Barriers to dispatcher-assisted cardiopulmonary resuscitation in Singapore.
Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is effective in increasing bystander CPR in out-of-hospital cardiac arrests (OHCA). Singapore has recently implemented a DA-CPR program. We aimed to characterize barriers to commencement of chest compressions by callers in Singapore.



We analyzed dispatch recordings of OHCA cases received by the ambulance call center between July 2012 and March 2015. Audio recordings of poor quality were excluded. Trained reviewers noted the sequential stages of the dispatcher's recognition of CPR, delivering CPR instructions and caller performing CPR. Time taken to reach these milestones was noted. Barriers to chest compressions were identified.



A total of 4897 OHCA occurred during the study period, overall bystander CPR rate was 45.7%. 1885 dispatch recordings were reviewed with 1157 cases qualified for dispatcher CPR. In 1128 (97.5%) cases, the dispatcher correctly recognized the need for CPR. CPR instructions were delivered in 1056 (91.3%) cases. Of these, 1007 (87.0%) callers performed CPR to instruction. One or more barriers to chest compressions were identified in 430 (37.2%) cases. The commonest barrier identified was "could not move patient" (27%). Cases where barriers were identified were less likely to have the need for CPR recognized by the dispatcher (94.9% vs. 99.0%, p<0.001), CPR instructions given (79.3% vs. 98.3%, p<0.001) and CPR started (67.9% vs. 98.3%, p<0.001), while the time taken to reach each of these stages were significantly longer (p<0.001).



Barriers were present in 37% of cases. They were associated with lower proportion of CPR started and longer delay to CPR.
Emergency Medicine Residency, Singapore Health Services, Singapore, Singapore. Electronic address: sophronesis@gmail.com.
Andrew Fu Wah
AF
Ho
Barts and the London School of Medicine and Dentistry, Greater London, United Kingdom.
Zariel Jiaying
ZJ
Sim
Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.
Nur
N
Shahidah
Division of Medicine, Singapore General Hospital, Singapore, Singapore.
Ying
Y
Hao
Medical Department, Singapore Civil Defence Force, Singapore, Singapore.
Yih Yng
YY
Ng
Emergency Medicine Department, National University Hospital, Singapore, Singapore.
Benjamin S H
BS
Leong
Operations Department, Singapore Civil Defence Force, Singapore, Singapore.
Siti
S
Zarinah
Operations Department, Singapore Civil Defence Force, Singapore, Singapore.
Winston K L
WK
Teo
Operations Department, Singapore Civil Defence Force, Singapore, Singapore.
Geraldine Shu Yi
GS
Goh
Operations Department, Singapore Civil Defence Force, Singapore, Singapore.
Hamizah
H
Jaafar
Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore.
Marcus E H
ME
Ong
D016887:Cardiopulmonary Resuscitation / Q000193:education / Q000379:methods* / Q000706:statistics & numerical data; D004631:Emergency Medical Service Communication Systems / Q000706:statistics & numerical data*; D006336:Heart Massage; D006801:Humans; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D015397:Program Evaluation; D012846:Singapore / Q000453:epidemiology; D061665:Time-to-Treatment
Bystander; Cardiac arrest; Cardiopulmonary resuscitation; Dispatcher-assisted; Telephone CPR