Importance of the first link: description and recognition of an out-of-hospital cardiac arrest in an emergency call.
BACKGROUND
The content of emergency calls for suspected cardiac arrest is rarely analyzed. This study investigated the recognition of a cardiac arrest by dispatchers and its influence on survival rates.


RESULTS
During 8 months, voice recordings of 14,800 consecutive emergency calls were collected to audit content and cardiac arrest recognition. The presence of cardiac arrest during the call was assessed from the ambulance crew report. Included calls were placed by laypersons on site and did not involve trauma. Prevalence of cardiac arrest was 3.0%. Of the 285 cardiac arrests, 82 (29%) were not recognized during the call, and 64 of 267 suspected calls (24%) were not cardiac arrest. We analyzed a random sample (n=506) of 9230 control calls. Three-month survival was 5% when a cardiac arrest was not recognized versus 14% when it was recognized (P=0.04). If the dispatcher did not recognize the cardiac arrest, the ambulance was dispatched a mean of 0.94 minute later (P<0.001) and arrived 1.40 minutes later on scene (P=0.01) compared with recognized calls. The main reason for not recognizing the cardiac arrest was not asking if the patient was breathing (42 of 82) and not asking to describe the type of breathing (16 of 82). Normal breathing was never mentioned in true cardiac arrest calls. A logistic regression model identified spontaneous trigger words like facial color that could contribute to cardiac arrest recognition (odds ratio, 7.8 to 9.7).


CONCLUSIONS
Not recognizing a cardiac arrest during emergency calls decreases survival. Spontaneous words that the caller uses to describe the patient may aid in faster and better recognition of a cardiac arrest.
Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. J.Berdowski@amc.nl
Jocelyn
J
Berdowski
Freerk
F
Beekhuis
Aeilko H
AH
Zwinderman
Jan G P
JG
Tijssen
Rudolph W
RW
Koster
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances / Q000706:statistics & numerical data; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data; D003142:Communication; D003463:Cues; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control; D003951:Diagnostic Errors / Q000517:prevention & control; D042241:Early Diagnosis; D004630:Emergencies; D004631:Emergency Medical Service Communication Systems / Q000458:organization & administration*; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012120:Respiration Disorders / Q000209:etiology; D012494:Sampling Studies; D016037:Single-Blind Method; D013689:Telephone