title: Introducing systematic dispatcher-assisted cardiopulmonary resuscitation (telephone-CPR) in a non-Advanced Medical Priority Dispatch System (AMPDS): implementation process and costs.
abstract: OBJECTIVE
  In order to improve the quality of our Emergency Medical Services (EMS), to raise bystander cardiopulmonary resuscitation rates and thereby meet what is becoming a universal standard in terms of quality of emergency services, we decided to implement systematic dispatcher-assisted or telephone-CPR (T-CPR) in our medical dispatch center, a non-Advanced Medical Priority Dispatch System. The aim of this article is to describe the implementation process, costs and results following the introduction of this new "quality" procedure.
  
  
  METHODS
  This was a prospective study. Over an 8-week period, our EMS dispatchers were given new procedures to provide T-CPR. We then collected data on all non-traumatic cardiac arrests within our state (Vaud, Switzerland) for the following 12 months. For each event, the dispatchers had to record in writing the reason they either ruled out cardiac arrest (CA) or did not propose T-CPR in the event they did suspect CA. All emergency call recordings were reviewed by the medical director of the EMS. The analysis of the recordings and the dispatchers' written explanations were then compared.
  
  
  RESULTS
  During the 12-month study period, a total of 497 patients (both adults and children) were identified as having a non-traumatic cardiac arrest. Out of this total, 203 cases were excluded and 294 cases were eligible for T-CPR. Out of these eligible cases, dispatchers proposed T-CPR on 202 occasions (or 69% of eligible cases). They also erroneously proposed T-CPR on 17 occasions when a CA was wrongly identified (false positive). This represents 7.8% of all T-CPR. No costs were incurred to implement our study protocol and procedures.
  
  
  CONCLUSIONS
  This study demonstrates it is possible, using a brief campaign of sensitization but without any specific training, to implement systematic dispatcher-assisted cardiopulmonary resuscitation in a non-Advanced Medical Priority Dispatch System such as our EMS that had no prior experience with systematic T-CPR. The results in terms of T-CPR delivery rate and false positive are similar to those found in previous studies. We found our results satisfying the given short time frame of this study. Our results demonstrate that it is possible to improve the quality of emergency services at moderate or even no additional costs and this should be of interest to all EMS that do not presently benefit from using T-CPR procedures. EMS that currently do not offer T-CPR should consider implementing this technique as soon as possible, and we expect our experience may provide answers to those planning to incorporate T-CPR in their daily practice.
authors.affiliation: Emergency Medical Services State of Vaud (Fondation Urgences-Santé), Lausanne, Switzerland. fabrice.dami@chuv.ch
authors.forename: Fabrice
authors.initials: F
authors.lastname: Dami
authors.forename: Vincent
authors.initials: V
authors.lastname: Fuchs
authors.forename: Laurent
authors.initials: L
authors.lastname: Praz
authors.forename: John-Paul
authors.initials: JP
authors.lastname: Vader
mesh_terms: D000293:Adolescent; D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation* / Q000379:methods; D002648:Child; D003362:Cost-Benefit Analysis; D004631:Emergency Medical Service Communication Systems / Q000191:economics* / Q000458:organization & administration; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006284:Health Plan Implementation; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011786:Quality Control; D016019:Survival Analysis; D013557:Switzerland; D013689:Telephone / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult