title: Dispatcher-assisted cardiopulmonary resuscitation: time to identify cardiac arrest and deliver chest compression instructions.
abstract: BACKGROUND
  Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR), in which 9-1-1 dispatchers provide CPR instructions over the telephone, has been shown to nearly double the rate of bystander CPR. We sought to identify factors that hampered the identification of cardiac arrest by 9-1-1 dispatchers and prevented or delayed the provision of dispatcher-assisted CPR chest compressions.
  
  
  RESULTS
  We reviewed dispatch recordings for 476 out-of-hospital cardiac arrests occurring between January 1, 2011, and December 31, 2011. We found that the dispatcher correctly identified cardiac arrest in 80% of reviewed cases and 92% of cases in which they were able to assess patient consciousness and breathing. The median time to recognition of the arrest was 75 seconds. Chest compressions following dispatcher-assisted CPR instructions occurred in 62% of cases when the dispatcher had the opportunity to asses for consciousness and breathing and bystander CPR was not already started. The median time to first dispatcher-assisted CPR chest compression was 176 seconds.
  
  
  CONCLUSIONS
  Dispatchers are able to accurately diagnose cardiac arrest over the telephone, but recognition is likely not possible in all circumstances. In some cases, recognition of cardiac arrest may be improved through training in the detection of agonal respirations. Delays in the delivery of dispatcher-assisted CPR chest compressions are common and are attributable to a mixture of dispatcher behavior and factors beyond the control of the dispatcher. Performance standards for the successful and quick recognition of cardiac arrest and delivery of first chest compressions should be adopted as metrics against which emergency medical services systems can measure their performance.
authors: School of Medicine (M.L.) and Department of Medicine (M.S.E.), University of Washington, Seattle; and Public Health Seattle & King County, Emergency Medical Services Division, Seattle, WA (B.A.S., M.S.E.).
authors: Miranda
authors: M
authors: Lewis
authors: Benjamin A
authors: BA
authors: Stubbs
authors: Mickey S
authors: MS
authors: Eisenberg
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000193:education / Q000706:statistics & numerical data*; D035641:Chest Wall Oscillation; D015331:Cohort Studies; D003243:Consciousness; D042241:Early Diagnosis; D004631:Emergency Medical Service Communication Systems / Q000706:statistics & numerical data*; D005260:Female; D005392:First Aid / Q000706:statistics & numerical data*; D015277:Hotlines; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D012119:Respiration; D012189:Retrospective Studies; D013997:Time Factors
keywords: cardiopulmonary resuscitation; death, sudden; heart arrest