title: Modified cardiopulmonary resuscitation (CPR) instruction protocols for emergency medical dispatchers: rationale and recommendations.
abstract: BACKGROUND
  International consensus guidelines now support the use of "chest compressions-only" cardiopulmonary resuscitation (CPR) instructions (CCOIs) by emergency medical dispatch (EMD) personnel providing telephone assistance to untrained bystanders at a cardiac arrest scene. These guidelines are based largely on evolving experimental data and a clinical trial conducted in one venue with distinct emergency medical services (EMS) system features. Accordingly, the Council of Standards for the National Academies of Emergency Dispatch was asked to adapt a modified telephone CPR protocol, and specifically one that could be applied more broadly to the spectrum of EMS systems.
  
  
  METHODS
  A group of international EMD specialists, researchers and professional association representatives analyzed available scientific data and considered variations in EMS systems, particularly those in Europe and North America.
  
  
  CONCLUSIONS
  Several recommendations were established: (1) to avoid confusion, bystanders already providing CPR should continue those previously learned methods; (2) following a sudden collapse unlikely to be of respiratory etiology, CCOIs should be provided when the bystander is not CPR-trained, declining to perform mouth-to-mouth ventilation or unsure of actions to take; (3) following 4 min of CCOIs, ventilations can be provided, but, for now, only at a compression-ventilation ratio of 100:2 until EMS arrives; (4) until more data become available, dispatchers should follow existing compression-ventilation protocols for children and adult cases involving probable respiratory/trauma etiologies; (5) EMD CPR protocols should account for EMS system features and receive quality oversight and expert medical direction.
authors.affiliation: Chair, Emergency Medicine, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Mail Code 8579, Dallas, TX 75390-8579, USA.
authors.forename: Lynn P
authors.initials: LP
authors.lastname: Roppolo
authors.forename: Paul E
authors.initials: PE
authors.lastname: Pepe
authors.forename: Nicole
authors.initials: N
authors.lastname: Cimon
authors.forename: Marc
authors.initials: M
authors.lastname: Gay
authors.forename: Brett
authors.initials: B
authors.lastname: Patterson
authors.forename: Arthur
authors.initials: A
authors.lastname: Yancey
authors.forename: Jeff J
authors.initials: JJ
authors.lastname: Clawson
mesh_terms: D000328:Adult; D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000592:standards*; D002985:Clinical Protocols; D004195:Disease Models, Animal; D004631:Emergency Medical Service Communication Systems / Q000592:standards*; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D012121:Respiration, Artificial / Q000379:methods / Q000592:standards; D014481:United States