title: Assessment of the quality of cardiopulmonary resuscitation following modification of a standard telephone-directed protocol.
abstract: BACKGROUND
  Current Advanced Medical Priority Dispatch System (AMPDS) V.11.1 telephone instructions are limited in their ability to produce correctly performed basic life support. The current telephone instructions were modified in an attempt to improve areas of poor CPR performance.
  
  
  METHODS
  Fifty subjects performed CPR on an instrumented adult manikin by following instructions modified from AMPDS V.11.1 instructions. Instructions were given by telephone from a different room.
  
  
  RESULTS
  No improvements were seen with opening the airway or delivering rescue breaths. The rate of chest compression improved from 52 to 81 min-1 (P=0.004), although the depth of chest compression fell to 2.0 cm compared with 3.2 cm documented with the original AMPDS instructions (P=0.004). Instructions to put the telephone down while performing CPR improved all aspects of CPR.
  
  
  CONCLUSIONS
  The effective delivery of telephone-directed CPR to untrained bystanders is a complex process. Changing verbal instructions to improve the quality of CPR is not easy. Further work is urgently needed to strengthen this important link in the chain of survival.
authors.affiliation: South Central Ambulance Service NHS Trust (Hampshire Division), Highcroft, Romsey Road, Winchester SO22 5DH, and Department of Medical Physics and Engineering, Southampton University Hospitals NHS Trust, UK. charlesdeakin@doctors.org.uk
authors.forename: Charles D
authors.initials: CD
authors.lastname: Deakin
authors.forename: Spencer
authors.initials: S
authors.lastname: Cheung
authors.forename: Graham W
authors.initials: GW
authors.lastname: Petley
authors.forename: Frank
authors.initials: F
authors.lastname: Clewlow
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation / Q000592:standards*; D004867:Equipment Design; D005260:Female; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D008297:Male; D008348:Manikins; D008875:Middle Aged; D013689:Telephone