Abstract 99: A Multidimensional Bundle Intervention Effectively Enhances Delivery of Dispatcher-Assisted Cardiopulmonary Resuscitation

Abstract

Objective: The better detection of OHCA through EMS calls by dispatchers may influence the performance of online dispatcher-assisted cardiopulmonary resuscitation (DA-CPR). In an EMS system with a bystander CPR rate around 20%, we launch a bundle intervention for better recognition of OHCA by EMS dispatchers and assess its impact on DA-CPR. Design: The EMS authority implements a multidimensional bundle for calls recognition of OHCA and DA-CPR, including 1) a simpler protocol prioritizing patient breathe identification, 2) post-hoc auditing the call audio records for confirmed OHCA cases upon paramedics contact, 3) feedback the audit results to each dispatcher, and a written response from dispatcher is demanded, 4) modifying the computer-aided dispatch (CAD) system to highlight the dialog of “breath not normally” instead of “no breath”, and 5) to add an icon for dispatcher to reassure the call case is unnecessary for DA-CPR before case close in CAD, 6) a leadership commitment for bundle, and 7) a steering team composed with both medical and fire administrative personnel for bundle execution. Settings: A centralized CAD system in a metropolitan EMS is studied. Routinely in system the call to ambulance dispatch time should be within 60 seconds. Methods: Through audio records evaluation, the proportions of calls recognition and DA-CPR for OHCA patients six months after the intervention are compared with that for the same month period in the prior year as the control group, using regression analysis for statistics. Results: A total of 717 calls after the intervention are compared with the 749 calls in control. The proportion of call recognition of OHCA after the intervention is significantly higher than the control (74.8% vs 57.7%, adjusted odds ratio: 2.2, 95% CI: 1.5-3.1). The proportion of dispatcher-assisted bystander chest compressions after the bundle is significantly higher than the control (28.2% vs 18.9%, adjusted odds ratio: 1.7, 95% CI: 1.1-2.5). Conclusions: We demonstrate a multidimensional bundle including simpler protocol, call records auditing, feedback, CAD with emphasizing patient breath status and reassuring assessment, leadership, and a joint steering team may effectively enhance EMS calls recognition and delivery of DA-CPR for OHCA.