed dispatcher audio recordings and emergency medical services reports for 404 cases of sudden cardiac arrest that occurred from July 1, 2000, to June 30, 2002, in the study county to assess the phase (1, instructions not offered; 2, instructions offered but declined; or 3, instructions offered and accepted but CPR not implemented) and specific factors within each phase that potentially impede telephone CPR.
  
  
  RESULTS
  Twenty-five percent (99/404) of victims received bystander CPR without dispatch assistance, 34% (139/404) received telephone CPR, and 41% (166/404) did not receive bystander CPR. Each phase of telephone CPR process impeded the implementation of CPR: (1) instructions not offered in 48% (80/166); (2) instructions offered but declined in 31% (52/166); and (3) instructions offered and accepted but CPR not implemented in 21% (34/166). During the first phase, telephone CPR was potentially impeded most frequently because the victim was reported to have signs of life (51/80, 64%); during the second and third phases, telephone CPR was most often impeded because of bystander physical limitation (32/86, 37%). Emotional distress, disease transmission, disagreeable victim characteristics, or medicolegal concerns uncommonly impeded telephone CPR (10/86, 12%).
  
  
  CONCLUSIONS
  Factors potentially impeding telephone CPR can be identified. Although many are logistically challenging, some may be addressable and hence provide opportunities to strengthen the chain of survival.
authors.affiliation: University of Washington School of medicine, Seattle, USA.
authors.forename: Samantha R
authors.initials: SR
authors.lastname: Hauff
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Rea
authors.forename: Linda L
authors.initials: LL
authors.lastname: Culley
authors.forename: Frieda
authors.initials: F
authors.lastname: Kerry
authors.forename: Linda
authors.initials: L
authors.lastname: Becker
authors.forename: Mickey S
authors.initials: MS
authors.lastname: Eisenberg
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000706:statistics & numerical data; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017064:Process Assessment, Health Care; D012189:Retrospective Studies; D017216:Telemedicine / Q000379:methods* / Q000706:statistics & numerical data; D014481:United States