Camilla Hardeland1, Christiane Skåre2, Jo Kramer-Johansen3, Tonje S Birkenes4, Helge Myklebust4, Andreas E Hansen5, Kjetil Sunde6, Theresa M Olasveengen2. 1. 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. 2. 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. 3. 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. 4. Laerdal Medical AS, Tanke Svilandsgate 30, N-4002 Stavanger, Norway. 5. Prehospital Clinic, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway. 6. 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.
Abstract
AIM: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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.
AIM: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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