title: Instructions to "put the phone down" do not improve the quality of bystander initiated dispatcher-assisted cardiopulmonary resuscitation.
abstract: OBJECTIVE
  The quality of early bystander CPR appears important in maximizing survival. This trial tests whether explicit instructions to "put the phone down" improve the quality of bystander initiated dispatch-assisted CPR.
  
  
  METHODS
  In a randomized, double-blinded, controlled trial, subjects were randomized to a modified version of the Medical Priority Dispatch System (MPDS) version 11.2 protocol or a simplified protocol, each with or without instruction to "put the phone down" during CPR. Data were recorded from a Laerdal Resusci Anne Skillreporter manikin. A simulated emergency medical dispatcher, contacted by cell phone, delivered standardized instructions. Primary outcome measures included chest compression rate, depth, and the proportion of compressions without error, with correct hand position, adequate depth, and total release. Time was measured in two distinct ways: time required for initiation of CPR and total amount of time hands were off the chest during CPR. Proportions were analyzed by Wilcoxon rank sum tests and time variables with ANOVA. All tests used a two-sided alpha-level of 0.05.
  
  
  RESULTS
  Two hundred and fifteen subjects were randomized-107 in the "put the phone down" instruction group and 108 in the group without "put the phone down" instructions. The groups were comparable across demographic and experiential variables. The additional instruction to "put the phone down" had no effect on the proportion of compressions administered without error, with the correct depth, and with the correct hand position. Likewise, "put the phone down" did not affect the average compression depth, the average compression rate, the total hands-off-chest time, or the time to initiate chest compressions. A statistically significant, yet trivial, effect was found in the proportion of compressions with total release of the chest wall.
  
  
  CONCLUSIONS
  Instructions to "put the phone down" had no effect on the quality of bystander initiated dispatcher-assisted CPR in this trial.
authors.affiliation: Department of Emergency Medicine, School of Medicine, University of Alabama at Birmingham, United States. toddbrown@uabmc.edu
authors.forename: Todd B
authors.initials: TB
authors.lastname: Brown
authors.forename: Devashish
authors.initials: D
authors.lastname: Saini
authors.forename: Tracy
authors.initials: T
authors.lastname: Pepper
authors.forename: Muzna
authors.initials: M
authors.lastname: Mirza
authors.forename: Hari Krishna
authors.initials: HK
authors.lastname: Nandigam
authors.forename: Niroop
authors.initials: N
authors.lastname: Kaza
authors.forename: Stacey S
authors.initials: SS
authors.lastname: Cofield
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000592:standards; D004311:Double-Blind Method; D004631:Emergency Medical Service Communication Systems; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D011785:Quality Assurance, Health Care; D013689:Telephone