title: Barriers to patient positioning for telephone cardiopulmonary resuscitation in out-of-hospital cardiac arrest.
abstract: 9-1-1 callers often face barriers preventing them from starting Telephone CPR (TCPR). The most common problem is getting patients to a hard, flat surface. This study describes barriers callers report when trying to move patients to a hard, flat surface and assesses conditions associated with overcoming these barriers.
  
  
  
  We audited 2396 out-of-hospital cardiac arrest (OHCA) audio recordings. A barrier was defined as any statement by the caller that the rescuer could not move the patient to the ground and into a supine position. Barriers were recorded and TCPR process metrics compared across the barrier and non-barrier groups.
  
  
  
  There were 802 OHCAs in the study group. Roughly 26% had a barrier. Telecommunicators were less likely to start TCPR instructions in the barrier group than in the non-barrier group (OR: 0.63, 95% CI: 0.45-0.88; p=0.007). Telecommunicator-directed bystander chest compressions were more than twice as likely to start in the non-barrier group (OR: 2.2, 95% CI: 1.6-3.2; p<0.001). Median time to first compression was longer in the barrier group (276s vs 171s; p<0.001). Rescuers were 3.7 times more likely to overcome a barrier and start compressions (OR: 3.7, 95% CI: 2.0-6.8; p<0.001) when multiple bystanders were present.
  
  
  
  Inability to move patients to a hard, flat surface is associated with a reduced rate of TCPR and increased time to first compression. Assessing the conditions under which such barriers are overcome is important for telecommunicator training and can help improve rates and timeliness of TCPR.
authors.affiliation: Arizona Department of Health Services, Phoenix, AZ, United States.
authors.forename: Blake T
authors.initials: BT
authors.lastname: Langlais
authors.affiliation: Arizona Department of Health Services, Phoenix, AZ, United States. Electronic address: micah.panczyk@azdhs.gov.
authors.forename: Micah
authors.initials: M
authors.lastname: Panczyk
authors.affiliation: University of Arizona College of Medicine, Phoenix, AZ, United States.
authors.forename: John
authors.initials: J
authors.lastname: Sutter
authors.affiliation: Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan.
authors.forename: Hidetada
authors.initials: H
authors.lastname: Fukushima
authors.affiliation: Department of Emergency Medicine, Foshan Hospital of Traditional Chinese Medicine Guangdong Province, China.
authors.forename: Zhixin
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Kyoto University Health Service, Kyoto, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Iwami
authors.affiliation: Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, AZ, United States; Arizona Emergency Medicine Research Center, University of Arizona College of Medicine, Phoenix, AZ, United States.
authors.forename: Daniel
authors.initials: D
authors.lastname: Spaite
authors.affiliation: Arizona Department of Health Services, Phoenix, AZ, United States; Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, AZ, United States; Arizona Emergency Medicine Research Center, University of Arizona College of Medicine, Phoenix, AZ, United States.
authors.forename: Bentley
authors.initials: B
authors.lastname: Bobrow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D004631:Emergency Medical Service Communication Systems; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055805:Moving and Lifting Patients; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D056888:Patient Positioning / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016683:Supine Position; D013689:Telephone; D061665:Time-to-Treatment; D055815:Young Adult