title: Misplaced links in the chain of survival due to an incorrect manual for the emergency call at public facilities.
abstract: BACKGROUND
  The incidence of delayed emergency calls and the outcome of out-of-hospital cardiac arrest (OHCA) may differ among public facilities when emergency calls are placed by institutional staff. The purpose of this study was to identify the actions prescribed in the rules and/or manuals of public facilities and to clarify whether the incidence of delayed emergency call placement and the outcome of OHCA differ among these facilities.
  
  
  METHODS
  We performed a questionnaire-based survey regarding emergency calls in public facilities in our community and analyzed our regional Utstein-based OHCA database.
  
  
  RESULTS
  Our questionnaire survey disclosed that the most common actions prescribed in the manuals or rules applied in care facilities and educational institutions are to report the situation when a cardiac arrest occurs and to follow the directions of a custodian or supervisor. The international web search disclosed that these actions are rarely prescribed in medical emergency manuals in other countries. Most of these manuals simply say that staff should make an emergency call immediately upon detecting a serious illness or medical emergency. Analysis of the Utstein-based database from our community revealed that the time interval between collapse and emergency call placement is prolonged and the outcome of cardiac arrest poor in care facilities. A prompt emergency call and cardiopulmonary resuscitation (CPR) after arrest are associated with improved 1-year survival following OHCA. Contrary to accepted wisdom, staff who recognize a cardiac arrest may consult their supervisor and then continue CPR until they receive instructions from him or her.
  
  
  CONCLUSIONS
  Manuals or rules for making emergency calls in our public facilities may contain incorrect information, and emergency calls may be delayed owing to correctable human factors. Such manuals should be checked and revised.
authors.affiliation: Departments of Emergency Medical Science and Emergency Medical Center, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa 920-8641, Japan. hidinaba@med.m.kanazawa-u.ac.jp.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Takei
authors.forename: Taiki
authors.initials: T
authors.lastname: Nishi
authors.forename: Keiko
authors.initials: K
authors.lastname: Takase
authors.forename: Takahisa
authors.initials: T
authors.lastname: Kamikura
authors.forename: Hideo
authors.initials: H
authors.lastname: Inaba