title: Time delays to reach dispatch centres in different regions in Europe. Are we losing the window of opportunity? - The EUROCALL study.
abstract: In out of hospital cardiac arrest (OHCA) the start of Cardiopulmonary Resuscitation (CPR) by a single rescuer may be delayed considerably if the total time (TT) to connect the telephone call to the Emergency Medical Communication Centre (EMCC) is prolonged. EUROCALL investigated the TT-EMCC and its components using different calling procedures.
  
  
  
  This prospective, multicentre, randomised study was performed in April 2013. Telephone calls were randomly allocated to time of call, and to those connecting directly to the EMCC (1-step procedure) and those diverted before connecting to the EMCC (2-step procedure).
  
  
  
  Twenty-one EMCCs from 11 countries participated in the study. Time to first ringtone was similar between 1-step 3.7s (IQR 1.0-5.2) and 2-step calls 4.0s (IQR 2.4-5.2). For the 1878 1-step calls, the median TT-EMCC was 11.7s (IQR 8.7-18.5). For the 1550 2-step calls, the median time from first ringtone to first call-taker was 7s (IQR 4.6-11.9) and from first call-taker to EMCC was 18.7s (IQR 13.4-29.9). Median TT-EMCC was 33.2 s (IQR 24.7-46.1) and was significantly longer than the TT-EMCC observed with the 1-step procedure (P<0.0001). Significant differences existed among participating regions between and within different countries both for 1-step and 2-step procedures.
  
  
  
  TT-EMCC was significantly shorter in a 1-step procedure compared to a 2-step procedure. Regional differences existed between countries but also within countries. This may be relevant in cases of OHCA and other situations where patient outcome is critically time-dependent.
authors.affiliation: Konstantopouleio General Hospital, Athens, Greece. Electronic address: nikosinikolaou@gmail.com.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Nikolaou
authors.affiliation: Dept. of Emergency Medicine and Services, Helsinki University Hospital and Helsinki University, Helsinki, Finland.
authors.forename: Maaret
authors.initials: M
authors.lastname: Castrén
authors.affiliation: Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.
authors.forename: Koenraad G
authors.initials: KG
authors.lastname: Monsieurs
authors.affiliation: Universitatea de Medicină şi Farmacie "Gr. T. Popa" Iaşi, Romania.
authors.forename: Diana
authors.initials: D
authors.lastname: Cimpoesu
authors.affiliation: American Medical Center, University of Nicosia, Cyprus.
authors.forename: Marios
authors.initials: M
authors.lastname: Georgiou
authors.affiliation: Municipal Institute for Emergency Medicine, Novi Sad, Serbia; Serbian Resuscitation Council, Novi Sad, Serbia.
authors.forename: Violetta
authors.initials: V
authors.lastname: Raffay
authors.affiliation: Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Rudolph
authors.initials: R
authors.lastname: Koster
authors.affiliation: Center for Emergency Medicine, Clinical Hospital Center Zagreb, Zagreb, Croatia.
authors.forename: Silvija
authors.initials: S
authors.lastname: Hunyadi-Antičević
authors.affiliation: Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czechia; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Kralove, Czechia.
authors.forename: Anatolij
authors.initials: A
authors.lastname: Truhlář
authors.affiliation: University of Antwerp, Antwerp, Belgium.
authors.forename: Leo
authors.initials: L
authors.lastname: Bossaert
mesh_terms: D016887:Cardiopulmonary Resuscitation; D004632:Emergency Medical Services; D005060:Europe; D006801:Humans; D011446:Prospective Studies; D013689:Telephone; D013997:Time Factors
keywords: Cardiopulmonary Resuscitation; Emergency medical service calls; Emergency medical services; Emergency medical services response times; Medical dispatch