Factors associated with the successful recognition of abnormal breathing and cardiac arrest by ambulance communications officers: a qualitative iterative survey.
OBJECTIVE
We sought to identify barriers and facilitators to ambulance communications officers' (ACOs') recognition of abnormal breathing and administration of cardiopulmonary resuscitation (CPR) instructions.


METHODS
We conducted semistructured qualitative interviews based on the constructs of the Theory of Planned Behavior to elicit salient attitudes, social influences, and behavioral controls potentially influencing ACOs' intent to recognize abnormal breathing as a symptom of cardiac arrest and administer CPR instructions over the phone. We conducted interviews until achieving data saturation. We recorded interviews and transcribed them verbatim. Two independent reviewers performed inductive analyses to identify emerging themes.


RESULTS
We interviewed 24 ACOs from four Canadian provinces (67% female, median 9.5 years of experience, 33% with paramedic training). We identified eight behavioral, 14 subjective normative, and 22 control beliefs. Important attitudes were as follows: 1) CPR instructions may help the patient and are likely to be beneficial for the caller; 2) abnormal breathing is an early sign of cardiac arrest; and 3) dispatch-assisted CPR instructions can improve survival. The leading social influence was management/quality assurance staff. Behavioral control was the construct most associated with ACOs' ability to recognize abnormal breathing, including 1) adherence to mandatory scripted protocol, 2) poor caller description of breathing pattern, and 3) ACO training on abnormal breathing.


CONCLUSIONS
This qualitative study found that control beliefs are most influential on ACOs' intention to recognize abnormal breathing and provide CPR instructions over the phone. Training and policy changes should target these beliefs to increase the frequency of ACO-administered CPR instructions to callers reporting a patient in cardiac arrest.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Jan L
JL
Jensen
Christian
C
Vaillancourt
Jessica
J
Tweedle
Ann
A
Kasaboski
Manya
M
Charette
Jeremy
J
Grimshaw
Jamie C
JC
Brehaut
Martin H
MH
Osmond
George A
GA
Wells
Ian G
IG
Stiell
D000328:Adult; D001291:Attitude of Health Personnel; D002170:Canada; D016887:Cardiopulmonary Resuscitation; D004631:Emergency Medical Service Communication Systems; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D011361:Professional Competence; D012120:Respiration Disorders / Q000175:diagnosis*