Conflict of Interest Declaration
The ILCOR Continuous Evidence Evaluation process is guided by a rigorous ILCOR Conflict of Interest policy. The following Task Force members and other authors were recused from the discussion as they declared a conflict of interest: N/A
The following Task Force members and other authors declared an intellectual conflict of interest, and this was acknowledged and managed by the Task Force Chairs and Conflict of Interest committees: Janet Bray and Christian Vaillancourt authored included papers.
Task Force Synthesis Citation
Dainty KN, Debaty G, Vaillancourt C, Smyth M, Olasveengen T, Bray J on behalf of the International Liaison Committee on Resuscitation Basic Life Support Task Force. Interventions used with Dispatcher-assisted CPR: A scoping review. [Internet] Brussels, Belgium: International Liaison Committee on Resuscitation (ILCOR) Basic Life Support Task Force, 2024 Jan 8. Available from: http://ilcor.org
Methodological Preamble and Link to Published Scoping Review
This was a scoping review of interventions used with Dispatcher-assisted CPR (DA-CPR) conducted by the ILCOR Basic Life Support Task Force. This topic has not previously been considered as a Scoping Review.
This scoping review was conducted in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for scoping reviews (Tricco 2019;467) and with regard for the Arksey and O’Malley framework (Arksey 2005;19).
Scoping Review
Webmaster to insert the Scoping Review citation and link to Pubmed using this format when/if it is available.
PICOST
PICOST |
Description (with recommended text) |
Population |
Adult and pediatric in out-of-hospital cardiac arrest where dispatcher-assisted CPR (DA-CPR) is implemented |
Intervention |
Interventions used in addition to DA-CPR |
Comparison |
Non-modified DA-CPR |
Outcomes |
|
Study Design |
Randomized controlled trials (RCTs) and non-randomized studies (non-randomized controlled trials, interrupted time series, controlled before-and-after studies, cohort studies) are eligible for inclusion. Unpublished studies (e.g., conference abstracts, trial protocols), editorials, commentaries, animal studies and systematic reviews are excluded. If there will be insufficient studies from which to draw a conclusion, case series may be included in the initial search. |
Timeframe |
2000 to May 17th 2023 and all languages are included if there is an English abstract |
Search Strategies
Search was run with input of IS from North York General Hospital. Following review from Task Force in May 2023, search updated. Current searches were run in Embase, Medline, CINAHL and Cochrane Database of Systematic Reviews on May 17th, 2023. We did not search grey literature.
We identified 36 articles for full-text review: One non-randomized implementation trial,1 16 simulation studies (15 RCTs,2-16 one non-randomized comparisons17) and 12 were observational studies reviewing real-world OHCAs from registries or collected data17-28 or emergency call review.29 Two included studies used qualitative30 and mixed methods.31
Inclusion and Exclusion criteria
We included any article that included primary data about an intervention that was used within a DA-CPR program to potentially increase the effectiveness of DA-CPR on any of the outcomes listed in the PICOST above, including simulation studies. We excluded studies examining compression-only CPR versus standard CPR as this is covered in another ILCOR CoSTR.32,33
Data tables: BLS 2113 Optimization of DA CPR Sc R 2024 Table 1, BLS 2113 Optimization of DA CPR Sc R 2024 Data Table 2
Task Force Insights
1. Why this topic was reviewed.
The 2020 evidence review recommends systems and the provision of CPR instructions by dispatchers in the emergency call.34,35 Although the certainty of evidence was rated as very low at that time, DA-CPR is widely implemented36-39 and the Task Force felt that the evidence has advanced to examine interventions aiming to optimize DA-CPR. A scoping review was conducted to map this evidence and determine if the evidence was currently sufficient to warrant a systematic review. Studies comparing compression-only CPR to standard CPR were excluded as this topic is covered in a separate ILCOR PICOST.32,33
The effectiveness of DA-CPR has been studied by the BLS Task Force previously and has been shown to increase bystander CPR rates and improve outcomes in OHCA.40 Although rib fractures and sternal fractures have been observed in as many as 30% and 15% of cardiac arrest victims during autopsy,41-44 [2-5] two studies failed to observe any adverse event resulting from CPR provided to patients not in cardiac arrest.45,46 This provides reassurance for the continued implementation of DA-CPR, with the next progression of this topic to explore the evidence for interventions designed to increase the effectiveness of DA-CPR.
2. Narrative summary of evidence identified
Thirty-one studies were included in this scoping review (Table 1). One non-randomized implementation trial,1 16 simulation studies (15 RCTs,2-16 one non-randomized comparisons17) and 12 were observational studies reviewing real-world OHCAs from registries or collected data17-28 or emergency call review.29 Two included studies used qualitative30 and mixed methods.31 Only one study focused on pediatric cardiac arrest.8
The interventions examined were advanced dispatcher training (n=318-20), centralization of the dispatch center (n=221,22), use of metronome or varied metronome rates (n=22,3), change in CPR sequence and compression ratio (n=123), an animated audio-visual recording (n=14), pre-recorded instructions vs. conversational live instructions (n=15), implementation of novel DA-CPR protocols (n=41,6,24,25), changes in terminology about compressions (n=67-9,17,26,29; 1 pediatric), inclusion of “undress patient” instructions (n=110), verbal encouragement (n=116), and use of video at the scene (n=911-15,27,28,30,31).
Advanced dispatcher training (n=3)
Three before-and-after studies examined the impact of advanced dispatcher training on patient outcomes.18-20 The specifics of each intervention in the three studies are provided in Appendix A and data Table 2a. Two of the three studies showed a statistically significant increase in rates of bystander CPR in the period of time following dispatcher training,18,20 but only one of these studies examined survival and reported an increase in adjusted survival at 30 days. The third study reported lower rates of bystander CPR after training was introduced, and no difference in survival or good neurological outcomes following advanced training.19
Centralized Dispatch Centre referral (n=2)
Two before-and-after studies examined the impact of centralizing dispatch centres on OHCA patient outcomes.21,22 Both studies showed increased rates of bystander CPR (Table 2b).21,22 Only one study reported survival, and found an increase in adjusted survival to hospital discharge.22
Use of Metronome or Varied Metronome Rates vs. control (n=2)
Two simulation RCTs studies examined the impact of using a metronome during DA-CPR instructions on CPR quality (Table 2c).2,3 One simulation RCT3 compared metronome sound-guided instruction to control without a metronome. This study reported the group with the metronome provided a higher mean compression rate, and a higher proportion with a rate between 100-120/min. There was no difference in mean compression depth, but the metronome group had a higher proportion of shallower compressions compared to the control group. The other simulation RCT found no significant differences in compression rates using three metronome rates (120/min, 110/min, and 100/min). In all groups, the mean depth of chest compression was less than 5 cm.2
Change in CPR sequence and ratio (n=1)
One before-and-after registry study examined the impact of changing dispatcher CPR instructions from 2 breaths and conventional CPR (15:2) to a compression-focused strategy (400 compressions: 2 breaths, followed by 100:2 ratio) in adult OHCA patients (Table 2d).23 The change to a compression-focused strategy was associated with a significant increase in rates of bystander CPR, and an increase in adjusted survival to hospital (shockable and non-shockable patients) and survival to discharge (shockable only).
Animated audiovisual instructions (n=1)
A simulated mannikin cluster RCT compared an animated audio-visual video on a cell phone to verbal DA-CPR instructions (Table 2e).4 Overall CPR performance, hand positioning and compression rate were better in the animated group.
Pre-recorded instructions vs. conversational live instructions (n=1)
In a single simulated mannikin RCT there were no significant differences in CPR quality between the recorded-assisted and dispatcher-assisted groups (Table 2f).5 The recorded-assisted group demonstrated significantly shorter times to first compressions, higher compression rate and more compressions provided.
Implementation of novel or standardized DA-CPR protocols vs. control (n=4)
Four studies examined the introduction of a novel or standardized DA-CPR protocol designed to improve the effectiveness of the DA-CPR programs in systems not using the Medical Priority Dispatch System (Appendix 2 and Table 2g).1,6,24,25
In a non-randomised three-armed implementation trial, sites opted for 1) a comprehensive (with quality improvement tool), 2) a basic DA-CPR package, or 30 served as controls.1 In a before-and-after analysis, the primary outcome of survival to discharge/30-days improved in all arms, but was greater in the comprehensive arm. Similar trends were reported for bystander CPR and survival with favorable neurological outcome.
Two observational before-and-after studies listened to emergency calls and examined patient outcomes.24,25 The first study reported a faster median time to recognition, but no difference in time to first compression, rate of shockable rhythm or unadjusted patient outcomes following the introduction of a standardised protocol.25 The other study noted a significant increase in rates of bystander CPR, but no difference in time to first compression or unadjusted patient outcomes.24
A simulated RCT reported a novel protocol improved an overall CPR quality score compared with the standard protocol.6 The novel protocol also resulted in deeper chest compressions, improved rates of correct hand position and participants felt more motivated by the dispatcher.
Changes in terminology (n=7; 1 pediatric)
Seven studies looked at the impact of changing the DA-CPR terminology, including one before-and-after observational study,26 four simulation RCTs7-10, use of secondary data from two simulation RCTs17 and one review of emergency calls (Table 2h).29
The before-and-after observational study compared a standard protocol for DA-CPR including the instruction ‘push 100 times a minute 5 cm deep’ versus a quality improvement initiative where the instruction was simplified to ‘push hard and fast’.26 The period with the simplified instruction was associated with a shorter time to first compression. Four other studies examined simplifying the language in CPR instructions in simulations.8,9,17,26 In general, these simulation studies found simplified language (e.g., “press hard and fast”, “push as hard as you can”) improved time to first compression and compression rate and depth.
Another simulation RCT looked at including the instruction to “put the phone down” during CPR and found no difference in the quality of CPR.7
A linguistic study of the words used by dispatchers to initiate CPR found increased agreement to perform CPR by callers when the dispatchers used words of futurity (“we are going to do CPR”) or obligation (“we need to do CPR”) over seeking willingness (“do you want to do CPR”).29
Inclusion of “undress patient” instructions vs. control (n=1)
One simulation RCT found longer time to first compressions when instructions to remove clothing were given (Table 2i).10 No difference was seen in the quality of CPR (rate, depth or recoil) between groups.
Verbal encouragement (n=1)
One simulation RCT found the use of verbal encouragement in a simulation RCT in addition to DA-instructions with a metronome, resulted in improved compression rate but no change in chest compression depth (Table 2j).16
Use of Video vs. Audio-only in call (n=9).
The use of video in the emergency call was examined in 9 studies, including 2 cohort studies,27,47 5 simulation RCTs,11-15 and single qualitative30 and mixed method31 studies (Table 2k).
Only one study examined patient outcomes and compared adult OHCA patients with video-instructed dispatcher CPR to those with audio-only CPR instructions.27 This study found no difference in survival to discharge of favorable neurological outcome in an adjusted or matched analysis. Another study conducted a subjective assessment of CPR quality in calls using video and found high rates of incorrect hand positioning (42%) before video assessment, which significantly improved following further instructions.47 This study also reported lower proportions of correct compression rates and depth, which also improved with video-assisted instructions.
In the simulation RCTs, most reported the video-instructed method resulted in a greater correct compression rate and positioning of the hands.11-13,15,24 However, another study reported the video group had more “hands-off” time, longer time to first chest compressions and total instruction time.14
A qualitative study was conducted to understand the dispatcher’s experience with adding video to calls following a simulation study.30 In this study dispatchers reported that: video-calls were useful for obtaining information and to support CPR assistance; their CPR assistance became easier; that the CPR might be of better quality; but that there is a risk of distraction (‘‘noise’’). The mixed methods simulation study reported better CPR quality with video, and that participants liked the ability to correct CPR.31
Narrative Reporting of the Task Force Discussions
There is insufficient evidence on most of the interventions included in this review to recommend progression to a formal systematic review of any intervention. There is a distinct lack of high-quality human research on any interventions and an opportunity for research.
In particular, the implementation of novel DA-CPR protocols, pre-recorded instructions, centralized dispatch, advanced dispatcher training, use of metronomes and varying metronome rates and instructions to undress the patient all have less than two papers published and therefore we are unable to make any summary comment on their effectiveness at this point.
The interventions which have five or more studies are showing directional trends:
- The studies which focus on simplifying the compression instruction language (ie. “Push as hard as you can” vs “Push approximately 2 inches/5cm”) suggests an improvement in CPR quality.
- The studies which look at adding video to the emergency call (vs. audio-only calls) suggests an improvement in CPR quality.
However, terminology changes in instructions may not be generalizable to other languages. Almost half of the studies comparing video to audio were simulation studies.
Knowledge Gaps
There is needed for:
- High-quality prospective research in humans.
- Data on paediatric cases.
References
1. Ong MEH, Shin SD, Ko PC-I, Lin X, Ma MH-M, Ryoo HW, Wong KD, Supasaowapak J, Lin C-H, Kuo C-W, et al. International multi-center real world implementation trial to increase out-of-hospital cardiac arrest survival with a dispatcher-assisted cardio-pulmonary resuscitation package (Pan-Asian resuscitation outcomes study phase 2). Resuscitation. 2022;171:80-89. doi: 10.1016/j.resuscitation.2021.12.032
2. Lee DH, Kim CW, Kim SE. The effect of the different methods indicating 100/min to 120/min using the metronome in dispatcher-assisted resuscitation. The American journal of emergency medicine. 2014;32:1282-1283. doi: 10.1016/j.ajem.2014.07.009
3. Park SO, Hong CK, Shin DH, Lee JH, Hwang SY. Efficacy of metronome sound guidance via a phone speaker during dispatcher-assisted compression-only cardiopulmonary resuscitation by an untrained layperson: a randomised controlled simulation study using a manikin. Emergency medicine journal : EMJ. 2013;30:657-661. doi: 10.1136/emermed-2012-201612
4. Choa M, Park I, Chung HS, Yoo SK, Shim H, Kim S. The effectiveness of cardiopulmonary resuscitation instruction: Animation versus dispatcher through a cellular phone. Resuscitation. 2008;77:87-94. doi: 10.1016/j.resuscitation.2007.10.023
5. Birkun A, Glotov M, Ndjamen HF, Alaiye E, Adeleke T, Samarin S. Pre-recorded instructional audio vs. dispatchers’ conversational assistance in telephone cardiopulmonary resuscitation: A randomized controlled simulation study. World journal of emergency medicine. 2018;9:165-171. doi: 10.5847/wjem.j.1920-8642.2018.03.001
6. Rasmussen SE, Nebsbjerg MA, Krogh LQ, Bjørnshave K, Krogh K, Povlsen JA, Riddervold IS, Grøfte T, Kirkegaard H, Løfgren B. A novel protocol for dispatcher assisted CPR improves CPR quality and motivation among rescuers—A randomized controlled simulation study. Resuscitation. 2017;110:74-80. doi: 10.1016/j.resuscitation.2016.09.009
7. Brown TB, Saini D, Pepper T, Mirza M, Nandigam HK, Kaza N, Cofield SS. Instructions to “put the phone down” do not improve the quality of bystander initiated dispatcher-assisted cardiopulmonary resuscitation. Resuscitation. 2008;76:249-255. doi: 10.1016/j.resuscitation.2007.07.026
8. Rodriguez SA, Sutton RM, Berg MD, Nishisaki A, Maltese M, Meaney PA, Niles DE, Leffelman J, Berg RA, Nadkarni VM. Simplified dispatcher instructions improve bystander chest compression quality during simulated pediatric resuscitation. Resuscitation. 2014;85:119-123. doi: 10.1016/j.resuscitation.2013.09.003
9. Trethewey SP, Vyas H, Evans S, Hall M, Melody T, Perkins GD, Couper K. The impact of resuscitation guideline terminology on quality of dispatcher-assisted cardiopulmonary resuscitation: A randomised controlled manikin study. Resuscitation. 2019;142:91-96. doi: 10.1016/j.resuscitation.2019.07.016
10. Eisenberg Chavez D, Meischke H, Painter I, Rea TD. Should dispatchers instruct lay bystanders to undress patients before performing CPR? A randomized simulation study. Resuscitation. 2013;84:979-981. doi: 10.1016/j.resuscitation.2012.12.010
11. Bolle SR, Scholl J, Gilbert M. Can video mobile phones improve CPR quality when used for dispatcher assistance during simulated cardiac arrest? Acta Anaesthesiologica Scandinavica. 2009;53:116-120. doi: 10.1111/j.1399-6576.2008.01779.x
12. Lee JS, Jeon WC, Ahn JH, Cho YJ, Jung YS, Kim GW. The effect of a cellular-phone video demonstration to improve the quality of dispatcher-assisted chest compression-only cardiopulmonary resuscitation as compared with audio coaching. Resuscitation. 2011;82:64-68. doi: 10.1016/j.resuscitation.2010.09.467
13. Lee HS, You K, Jeon JP, Kim C, Kim S. The effect of video-instructed versus audio-instructed dispatcher-assisted cardiopulmonary resuscitation on patient outcomes following out of hospital cardiac arrest in Seoul. Scientific reports. 2021;11:15555-15555. doi: 10.1038/s41598-021-95077-5
14. Yang C-W, Wang H-C, Chiang W-C, Hsu C-W, Chang W-T, Yen Z-S, Ko PC-I, Ma MH-M, Chen S-C, Chang S-C. Interactive video instruction improves the quality of dispatcher-assisted chest compression-only cardiopulmonary resuscitation in simulated cardiac arrests. Critical care medicine. 2009;37:490-495. doi: 10.1097/CCM.0b013e31819573a5
15. Peters M, Stipulante S, Cloes V, Mulder A, Lebrun F, Donneau A-F, Ghuysen A. Can Video Assistance Improve the Quality of Pediatric Dispatcher-Assisted Cardiopulmonary Resuscitation? Pediatric emergency care. 2022;38:e451-e457. doi: 10.1097/PEC.0000000000002392
16. Hwang BN, Lee EH, Park HA, Park JO, Lee CA. Effects of positive dispatcher encouragement on the maintenance of bystander cardiopulmonary resuscitation quality. Medicine. 2020;99:e22728. doi: 10.1097/MD.0000000000022728
17. Mirza M, Brown TB, Saini D, Pepper TL, Nandigam HK, Kaza N, Cofield SS. Instructions to “push as hard as you can” improve average chest compression depth in dispatcher-assisted cardiopulmonary resuscitation. Resuscitation. 2008;79:97-102. doi: 10.1016/j.resuscitation.2008.05.012
18. Harjanto S, Na MXB, Hao Y, Ng YY, Doctor N, Goh ES, Leong BS-H, Gan HN, Chia MYC, Tham LP, et al. A before–after interventional trial of dispatcher-assisted cardio-pulmonary resuscitation for out-of-hospital cardiac arrests in Singapore. Resuscitation. 2016;102:85-93. doi: 10.1016/j.resuscitation.2016.02.014
19. Park GJ, Song KJ, Shin SD, Hong KJ, Kim TH, Park YM, Kong J. Clinical effects of a new dispatcher-assisted basic life support training program in a metropolitan city. Medicine. 2022;101:e29298. doi: 10.1097/MD.0000000000029298
20. Tsunoyama T, Nakahara S, Yoshida M, Kitamura M, Sakamoto T. Effectiveness of dispatcher training in increasing bystander chest compression for out‐of‐hospital cardiac arrest patients in Japan. Acute Medicine & Surgery. 2017;4:439-445. doi: 10.1002/ams2.303
21. Lerner EB, Farrell BM, Colella MR, Sternig KJ, Westrich C, Cady CE, Liu JM. A centralized system for providing dispatcher assisted CPR instructions to 9-1-1 callers at multiple municipal public safety answering points. Resuscitation. 2019;142:46-49. doi: 10.1016/j.resuscitation.2019.07.010
22. Ro YS, Shin SD, Lee SC, Song KJ, Jeong J, Wi DH, Moon S. Association between the centralization of dispatch centers and dispatcher-assisted cardiopulmonary resuscitation programs: A natural experimental study. Resuscitation. 2018;131:29-35. doi: 10.1016/j.resuscitation.2018.07.034
23. Bray JE, Deasy C, Walsh J, Bacon A, Currell A, Smith K. Changing EMS dispatcher CPR instructions to 400 compressions before mouth-to-mouth improved bystander CPR rates. Resuscitation. 2011;82:1393-. doi: 10.1016/j.resuscitation.2011.06.018
24. Stipulante S, Tubes R, El Fassi M, Donneau A-F, Van Troyen B, Hartstein G, D’Orio V, Ghuysen A. Implementation of the ALERT algorithm, a new dispatcher-assisted telephone cardiopulmonary resuscitation protocol, in non-Advanced Medical Priority Dispatch System (AMPDS) Emergency Medical Services centres. Resuscitation. 2014;85:177-181. doi: 10.1016/j.resuscitation.2013.10.005
25. Plodr M, Truhlar A, Krencikova J, Praunova M, Svaba V, Masek J, Bejrova D, Paral J. Effect of introduction of a standardized protocol in dispatcher-assisted cardiopulmonary resuscitation. Resuscitation. 2016;106:18-23. doi: 10.1016/j.resuscitation.2016.05.031
26. Leong PWK, Leong BS-H, Arulanandam S, Ng MXR, Ng YY, Ong MEH, Mao DRH. Simplified instructional phrasing in dispatcher-assisted cardiopulmonary resuscitation – when ‘less is more’. Singapore medical journal. 2021;62:647-652. doi: 10.11622/smedj.2020080
27. Lee SY, Song KJ, Shin SD, Hong KJ, Kim TH. Comparison of the effects of audio-instructed and video-instructed dispatcher-assisted cardiopulmonary resuscitation on resuscitation outcomes after out-of-hospital cardiac arrest. Resuscitation. 2020;147:12-20. doi: 10.1016/j.resuscitation.2019.12.004
28. Linderoth G, Lippert F, Østergaard D, Ersbøll AK, Meyhoff CS, Folke F, Christensen HC. Live video from bystanders’ smartphones to medical dispatchers in real emergencies. BMC Emergency Medicine. 2021;21:101. doi: 10.1186/s12873-021-00493-5
29. Riou M, Ball S, Whiteside A, Bray J, Perkins GD, Smith K, O’Halloran KL, Fatovich DM, Inoue M, Bailey P, et al. ‘We’re going to do CPR’: A linguistic study of the words used to initiate dispatcher-assisted CPR and their association with caller agreement. Resuscitation. 2018;133:95-100. doi: 10.1016/j.resuscitation.2018.10.011
30. Johnsen E, Bolle SR. TO SEE OR NOT TO SEE—Better dispatcher-assisted CPR with video-calls? A qualitative study based on simulated trials. Resuscitation. 2008;78:320-326. doi: 10.1016/j.resuscitation.2008.04.024
31. Kim H-J, Kim J-H, Park D. Comparing audio- and video-delivered instructions in dispatcher-assisted cardiopulmonary resuscitation with drone-delivered automatic external defibrillator: a mixed methods simulation study. PeerJ. 2021;9:e11761-e11761. doi: 10.7717/peerj.11761
32. Olasveengen TM, de Caen AR, Mancini ME, Maconochie IK, Aickin R, Atkins DL, Berg RA, Bingham RM, Brooks SC, Castren M, et al. 2017 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Summary. Resuscitation. 2017;121:201-214. doi: 10.1016/j.resuscitation.2017.10.021
33. Olasveengen TM, de Caen AR, Mancini ME, Maconochie IK, Aickin R, Atkins DL, Berg RA, Bingham RM, Brooks SC, Castren M, et al. 2017 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Summary. Circulation. 2017;136:e424-e440. doi: 10.1161/CIR.0000000000000541
34. Olasveengen TM, Mancini ME, Perkins GD, Avis S, Brooks S, Castren M, Chung SP, Considine J, Couper K, Escalante R, et al. Adult Basic Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2020;142:S41-S91. doi: 10.1161/CIR.0000000000000892
35. Olasveengen TM, Mancini ME, Perkins GD, Avis S, Brooks S, Castren M, Chung SP, Considine J, Couper K, Escalante R, et al. Adult Basic Life Support: International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation. 2020;156:A35-A79. doi: 10.1016/j.resuscitation.2020.09.010
36. Govindarajan P, Lin L, Landman A, McMullan JT, McNally BF, Crouch AJ, Sasson C. Practice variability among the EMS systems participating in Cardiac Arrest Registry to Enhance Survival (CARES). Resuscitation. 2012;83:76-80. doi: https://doi.org/10.1016/j.resuscitation.2011.06.026
37. Lee SCL, Mao DR, Ng YY, Leong BS, Supasaovapak J, Gaerlan FJ, Son DN, Chia BY, Do Shin S, Lin CH, et al. Emergency medical dispatch services across Pan-Asian countries: a web-based survey. BMC Emerg Med. 2020;20:1. doi: 10.1186/s12873-019-0299-1
38. Tjelmeland IBM, Masterson S, Herlitz J, Wnent J, Bossaert L, Rosell-Ortiz F, Alm-Kruse K, Bein B, Lilja G, Grasner JT, et al. Description of Emergency Medical Services, treatment of cardiac arrest patients and cardiac arrest registries in Europe. Scand J Trauma Resusc Emerg Med. 2020;28:103. doi: 10.1186/s13049-020-00798-7
39. Beck B, Bray JE, Smith K, Walker T, Grantham H, Hein C, Thorrowgood M, Smith A, Inoue M, Smith T, et al. Description of the ambulance services participating in the Aus-ROC Australian and New Zealand out-of-hospital cardiac arrest Epistry. Emerg Med Australas. 2016;28:673-683. doi: 10.1111/1742-6723.12690
40. Nikolaou N, Dainty KN, Couper K, Morley P, Tijssen J, Vaillancourt C, International Liaison Committee on Resuscitation's Basic Life S, Pediatric Task F. A systematic review and meta-analysis of the effect of dispatcher-assisted CPR on outcomes from sudden cardiac arrest in adults and children. Resuscitation. 2019;138:82-105. doi: 10.1016/j.resuscitation.2019.02.035
41. Lederer W, Mair D, Rabl W, Baubin M. Frequency of rib and sternum fractures associated with out-of-hospital cardiopulmonary resuscitation is underestimated by conventional chest X-ray. Resuscitation. 2004;60:157-162. doi: 10.1016/j.resuscitation.2003.10.003
42. Krischer JP, Fine EG, Davis JH, Nagel EL. Complications of cardiac resuscitation. Chest. 1987;92:287-291. doi: 10.1378/chest.92.2.287
43. Hoke RS, Chamberlain D. Skeletal chest injuries secondary to cardiopulmonary resuscitation. Resuscitation. 2004;63:327-338. doi: 10.1016/j.resuscitation.2004.05.019
44. Black CJ, Busuttil A, Robertson C. Chest wall injuries following cardiopulmonary resuscitation. Resuscitation. 2004;63:339-343. doi: 10.1016/j.resuscitation.2004.07.005
45. Ng JYX, Sim ZJ, Siddiqui FJ, Shahidah N, Leong BS, Tiah L, Ng YY, Blewer A, Arulanandam S, Lim SL, et al. Incidence, characteristics and complications of dispatcher-assisted cardiopulmonary resuscitation initiated in patients not in cardiac arrest. Resuscitation. 2022;170:266-273. doi: 10.1016/j.resuscitation.2021.09.022
46. Hallstrom AP, Cobb LA, Johnson E, Copass MK. Dispatcher assisted CPR: implementation and potential benefit. A 12-year study. Resuscitation. 2003;57:123-129. doi: 10.1016/s0300-9572(03)00005-4
47. Linderoth G, Rosenkrantz O, Lippert F, Østergaard D, Ersbøll AK, Meyhoff CS, Folke F, Christensen H. Live video from bystanders’ smartphones to improve cardiopulmonary resuscitation. Resuscitation. 2021;168:35-43. doi: 10.1016/j.resuscitation.2021.08.048
Appendix A – Intervention Descriptions for “Advanced Dispatcher Training Program” studies
STUDY |
INTERVENTION DESCRIPTION |
Harjanto 2016 |
(1) A standardized dispatch protocol that will guide dispatchers to systematically question callers to accurately and rapidly determine whether the patient is in cardiac arrest. When OHCA is identified, to give CPR instructions to assist bystanders if CPR is not already ongoing. (2) A training package consisting of 1-day intensive training course both call-takers and dispatch center managers. Comprised of didactic teaching and practical exercises and scenarios for dispatchers as well as supervisors/medical directors. (3) A standardized measurement quality improvement (QI) tool to collect data on individual dispatcher and organizational-level performance through review of the dispatch audio recordings. (4) An integrated quality improvement program that includes cooperation and collaboration of pre-hospital and hospital stakeholders. The program provides feedback at the individual and organizational level. It involved review of dispatcher-CPR audio recordings and use of the QI tool mentioned in step 3. (5) A community education program known as Dispatcher Assisted First REsponder (DARE) program to update the public on DA-CPR, how to recognize cardiac arrest, the importance of early activation of EMS and staying on the line for DACPR. |
Tsunoyama et al 2017 |
The Fire and Disaster Management Agency developed a training program for dispatchers to improve the dispatchers’ skills in communication, diagnosis, and instructions. The educational content includes basic medical education, the role of the dispatcher, identification of the urgency and severity (details of signs and symptoms of cardiac arrests, including those of impending arrests), and outline of oral guidance. The Total Classroom lecture is 7 h 45 min. Simulation training (7 h 45 min) was also included to acquire skills. Eligible participants are EMTs, second level EMTs, and ELSTs. |
Park et al 2022 |
In collaboration with the Laerdal Medical Strategic Research team, we developed a 1-hour dispatcher-assisted basic life support (DA-BLS) training program called “Home Education and Resuscitation Outcome Study” (HEROS). The HEROS program is a 1-hour training course that includes a 30-minute video-based self-instruction training session, a short role-play, and a debriefing. The video consists of a bystander CPR simulation with dispatcher instructions using the trainee’s own phone and practice session following demonstration by a simulated layperson. After watching the video clip, all trainees are divided into 2 groups and conduct a role-play for 15 minutes. During the role-play, 1 trainee acts as a layperson and the other acts as a dispatcher with the same scenario used in the actual DA-CPR and they switch the roles. Finally, there is a 15-minute debriefing session with several assignments. |