Abstract 2232: Survival Is Decreased If Ambulance Dispatchers Do Not Recognize Out-of-Hospital Cardiac Arrest

Abstract

Introduction Exact content of 112 emergency calls for suspected cardiac arrest (CA) are rarely analyzed. The purpose of this study was to investigate if not recognizing a CA by emergency medical dispatchers influences survival rates. Methods This was a prospective, observational study. During 8 months, all digitalized voice recordings of consecutive 112 high priority emergency calls were collected from the Amsterdam dispatch center and audited for CA recognition, time to recognition of CA and telephone CPR. Also, description of breathing and consciousness that the caller uses to describe a CA were scored. Actual presence of CA during call was assessed from the ambulance crew report. Calls were placed by laypersons on site, not involving trauma. Exclusion criteria were calls by a professional, by the victim or when victim was known to be conscious. Time recordings of call, dispatching and arrival were generated automatically. Survival after 3 months was taken as the primary endpoint. Results Results are shown in table 1 . In 8 months, out of 11.329 calls, 285 involved patients in CA. Of these, 203 were recognized during the call; the remaining 82 cases (29%) were only diagnosed on site. Recognizing CA resulted in faster dispatch and earlier arrival on scene. When not recognizing CA, the dispatchers did not ask the caller about respiration in over 50% of the calls. Not recognizing the CA was associated with no telephone CPR, and significantly lower three-month survival. Conclusion If the dispatcher did not recognize the CA, no CPR instruction is given. The ambulance is dispatched less rapidly and arrives a median of 2 minutes later at the scene. Both factors may contribute to the lower survival rates. Consequent interrogating the caller about the patientâ™s consciousness and respiration could improve CA recognition. In conclusion, not only early call, but also early recognition of a CA by dispatcher contributes to the survival after CA. Table 1: A comparison between calls where the dispatcher did and did not recognize CA