title: Use of telephone CPR advice in Ireland: Uptake by callers and delays in the assessment process.
abstract: BACKGROUND
  Telephone CPR (T-CPR) has significant variations in time from call receipt to first compression, with reported delays of up to five minutes. Ireland's National Ambulance Service (NAS) uses T-CPR based on standard AMPDS questions; we aimed to identify the time to first compression and the times needed for question blocks. Ireland has a low survival rate from out-of-hospital cardiac arrest, (6% in 2013).
  
  
  METHODS
  A retrospective review of all cardiac arrests in a two-year period was carried out in one NAS region. All cardiac arrests were identified from the national registry and audio tapes and Patient Care Reports reviewed, together with survival data. Times from call handover were noted and categorised in terms of the key question items.
  
  
  RESULTS
  202 cardiac arrests occurred in the period (36/10(5)/year); 30 (14.9%) patients were not in cardiac arrest at the time of the call. Records were available for 145/172 patients in cardiac arrest at the time of the call. In 63/145 (43.4%) cases, the caller was not at the patient's side. Of the remaining 82 cases, in 13/82 (15.8%) CPR was underway (two survivors), in 22/82 (26.8%) the caller would not attempt T-CPR (one survivor); in 47/82 (57.3%), T-CPR was carried out (two survivors). Median time to first compression was 05:28min (range 03:18-10:29). Repeated questioning in relation to the patient's condition caused most of the delays.
  
  
  CONCLUSIONS
  Many callers are willing to attempt T-CPR but the questioning/instruction process causes significant delays. A focused, brief questioning process is required.
authors.affiliation: Advanced Paramedic, National Ambulance Service, Radharc n Tulaí, Baile Uí Dhálaigh, An Tulach Mhór, Co. Uíbh, Fhailí, Éire, Ireland. Electronic address: paraoman@gmail.com.
authors.forename: Gearóid
authors.initials: G
authors.lastname: Oman
authors.affiliation: School of Medicine & Medical Science University College Dublin, Belfield, Dublin 4, Ireland.
authors.forename: Gerard
authors.initials: G
authors.lastname: Bury
mesh_terms: D000552:Ambulances; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004631:Emergency Medical Service Communication Systems / Q000706:statistics & numerical data*; D004632:Emergency Medical Services; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007494:Ireland / Q000453:epidemiology; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology / Q000628:therapy*; D019114:Remote Consultation / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013689:Telephone / Q000706:statistics & numerical data*; D013997:Time Factors
keywords: AMPDS; Ambulance dispatch; Dispatcher assisted CPR; Telephone CPR; Telephone assisted CPR; Time to first compression