title: Changes to DA-CPR instructions: can we reduce time to first compression and improve quality of bystander CPR?
abstract: BACKGROUND
  Dispatcher-assisted CPR (DA-CPR) can increase rates of bystander CPR, survival, and quality of life following cardiac arrest. Dispatcher protocols designed to improve rapid recognition of arrest and coach CPR may increase survival by (1) reducing preventable time delays to start of chest compressions and (2) improving the quality of bystander CPR.
  
  
  METHODS
  We conducted a randomized controlled trial comparing a simplified DA CPR script to a conventional DA CPR script in a manikin cardiac arrest simulation with lay participants. The primary outcomes measured were the time interval from call receipt to the first chest compression and the core metrics of chest compression (depth, rate, release, and compression fraction). CPR was measured using a recording manikin for the first 3 min of participant CPR.
  
  
  RESULTS
  Of the 75 participants, 39 were randomized to the simplified instructions and 36 were randomized to the conventional instructions. The interval from call receipt to first compression was 99 s using the simplified script and 124 s using the conventional script for a difference of 24s (p<0.01). Although hand position was judged to be correct more often in the conventional instruction group (88% versus 63%, p<0.01), compression depth was an average 7 mm deeper among those receiving the simplified CPR script (32 mm versus 25 mm, p<0.05). No statistically significant differences were detected between the two instruction groups for compression rate, complete release, number of hands-off periods, or compression fraction.
  
  
  CONCLUSIONS
  Simplified DA-CPR instructions to lay callers in simulated cardiac arrest settings resulted in significant reductions in time to first compression and improvements in compression depth. These results suggest an important opportunity to improve DA CPR instructions to reduce delays and improve CPR quality.
authors.affiliation: Northwest Center for Public Health Practice, School of Public Health, University of Washington, 1107 NE 45th Street, Suite 400, Seattle, WA 98105, USA. Electronic address: ipainter@uw.edu.
authors.forename: Ian
authors.initials: I
authors.lastname: Painter
authors.affiliation: Northwest Center for Public Health Practice, School of Public Health, University of Washington, USA. Electronic address: devora@uw.edu.
authors.forename: Devora Eisenberg
authors.initials: DE
authors.lastname: Chavez
authors.affiliation: Northwest Center for Public Health Practice, School of Public Health, University of Washington, USA. Electronic address: bike2@uw.edu.
authors.forename: Brooke R
authors.initials: BR
authors.lastname: Ike
authors.affiliation: General Internal Medicine, Department of Medicine, University of Washington, USA. Electronic address: yipm@uw.edu.
authors.forename: Mei Po
authors.initials: MP
authors.lastname: Yip
authors.affiliation: Department of Medicine, University of Washington, USA. Electronic address: shinping@uw.edu.
authors.forename: Shin Ping
authors.initials: SP
authors.lastname: Tu
authors.affiliation: VA Eastern Colorado Health Care System and University of Colorado, Denver, USA. Electronic address: Steven.Bradley@va.gov.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Bradley
authors.affiliation: EMS Division of Public Health - Seattle and King County, University of Washington, Seattle, WA, USA. Electronic address: Rea123@uw.edu.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Rea
authors.affiliation: Northwest Center for Public Health Practice, School of Public Health, University of Washington, USA. Electronic address: hendrika@uw.edu.
authors.forename: Hendrika
authors.initials: H
authors.lastname: Meischke
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000592:standards*; D004631:Emergency Medical Service Communication Systems; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D008348:Manikins; D008875:Middle Aged; D011312:Pressure; D058996:Quality Improvement; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Chest compressions; Dispatch-assisted instructions; Simulation; Time-delay