Christian Vaillancourt1, Manya Charette2, Ann Kasaboski2, Marianne Hoad3, Vivianne Larocque4, Denis Crête4, Stephanie Logan4, Patrick Lamoureux4, Jeff McBride4, Sheldon Cheskes5, George A Wells6, Ian G Stiell7. 1. Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; Department of Epidemiology and Community Medicine, University of Ottawa, ON, Canada. Electronic address: cvaillancourt@ohri.ca. 2. Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada. 3. Advanced Care Paramedic, Ottawa Paramedic Service, Ottawa, ON, Canada. 4. Ottawa Paramedic Service Central Ambulance Communication Center, Ottawa, ON, Canada. 5. Sunnyrook Center for Prehospital Medicine, Department of Emergency Medicine, University of Toronto, ON, Canada. 6. Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; Ottawa Heart Institute, Ottawa, ON, Canada; Department of Medicine, University of Ottawa, Ottawa, ON, Canada. 7. Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; Department of Epidemiology and Community Medicine, University of Ottawa, ON, Canada.
Abstract
INTRODUCTION: We sought to determine the ability of 9-1-1 dispatchers to accurately determine the presence of out-of-hospital cardiac arrest (OOHCA) over the telephone, and to determine the frequency with which CPR instructions are initiated and chest compressions delivered in patients not in cardiac arrest. METHODS: We conducted a multi-center, prospective cohort study of adult OOHCA patients not witnessed by EMS for which resuscitation was attempted. Dispatchers were not health care professionals and received 6 weeks of training followed by a 6-month preceptorship. We reviewed 9-1-1 call digital recordings for all unconscious patients for which the possibility of cardiac arrest was considered using a piloted standardized data collection sheet. RESULTS: We reviewed 2260 recordings occurring between January 2008 and October 2009. Among those, 1536 were confirmed OOHCA, and 724 were not. Among the 1536 confirmed OOHCA cases, 1012 were recognized by dispatchers and 524 were not. Among the 724 cases not in cardiac arrest, dispatchers suspected cardiac arrest was present in 490 and absent in 234. OOHCA diagnostic accuracy characteristics were: sensitivity 65.9% (95% CI 63.5-68.2%), specificity 32.3% (95% CI 29.0-35.9%), PPV 67.4%, and NPV 30.9%. Dispatchers believed that OOHCA was present in 490/2260 (21.7%) cases when it was not, resulting in 54/490 (11.0%) patients inappropriately receiving chest compressions, or 54/2260 (2.4%) of the whole cohort. CONCLUSIONS: Dispatchers had a fair sensitivity and modest specificity for the recognition of OOHCA. We found a very small number of patients receiving CPR when not in cardiac arrest, supporting the current use of dispatch-assisted CPR instructions.
INTRODUCTION: We sought to determine the ability of 9-1-1 dispatchers to accurately determine the presence of out-of-hospital cardiac arrest (OOHCA) over the telephone, and to determine the frequency with which CPR instructions are initiated and chest compressions delivered in patients not in cardiac arrest. METHODS: We conducted a multi-center, prospective cohort study of adult OOHCA patients not witnessed by EMS for which resuscitation was attempted. Dispatchers were not health care professionals and received 6 weeks of training followed by a 6-month preceptorship. We reviewed 9-1-1 call digital recordings for all unconscious patients for which the possibility of cardiac arrest was considered using a piloted standardized data collection sheet. RESULTS: We reviewed 2260 recordings occurring between January 2008 and October 2009. Among those, 1536 were confirmed OOHCA, and 724 were not. Among the 1536 confirmed OOHCA cases, 1012 were recognized by dispatchers and 524 were not. Among the 724 cases not in cardiac arrest, dispatchers suspected cardiac arrest was present in 490 and absent in 234. OOHCA diagnostic accuracy characteristics were: sensitivity 65.9% (95% CI 63.5-68.2%), specificity 32.3% (95% CI 29.0-35.9%), PPV 67.4%, and NPV 30.9%. Dispatchers believed that OOHCA was present in 490/2260 (21.7%) cases when it was not, resulting in 54/490 (11.0%) patients inappropriately receiving chest compressions, or 54/2260 (2.4%) of the whole cohort. CONCLUSIONS: Dispatchers had a fair sensitivity and modest specificity for the recognition of OOHCA. We found a very small number of patients receiving CPR when not in cardiac arrest, supporting the current use of dispatch-assisted CPR instructions.
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