title: Targeted simulation and education to improve cardiac arrest recognition and telephone assisted CPR in an emergency medical communication centre.
abstract: Recognition of cardiac arrest and prompt activation time by emergency medical dispatch are key process measures that have been associated with improved survival after out-of-hospital cardiac arrest (OHCA). The aim of this study is to improve recognition of OHCA and time to initiation of telephone assisted chest compressions in an emergency medical communication centre (EMCC).
  
  
  
  A prospective, interventional study implementing targeted interventions in an EMCC. Interventions included: (1) lectures focusing on agonal breathing and interrogation strategy (2) simulation training (3) structured dispatcher feedback (4) web-based telephone assisted CPR training program. All ambulance-confirmed OHCA calls in the study period were assessed and relevant process and result measures were recorded pre- and post-intervention. Cardiac arrest was reported as (1) recognised, (2) not recognised or (3) delayed recognition.
  
  
  
  We included 331 and 230 calls pre- and post-intervention, respectively. Recognition of cardiac arrest improved significantly after intervention (89 vs. 95%, p=0.024). Delayed recognition was significantly reduced (21 vs. 6%, p>0.001), as was misinterpretation of agonal breathing (25 vs. 10%, p<0.001). Telephone assisted compressions increased (71% vs. 83%, p=0.002) whereas bystander performed ventilations decreased after intervention (23% vs. 15%, p=0.016). Time intervals for initiation of chest compression instructions (2.6 vs. 2.3min, p=0.042) and delivery of telephone assisted chest compressions (3.3 vs. 2.8min, p=0.015) were significantly shortened after intervention.
  
  
  
  Targeted simulation, education and feedback significantly improved recognition of OHCA and reduced time to first chest compression. Continuous measurement of key quality metrics can facilitate development of targeted education and training.
authors.affiliation: Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, N-0318 Oslo, Norway; Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway. Electronic address: camilla.hardeland@medisin.uio.no.
authors.forename: Camilla
authors.initials: C
authors.lastname: Hardeland
authors.affiliation: Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; Department of Anaesthesiology, Oslo University Hospital and University of Oslo, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway.
authors.forename: Christiane
authors.initials: C
authors.lastname: Skåre
authors.affiliation: Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, N-0318 Oslo, Norway; Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway.
authors.forename: Jo
authors.initials: J
authors.lastname: Kramer-Johansen
authors.affiliation: Laerdal Medical AS, Tanke Svilandsgate 30, N-4002 Stavanger, Norway.
authors.forename: Tonje S
authors.initials: TS
authors.lastname: Birkenes
authors.affiliation: Laerdal Medical AS, Tanke Svilandsgate 30, N-4002 Stavanger, Norway.
authors.forename: Helge
authors.initials: H
authors.lastname: Myklebust
authors.affiliation: Prehospital Clinic, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway.
authors.forename: Andreas E
authors.initials: AE
authors.lastname: Hansen
authors.affiliation: Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, N-0318 Oslo, Norway; Department of Anaesthesiology, Oslo University Hospital and University of Oslo, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway.
authors.forename: Kjetil
authors.initials: K
authors.lastname: Sunde
authors.affiliation: Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; Department of Anaesthesiology, Oslo University Hospital and University of Oslo, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway.
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Olasveengen
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000193:education* / Q000379:methods; D004631:Emergency Medical Service Communication Systems / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D000068156:Formative Feedback; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis* / Q000628:therapy; D011446:Prospective Studies; D011787:Quality of Health Care; D000066908:Simulation Training / Q000379:methods*; D013689:Telephone; D013997:Time Factors
keywords: CPR; Cardiopulmonary resuscitation; Education; Emergency medical dispatch; Out-of-hospital-cardiac-arrest; Telephone-CPR