title: Dispatch-assisted CPR: where are the hold-ups during calls to emergency dispatchers? A preliminary analysis of caller-dispatcher interactions during out-of-hospital cardiac arrest using a novel call transcription technique.
abstract: BACKGROUND
  Survival from out-of-hospital cardiac arrest (OHCA) is dependent on the chain of survival. Early recognition of cardiac arrest and provision of bystander cardiopulmonary resuscitation (CPR) are key determinants of OHCA survival. Emergency medical dispatchers play a key role in cardiac arrest recognition and giving telephone CPR advice. The interaction between caller and dispatcher can influence the time to bystander CPR and quality of resuscitation. We sought to pilot the use of emergency call transcription to audit and evaluate the holdups in performing dispatch-assisted CPR.
  
  
  METHODS
  A retrospective case selection of 50 consecutive suspected OHCA was performed. Audio recordings of calls were downloaded from the emergency medical dispatch centre computer database. All calls were transcribed using proprietary software and voice dialogue was compared with the corresponding stage on the Medical Priority Dispatch System (MPDS). Time to progress through each stage and number of caller-dispatcher interactions were calculated.
  
  
  RESULTS
  Of the 50 downloaded calls, 47 were confirmed cases of OHCA. Call transcription was successfully completed for all OHCA calls. Bystander CPR was performed in 39 (83%) of these. In the remaining cases, the caller decided the patient was beyond help (n = 7) or the caller said that they were physically unable to perform CPR (n = 1). MPDS stages varied substantially in time to completion. Stage 9 (determining if the patient is breathing through airway instructions) took the longest time to complete (median = 59 s, IQR 22-82 s). Stage 11 (giving CPR instructions) also took a relatively longer time to complete compared to the other stages (median = 46 s, IQR 37-75 s). Stage 5 (establishing the patient's age) took the shortest time to complete (median = 5.5s, IQR 3-9s).
  
  
  CONCLUSIONS
  Transcription of OHCA emergency calls and caller-dispatcher interaction compared to MPDS stage is feasible. Confirming whether a patient is breathing and completing CPR instructions required the longest time and most interactions between caller and dispatcher. Use of call transcription has the potential to identify key factors in caller-dispatcher interaction that could improve time to CPR and further research is warranted in this area.
authors.affiliation: Emergency Medicine Research Group, Edinburgh, United Kingdom; Queen's Medical Research Institute, The University of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, United Kingdom.
authors.forename: Gareth R
authors.initials: GR
authors.lastname: Clegg
authors.affiliation: Emergency Medicine Research Group, Edinburgh, United Kingdom; Emergency Department, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, United Kingdom. Electronic address: richardlyon@doctors.org.uk.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Lyon
authors.affiliation: Emergency Medicine Research Group, Edinburgh, United Kingdom.
authors.forename: Scott
authors.initials: S
authors.lastname: James
authors.affiliation: Department of Psychology, University of Edinburgh, United Kingdom.
authors.forename: Holly P
authors.initials: HP
authors.lastname: Branigan
authors.affiliation: Department of Linguistics and English Language, University of Edinburgh, United Kingdom.
authors.forename: Ellen G
authors.initials: EG
authors.lastname: Bard
authors.affiliation: Scottish Ambulance Service, United Kingdom.
authors.forename: Gerry J
authors.initials: GJ
authors.lastname: Egan
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002985:Clinical Protocols; D003142:Communication; D004631:Emergency Medical Service Communication Systems; D057209:Hospital Rapid Response Team; D006801:Humans; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D012189:Retrospective Studies
keywords: Cardiopulmonary resuscitation; Dispatch; Out-of-hospital cardiac arrest; Resuscitation