title: Implementation of the ALERT algorithm, a new dispatcher-assisted telephone cardiopulmonary resuscitation protocol, in non-Advanced Medical Priority Dispatch System (AMPDS) Emergency Medical Services centres.
abstract: OBJECTIVE
  Early bystander cardiopulmonary resuscitation (CPR) is a key factor in improving survival from out-of-hospital cardiac arrest (OHCA). The ALERT (Algorithme Liégeois d'Encadrement à la Réanimation par Téléphone) algorithm has the potential to help bystanders initiate CPR. This study evaluates the effectiveness of the implementation of this protocol in a non-Advanced Medical Priority Dispatch System area.
  
  
  METHODS
  We designed a before and after study based on a 3-month retrospective assessment of victims of OHCA in 2009, before the implementation of the ALERT protocol in Liege emergency medical communication centre (EMCC), and the prospective evaluation of the same 3 months in 2011, immediately after the implementation.
  
  
  RESULTS
  At the moment of the call, dispatchers were able to identify 233 OHCA in the first period and 235 in the second. Victims were predominantly male (59%, both periods), with mean ages of 64.1 and 63.9 years, respectively. In 2009, only 9.9% victims benefited from bystander CPR, this increased to 22.5% in 2011 (p<0.0002). The main reasons for protocol under-utilisation were: assistance not offered by the dispatcher (42.3%), caller physically remote from the victim (20.6%). Median time from call to first compression, defined here as no flow time, was 253s in 2009 and 168s in 2011 (NS). Ten victims were admitted to hospital after ROSC in 2009 and 13 in 2011 (p=0.09).
  
  
  CONCLUSIONS
  From the beginning and despite its under-utilisation, the ALERT protocol significantly improved the number of patients in whom bystander CPR was attempted.
authors.affiliation: Federal Public Health Services, Liege, Belgium.
authors.forename: Samuel
authors.initials: S
authors.lastname: Stipulante
authors.affiliation: Department of Public Health, University of Liege, Belgium.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Tubes
authors.affiliation: Federal Public Health Services, Liege, Belgium.
authors.forename: Mehdi
authors.initials: M
authors.lastname: El Fassi
authors.affiliation: Department of Medical Informatics and Biostatistics, University of Liege, Belgium.
authors.forename: Anne-Francoise
authors.initials: AF
authors.lastname: Donneau
authors.affiliation: Department of Emergency Medicine, Jessa of Hasselt, Belgium.
authors.forename: Barbara
authors.initials: B
authors.lastname: Van Troyen
authors.affiliation: Department of Emergency Medicine, University Hospital of Liege, Belgium.
authors.forename: Gary
authors.initials: G
authors.lastname: Hartstein
authors.affiliation: Department of Emergency Medicine, University Hospital of Liege, Belgium.
authors.forename: Vincent
authors.initials: V
authors.lastname: D'Orio
authors.affiliation: Department of Public Health, University of Liege, Belgium. Electronic address: A.Ghuysen@chu.ulg.ac.be.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Ghuysen
mesh_terms: D000465:Algorithms; D001530:Belgium; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D004631:Emergency Medical Service Communication Systems; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D011446:Prospective Studies; D012189:Retrospective Studies; D013689:Telephone; D013997:Time Factors; D016526:Workload
keywords: Algorithm; Cardiac arrest; Dispatcher; Phone CPR