title: Dispatcher-assisted cardiopulmonary resuscitation: risks for patients not in cardiac arrest.
abstract: BACKGROUND
  Dispatcher-assisted cardiopulmonary resuscitation (CPR) instructions can increase bystander CPR and thereby increase the rate of survival from cardiac arrest. The risk of bystander CPR for patients not in arrest is uncertain and has implications for how assertive dispatch is in instructing CPR. We determined the frequency of dispatcher-assisted CPR for patients not in arrest and the frequency and severity of injury related to chest compressions.
  
  
  RESULTS
  The investigation was a prospective cohort study of adult patients not in cardiac arrest for whom dispatchers provided CPR instructions in King County, Washington, between June 1, 2004, and January 31, 2007. The study focused on those who received chest compressions. Information was collected through review of the audio and written dispatch report, written emergency medical services report, hospital record, and telephone survey. Of the 1700 patients for whom dispatcher CPR instructions were initiated, 55% (938 of 1700) were in arrest, 45% (762 of 1700) were not in arrest, and 18% (313 of 1700) were not in arrest and received bystander chest compressions. Of the 247 not in arrest who received chest compressions and had complete outcome ascertainment, 12% (29 of 247) experienced discomfort, and 2% (6 of 247) sustained injuries likely or possibly caused by bystander CPR. Only 2% (5 of 247) suffered a fracture, and no patients suffered visceral organ injury.
  
  
  CONCLUSIONS
  In this prospective study, the frequency of serious injury related to dispatcher-assisted bystander CPR among nonarrest patients was low. When coupled with the established benefits of bystander CPR among those with arrest, these results support an assertive program of dispatcher-assisted CPR.
authors.affiliation: Emergency Medical Services Division, Public Health Seattle-King County, 401 Fifth Ave, Suite 1200, Seattle, WA 98104, USA. lindsay.white@kingcounty.gov
authors.forename: Lindsay
authors.initials: L
authors.lastname: White
authors.forename: Joseph
authors.initials: J
authors.lastname: Rogers
authors.forename: Megan
authors.initials: M
authors.lastname: Bloomingdale
authors.forename: Carol
authors.initials: C
authors.lastname: Fahrenbruch
authors.forename: Linda
authors.initials: L
authors.lastname: Culley
authors.forename: Cleo
authors.initials: C
authors.lastname: Subido
authors.forename: Mickey
authors.initials: M
authors.lastname: Eisenberg
authors.forename: Thomas
authors.initials: T
authors.lastname: Rea
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects* / Q000706:statistics & numerical data*; D015331:Cohort Studies; D004631:Emergency Medical Service Communication Systems / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D006306:Health Surveys; D006323:Heart Arrest; D006801:Humans; D008499:Medical Records / Q000706:statistics & numerical data; D009017:Morbidity; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013898:Thoracic Injuries / Q000453:epidemiology* / Q000209:etiology