title: Time to identify cardiac arrest and provide dispatch-assisted cardio-pulmonary resuscitation in a criteria-based dispatch system.
abstract: BACKGROUND
  Dispatch-assisted cardiopulmonary resuscitation (DA-CPR) plays a key role in out-of-hospital cardiac arrests. We sought to measure dispatchers' performances in a criteria-based system in recognizing cardiac arrest and delivering DA-CPR. Our secondary purpose was to identify the factors that hampered dispatchers' identification of cardiac arrests, the factors that prevented them from proposing DA-CPR, and the factors that prevented bystanders from performing CPR.
  
  
  RESULTS
  We reviewed dispatch recordings for 1254 out-of-hospital cardiac arrests occurring between January 1, 2011 and December 31, 2013. Dispatchers correctly identified cardiac arrests in 71% of the reviewed cases and 84% of the cases in which they were able to assess for patient consciousness and breathing. The median time to recognition of the arrest was 60s. The median time to start chest compression was 220s.
  
  
  CONCLUSIONS
  This study demonstrates that performances from a criteria-based dispatch system can be similar to those from a medical-priority dispatch system regarding out-of-hospital cardiac arrest (OHCA) time recognition and DA-CPR delivery. Agonal breathing recognition remains the weakest link in this sensitive task in both systems. It is of prime importance that all dispatch centers tend not only to implement DA-CPR but also to have tools to help them reach this objective, as today it should be mandatory to offer this service to the community. In order to improve benchmarking opportunities, we completed previously proposed performance standards as propositions.
authors.affiliation: Department of Emergency Medicine, University Hospital Center (CHUV), Lausanne, Switzerland; Emergency Medical Services, Dispatch Center, State of Vaud (Fondation Urgences-Santé), Lausanne, Switzerland. Electronic address: fabrice.dami@chuv.ch.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Dami
authors.affiliation: Department of Emergency Medicine, University Hospital Center (CHUV), Lausanne, Switzerland; Department of Anesthesiology, University Hospital Center (CHUV), Lausanne, Switzerland.
authors.forename: Eric
authors.initials: E
authors.lastname: Heymann
authors.affiliation: Department of Emergency Medicine, University Hospital Center (CHUV), Lausanne, Switzerland.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Pasquier
authors.affiliation: Emergency Medical Services, Dispatch Center, State of Vaud (Fondation Urgences-Santé), Lausanne, Switzerland.
authors.forename: Vincent
authors.initials: V
authors.lastname: Fuchs
authors.affiliation: Department of Emergency Medicine, University Hospital Center (CHUV), Lausanne, Switzerland.
authors.forename: Pierre-Nicolas
authors.initials: PN
authors.lastname: Carron
authors.affiliation: Department of Emergency Medicine, University Hospital Center (CHUV), Lausanne, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Hugli
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation; D057210:Delayed Diagnosis; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis* / Q000628:therapy*; D011446:Prospective Studies; D013997:Time Factors
keywords: Bystander; Cardiopulmonary resuscitation; Delay; Dispatch