Abstract
Increasing bystander cardiopulmonary resuscitation (CPR) among racial/ethnic minority groups and culturally underserved populations is a key strategy in improving health care disparities in out-of-hospital cardiac arrest. To ascertain whether implementation of the Los Angeles Tiered Dispatch System (LA-TDS) was associated with improved performance of telecommunicator-assisted CPR (T-CPR) among 9-1-1 callers with limited English proficiency in the City of Los Angeles. This cohort study compared emergency medical services-treated, nontraumatic out-of-hospital cardiac arrest calls using the Medical Priority Dispatch System (MPDS) from January 1 to March 31, 2014, with calls using LA-TDS from January 1 to March 31, 2015. Trained data abstractors evaluated all 9-1-1 audio recordings for the initiation of T-CPR and the elapsed time to predefined events. Data were analyzed between January and December 2017. The primary outcome was the prevalence of T-CPR among 9-1-1 callers with limited English proficiency for field-confirmed nontraumatic cardiac arrests. Additional outcomes included T-CPR among callers with English proficiency and the elapsed time until key events in the call. Of the 1027 emergency medical services calls during the study periods, 597 met the inclusion criteria. A total of 289 calls (48%) were made using MPDS (263 callers with English proficiency, and 26 callers with limited English proficiency), and 308 calls (52%) were made using LA-TDS (273 callers with English proficiency, and 35 callers with limited English proficiency). No differences between MPDS and LA-TDS cohorts were found in age, sex, known comorbidities, arrest location (private vs public), or witnessed status. The prevalence of T-CPR among callers with limited English proficiency was significantly greater using LA-TDS (69%) vs MPDS (28%) (odds ratio [OR], 5.66; 95% CI, 1.79-17.85; P = .003). For callers with English proficiency, the prevalence of T-CPR improved from 55% using MPDS to 67% using LA-TDS (OR, 1.66; 95% CI, 1.15-2.41; P = .007). With LA-TDS, callers with limited English proficiency had a significant decrease in time to recognition of cardiac arrest (OR, 0.59; 95% CI, 0.41-0.84; P = .005) and dispatch of resources (OR, 0.71; 95% CI, 0.54-0.94; P = .02). The LA-TDS compared with MPDS was associated with increased performance of T-CPR for out-of-hospital cardiac arrests involving 9-1-1 callers with limited English proficiency. Further studies are needed in communities with a predominance of people with limited English proficiency to characterize bystander response, promote activation of the chain of survival, and clarify the precise elements of LA-TDS that can improve T-CPR performance.
Highlights
Provision of cardiopulmonary resuscitation (CPR) is a key factor in survival from out-of-hospital cardiac arrest (OHCA).[1,2,3] the benefit of bystander CPR has been well established, previous literature indicates that less than 30% of patients in Los Angeles (California) who experienced cardiac arrest received bystander CPR,[4] including only 13% of cases involving African American or Latino patients.[5]
For callers with English proficiency, the prevalence of Telecommunicator-assisted CPR (T-CPR) improved from 55% using Medical Priority Dispatch System (MPDS) to 67% using Los Angeles Tiered Dispatch System (LA-TDS) (OR, 1.66; 95% CI, 1.15-2.41; P = .007)
The LA-TDS compared with MPDS was associated with increased performance of T-CPR for out-of-hospital cardiac arrests involving [-1] callers with limited English proficiency
Summary
Provision of cardiopulmonary resuscitation (CPR) is a key factor in survival from out-of-hospital cardiac arrest (OHCA).[1,2,3] the benefit of bystander CPR has been well established, previous literature indicates that less than 30% of patients in Los Angeles (California) who experienced cardiac arrest received bystander CPR,[4] including only 13% of cases involving African American or Latino patients.[5]. In late 2014, the LAFD developed a new series of scripted questions that decreased the number of questions needed to identify individuals experiencing a potential cardiac arrest and lowered the threshold for providing T-CPR. This new program, called the Los Angeles Tiered Dispatch System (LA-TDS), went into use on December 1, 2014. LA-TDS has substantially decreased call processing times for time-critical [-1] emergencies,[11] decreased undertriage in cases of field-confirmed OHCA,[12] and improved the global rates of T-CPR.[13]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
