150 Dispatch Accuracy Effect on Neurologically Intact Survival: A Retrospective Cohort Study

Abstract

The effect of public-safety answering point (PSAP) dispatch accuracy on Out-of-Hospital Cardiac Arrest (OHCA) neurologically intact survival is not well documented in the scientific literature. The goal of our study is to determine if OHCA dispatcher accuracy will correlate with neurologically intact survival. We analyzed data from the San Antonio OHCA Database from January 2014 thru June 2015. Exclusion criteria were: traumatic arrest, no dispatch type recorded, and EMS witnessed arrest. The primary variable was accurate PSAP dispatch. The primary outcome was neurologically-intact survival (cerebral performance category (CPC) 1-2) to hospital discharge. The secondary outcome was prearrival CPR (defined as any CPR given prior to ambulance arrival). Of 1770 cases, 1447 met the inclusion criteria. 1063 cases (73.5%) were dispatched as OHCA, upgraded to OHCA, or suspected dead on arrival. 384 cases (26.5%) were dispatched as another chief complaint. Unconscious/Faint (34.3%) and difficulty breathing (22.9%) were the most common inaccurate dispatches. The accurate vs inaccurate dispatch groups had no statistical difference in racial composition, age (62.0 vs 62.3) or initial shockable rhythm (15.2% vs 18.7%). Neurologically-intact survival occurred in 4.7%, 95% CI[3.5,6.3] of the accurate dispatch group and 4.3%, 95% CI[2.6,7.2] of the inaccurate dispatch group (p=0.88). Prearrival CPR occurred in 76.1%, 95% CI[73.5,78.6] of the accurate dispatch group vs 52.7%, 95% CI[47.7,57.7] of the inaccurate dispatch group (p<0.001). OHCA dispatch accuracy is not associated with neurologically intact survival in our fire department-based, urban, EMS system.