title: Challenges in out-of-hospital cardiac arrest - A study combining closed-circuit television (CCTV) and medical emergency calls.
abstract: The aim of this study was to explore challenges in recognition and initial treatment of out-of-hospital cardiac arrest (OHCA) by using closed-circuit television (CCTV) recordings combined with audio recordings from emergency medical calls.
  
  
  METHODS
  All OHCA captured by CCTV in the Capital Region of Denmark, 15 June 2013-14 June 2014, were included. Using a qualitative approach based on thematic analysis, we focused on the interval from the victim's collapse to the arrival of the ambulance.
  
  
  RESULTS
  Based on the 21 CCTV recordings collected, the main challenges in OHCA seemed to be situation awareness, communication and attitude/approach. Situation awareness among bystanders and the emergency medical dispatchers (dispatcher) differed. CCTV showed that bystanders other than the caller, were often physically closer to the victim and initiated cardiopulmonary resuscitation (CPR). Hence, information from the dispatcher had to pass through the caller to the other bystanders. Many bystanders passed by or left, leaving the resuscitation to only a few. In addition, we observed that the callers did not delegate tasks that could have been performed more effectively by other bystanders, for example, receiving the ambulance or retrieving an Automated External Defibrillator (AED).
  
  
  CONCLUSIONS
  CCTV combined with audio recordings from emergency calls can provide unique insights into the challenges of recognition and initial treatment of OHCA and can improve understanding of the situation. The main barriers to effective intervention were situation awareness, communication and attitude/approach. Potentially, some of these challenges could be minimized if the dispatcher was able to see the victim and the bystanders at the scene. A team approach, with the dispatcher responsible for the role as team leader of a remote resuscitation team of a caller and bystanders, may potentially improve treatment of OHCA.
authors.affiliation: Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, DK-2750 Ballerup, Denmark. Electronic address: gitte.linderoth@gmail.com.
authors.forename: Gitte
authors.initials: G
authors.lastname: Linderoth
authors.affiliation: Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen Ø, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Hallas
authors.affiliation: Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, DK-2750 Ballerup, Denmark.
authors.forename: Freddy K
authors.initials: FK
authors.lastname: Lippert
authors.affiliation: Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, DK-2750 Ballerup, Denmark.
authors.forename: Ida
authors.initials: I
authors.lastname: Wibrandt
authors.affiliation: Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, DK-2750 Ballerup, Denmark; Department of Anaesthesia, Centre of Head and Orthopaedics, University of Copenhagen, Blegdamsvej 9, Copenhagen Ø, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Loumann
authors.affiliation: Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, DK-2750 Ballerup, Denmark.
authors.forename: Thea Palsgaard
authors.initials: TP
authors.lastname: Møller
authors.affiliation: Danish Institute for Medical Simulation, University of Copenhagen, Ringvej 75, DK-2730 Herlev, Denmark.
authors.forename: Doris
authors.initials: D
authors.lastname: Østergaard
mesh_terms: D000328:Adult; D000368:Aged; D000552:Ambulances / Q000592:standards*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003718:Denmark / Q000453:epidemiology; D004631:Emergency Medical Service Communication Systems / Q000592:standards*; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate / Q000639:trends; D013690:Television; D013997:Time Factors; D014741:Video Recording / Q000379:methods*
keywords: Basic life support; Bystander; Cardiopulmonary resuscitation; Emergency medical dispatch; Human factors; Out-of-hospital cardiac arrest