title: Factors impacting upon timely and adequate allocation of prehospital medical assistance and resources to cardiac arrest patients.
abstract: Explore, understand and address issues that impact upon timely and adequate allocation of prehospital medical assistance and resources to out-of-hospital cardiac arrest (OHCA) patients.
  
  
  
  Mixed-methods design obtaining data for one year in three emergency medical communication centres (EMCC); Oslo-Akershus (OA), Vestfold-Telemark (VT) and Østfold (Ø). Data collection included quantitative data from analysis of dispatch logs, ambulance records and audio files. Qualitative data were collected through in-depth interviews and non-participant observations.
  
  
  
  OA-, VT- and Ø-EMCC responded to 1095 OHCAs and 579 of these calls were included for further analysis (333, 143 and 103, respectively). There were significant site differences in their recognition of OHCA (89, 94 and 78%, respectively, p<0.001), provision of CPR instructions (83, 83 and 61%, respectively, p<0.001), time from call answered to initial CPR instructions (1.4min (1.2, 1.6), 1.1min (0,9, 1.2) and 1.3 (1.2, 1.7) respectively, p=0.002). The most frequent reason for delayed or failed recognition of OHCA was misinterpretation of agonal breathing. Interviews and observations revealed individual differences in protocol use, interrogation strategy and assessment of breathing. Use of protocol was only part of decision making, dispatchers trusted their own clinical experience and intuition, and used assumptions about the patient and the situation as part of decision making.
  
  
  
  Agonal breathing continues to be the main barrier to recognition of cardiac arrest. Individual differences among dispatchers' strategies can directly impact on performance, mainly due to the wide definition of cardiac arrest and lack of uniform tools for assessment of breathing.
authors: Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, PB 1171 Blindern, N-0318 Oslo, Norway; Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, PB 4956 Nydalen, N-0424 Oslo, Norway. Electronic address: camilla.hardeland@medisin.uio.no.
authors: Camilla
authors: C
authors: Hardeland
authors: Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, PB 1171 Blindern, N-0318 Oslo, Norway; Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, PB 4956 Nydalen, N-0424 Oslo, Norway.
authors: Kjetil
authors: K
authors: Sunde
authors: Department of Health and Social Studies,​ Østfold University College, PB 700, 1757 Halden, Norway.
authors: Helge
authors: H
authors: Ramsdal
authors: Prehospital Clinic, Vestfold and Telemark Emergency Medical Communication Centre, Vestfold Hospital Trust, PB 2168, NO-3103 Tønsberg, Norway.
authors: Susan R
authors: SR
authors: Hebbert
authors: Prehospital clinic, Oslo Emergency Medical Communication Centre, Oslo University Hospital, PB 4956 Nydalen, N-0424 Oslo, Norway.
authors: Linda
authors: L
authors: Soilammi
authors: Prehospital Clinic, Østfold HF Hospital Trust, PB 300, NO-1714 Sarpsborg, Norway.
authors: Fredrik
authors: F
authors: Westmark
authors: Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, PB 4956 Nydalen, N-0424 Oslo, Norway; Prehospital clinic, Oslo University Hospital, PB 4956 Nydalen, N-0424 Oslo, Norway.
authors: Fredrik
authors: F
authors: Nordum
authors: Prehospital clinic, Oslo Emergency Medical Communication Centre, Oslo University Hospital, PB 4956 Nydalen, N-0424 Oslo, Norway.
authors: Andreas E
authors: AE
authors: Hansen
authors: Prehospital Clinic, Vestfold and Telemark Emergency Medical Communication Centre, Vestfold Hospital Trust, PB 2168, NO-3103 Tønsberg, Norway.
authors: Jon E
authors: JE
authors: Steen-Hansen
authors: Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, PB 4956 Nydalen, N-0424 Oslo, Norway; Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, PB 4956 Nydalen, N-0424 Oslo, Norway.
authors: Theresa M
authors: TM
authors: Olasveengen
mesh_terms: D016887:Cardiopulmonary Resuscitation; D000071822:Emergency Medical Dispatcher / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000592:standards; D004634:Emergency Medical Technicians / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D036301:Qualitative Research; D061665:Time-to-Treatment
keywords: Emergency medical dispatch; cardiac arrest; cardiopulmonary resuscitation; cpr; dispatcher; dispatchers; emergency medical communication centre; mixed-methods