Abstract 239: 911 Caller Description of Seizure-Like Symptoms and Delays to Starting Telecommunicator CPR

Abstract

Background: Bystander cardiopulmonary resuscitation (BCPR) improves survival after out-of-hospital cardiac arrest (OHCA). Identifying delays to starting Telecommunicator CPR (TCPR) may improve outcomes. Identifying terms callers use to describe seizure-like symptoms may improve accuracy and expedite TCPR. Methods: A total of 586 confirmed OHCA calls from 3 regional 911 centers in Arizona were reviewed between 2013 to 2016. Frequency of terms callers use to describe seizure-like symptoms were assessed. Demographics and TCPR process measures were compared between the seizure and non-seizure cohorts using Chi-square analysis for categorical variables and Kruskal-Wallis test for continuous variables. Other data points were time to start of seizure description, time to end of description, and time to start of seizure intervention. Results: There were 545 calls after exclusions. Twenty-six (.05%) had seizure-like symptoms described. Of these, “seizure” or “seizing” were used in 22 (84.6%) calls, “shaking” in 6 (23.1%), “cramping up” in 2 (7.7%) and convulsing in 2 (7.7%). Descriptions were more common in witnessed arrests [65.4% (17/26) vs. 34.6% (9/26); p=0.045] and in younger patients [median age=57 (QI=45, Q3=68) vs. 66 (Q1=51, Q3=77); p=0.036.] In calls with descriptions, telecommunicators were less likely to recognize OHCA [56.0% (14/25) vs. 74.5% (382/513), .031% (17/545) missing; (p=0.041] but bystanders were not less likely to start compressions [42.3% (11/26) vs. 57.6% (289/501), .033% (18/545) missing; p=0.122]. Median time to recognition in calls with descriptions was delayed vs. calls without descriptions [142 s (Q1=74 s, Q3=194 s), n=13, vs. 63 s (Q1=40 s, Q3=112 s), n=336; p=0.005], as was time to first chest compression [262 s (Q1=182 s, Q3=291 s), n=6 vs. 154 s (Q1=110 s, Q3=206 s), n=155; p=0.011]. Median times to start of description, end of description, and start of intervention were respectively: 33 s (Q1=20 s, Q3=40 s; 54 s (Q1=37 s, Q3=138 s; and 50 s (Q1=38 s, Q3=162 s). Conclusion: Description of seizure-like symptoms were uncommon and were associated with reduced and delayed OHCA recognition and delayed start of compressions.