In 2012, the American Heart Association (AHA) published guidelines for emergency dispatchers to provide CPR instruction over the telephone. Research presented late last year at the AHA’s Scientific Sessions showed that the program resulted in a relative increase in cardiac arrest survival to hospital discharge of 42 percent, from 7.9 percent to 11.2 percent.
“We believe…that the telephone-CPR intervention may be the most efficient way to actually improve cardiac arrest survival across the country,” said Bentley Bobrow, MD, an emergency physician at The University of Arizona College of Medicine in Phoenix and medical director of the Bureau of Emergency Medicine Service & Trauma System for the Arizona Department of Health Services. “As a country, we really haven’t moved the needle much in 30 years because 911 centers are ubiquitous and everyone has a cell phone…We have to utilize that invaluable infrastructure that is in place.”
The research analyzed some 6,000 audio recordings of 911 calls from nine dispatch centers and linked them to data from emergency responders and hospitals. Dr. Bobrow says that simply training dispatchers to give instruction isn’t enough: “We have to give them confidence through data, feedback—and show them the survivors.”
“We did a lot of simulation work with our 911 centers, and we told them to use specific terms,” he said. “Historically, what was commonly said was something like, ‘Ma’am, do you know CPR?’ or ‘Sir, would you be willing to do CPR?’ … We no longer ask them if they’re trained or if they want to do CPR. Dispatchers say, ‘You need to do chest compressions. I’m going to help you; let’s start.’ We don’t give the caller the option of bowing out.”
That approach is one Dr. Bobrow hopes will be replicated across the country. He believes that emergency physicians and emergency medical services directors should work closely with dispatch centers to improve outcomes for both. In addition, for locales where the instructions are being given to callers, measuring outcomes is critical.
“Unless they’re measuring their process, they have no idea on their performance,” he said. “When we first started we would hear calls where, yes, the dispatcher would identify cardiac arrest, but it would take six minutes…[There’s] a world of difference between starting CPR at minute six compared with one minute into the call, which is our target.”