Emergency Medical Service Dispatch Cardiopulmonary Resuscitation Prearrival Instructions to Improve Survival From Out-of-Hospital Cardiac Arrest

Abstract

Each year, millions of people around the world experience out-of-hospital cardiac arrest (OHCA), a condition characterized by unexpected cardiovascular collapse.1,2 OHCA is a leading cause of death. The incidence of treated OHCA is ≈50 to 60 per 100 000 person-years and is comparable throughout many parts of the world. Resuscitation of these patients is challenging and requires a coordinated set of rescuer actions termed the “Chain of Survival.” The links in the Chain of Survival are immediate recognition of cardiac arrest and activation of the emergency response system, early cardiopulmonary resuscitation (CPR), rapid defibrillation, effective advanced life support, and integrated post–cardiac arrest care.3 These actions involve the participation of a spectrum of rescuers, including family members, bystanders, emergency medical service (EMS) dispatchers, pre–hospital care providers, and hospital-based personnel; each group of rescuers has specific motivations, responsibilities, and skills. Unfortunately, in most communities in the United States and Canada, only 5% to 10% of all OHCA patients in whom resuscitation is attempted survive to discharge from the hospital. In contrast, survival rates can approach 20% (50% for witnessed ventricular fibrillation) in communities where the Chain of Survival is strong.4 Efforts to improve survival from OHCA should be aimed at strengthening each link in the Chain of Survival. An important underpinning of successful resuscitation is the interdependence of each of these links. Specifically, the early links, those involving bystanders (immediate emergency activation and early bystander CPR), are essential for the effectiveness of subsequent links. Thus, efforts that can improve early recognition of OHCA and increase bystander CPR are likely to improve survival from OHCA. When a bystander calls the community emergency response number (eg, 911 in the United States) to request medical aid, the call creates an opportunity to improve both identification of OHCA and provision of …