title: Barriers to recognition of out-of-hospital cardiac arrest during emergency medical calls: a qualitative inductive thematic analysis.
abstract: BACKGROUND
  The chance of surviving out-of-hospital cardiac arrest (OHCA) depends on early and correct recognition of cardiac arrest by the emergency medical dispatcher during the emergency call. When cardiac arrest is identified, telephone guided cardiopulmonary resuscitation (CPR) and referral to an automated external defibrillator should be initiated. Previous studies have investigated barriers to recognition of OHCA, and found the caller's description of sign of life, the type of caller, caller's emotional state, an inadequate dialogue during the emergency call, and patient's agonal breathing as influential factors. Though many of these factors are included in the algorithms used by medical dispatchers, many OHCA still remain not recognised. Qualitative studies investigating the communication between the caller and dispatcher are very scarce. There is a lack of knowledge about what influences the dispatchers' recognition of OHCA, focusing on the communication during the emergency call. The purpose of this study is to identify factors affecting medical dispatchers' recognition of OHCA during emergency calls in a qualitative analysis of calls.
  
  
  METHODS
  An investigator triangulated inductive thematic analysis of recordings of out-of-hospital cardiac arrest emergency calls from December 2012. Participants were the callers (bystanders) and the emergency medical dispatchers. Data were analysed using a hermeneutic approach.
  
  
  RESULTS
  Based on the concept of data saturation, 13 recordings of not recognised cardiac arrest and 8 recordings of recognised cardiac arrests were analysed. Three main themes, six subthemes and an embedded theme emerged from the analysis: caller's physical distance (caller near patient, caller not near patient), caller's emotional distance (keeping calm, losing control), caller is a healthcare professional (responsibility is handed over to the caller, caller assumes responsibility), and the embedded theme: caller assesses the patient.
  
  
  CONCLUSIONS
  The physical and emotional proximity of the caller (bystander) as well as the caller's professional background affect the dispatcher's chances of correct recognition and handling of cardiac arrest. The dispatcher should acknowledge the triple roles of conducting patient assessment, instructing the caller, and reassuring the emotionally affected caller.
authors.affiliation: Emergency Medical Services Copenhagen, The Capital Region of Denmark, Telegrafvej 5, 2750, Ballerup, Denmark. david.alfsen@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Alfsen
authors.affiliation: Emergency Medical Services Copenhagen, The Capital Region of Denmark, Telegrafvej 5, 2750, Ballerup, Denmark. thea.palsgaard.moeller@regionh.dk.|University of Copenhagen, Faculty of Health and Medical Sciences, 2200, Copenhagen N, Denmark. thea.palsgaard.moeller@regionh.dk.
authors.forename: Thea Palsgaard
authors.initials: TP
authors.lastname: Møller
authors.affiliation: University of Copenhagen, Faculty of Health and Medical Sciences, 2200, Copenhagen N, Denmark. ingrid.egerod@regionh.dk.|Rigshospitalet, Trauma Centre, HOC 3193, 2100, Copenhagen Ø, Denmark. ingrid.egerod@regionh.dk.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Egerod
authors.affiliation: Emergency Medical Services Copenhagen, The Capital Region of Denmark, Telegrafvej 5, 2750, Ballerup, Denmark. lippert@regionh.dk.|University of Copenhagen, Faculty of Health and Medical Sciences, 2200, Copenhagen N, Denmark. lippert@regionh.dk.
authors.forename: Freddy K
authors.initials: FK
authors.lastname: Lippert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D003718:Denmark; 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 / Q000175:diagnosis*; D036301:Qualitative Research