Telephone Cardiopulmonary Resuscitation Research Articles

Dispatcher-assisted telephone-CPR by elderly: A feasibility (pre-)study in the Bruges areaStatus: PendingCategory: CPR Quality

Purpose of the study: The study aims to assess the practical effectiveness of the Belgian protocol ‘phone CPR’ by the elderly layperson1 and evaluate the quality of telephone CPR performed by lay CPR-providers.

CPR initiated after telephone-assisted instruction produces a better outcome of bystander-witnessed out-of-hospital cardiac arrests than no bystander CPR but is less effective than CPR on the bystander's own initiative

Telephone CPR has been shown to increase the incidence of bystander CPR and is expected to improve the outcomes of out-of-hospital cardiac arrests (OHCAs). The aim of present study was to clarify if the outcomes of bystander-witnessed OHCAs having CC-only and conventional CPR following telephone CPR may be better than those having no bystander CPR and if the type (CC-only and conventional) and origin (following telephone CPR and on bystander's own initiative) may affect the outcomes of bystander-witnessed OHCAs with bystander CPR.

Proportion of out-of-hospital adult non-traumatic cardiac or respiratory arrest among calls for seizure

ObjectivesTo measure the proportion of adult non-traumatic cardiac or respiratory arrest among calls for seizure to an emergency medical dispatch centre and to record whether known epileptic patients present cardiac...

Abstract 185: Emergency Calls Made Away from the Out-of-Hospital Cardiac Arrest Scene Are Frequently Classified as an Uninformative “Hearsay Call” and Associated with Poor Outcomes

Backgrounds and Aim Emergency calls made away from the scene may affect the incidences of telephone-cardiopulmonary resuscitation (CPR) and bystander CPR, and hence may modify the prognosis of out-of -hospital cardiac arrests (OHCAs) recognized or witnessed by citizens. The aims of this study are to investigate the incidence and causes of emergency calls away from the scene and to study their effects on the prognosis of OHCAs. Methods Data from 4861 OHCAs that occurred from April, 2004 to March, 2010 in Ishikawa prefecture were prospectively collected and analyzed. The emergency calls made away from the scene were identified by dispatch records and interviews to callers and/or bystanders. Results The incidence of emergency calls made away from the scene was 15.2% (737/4861) for all OHCAs and 10.2% (328/3228) for OHCAs that occurred at home. More than half of emergency call away from the scene was preventable and classified as an uninformative “hearsay” call (52% for all OHCAs and 58% for OHCAs at home). The emergency calls away from the scene were associated with low incidences of telephone-CPR and bystander CPR, and 1-M and 1-Y survivals. Mutiple logistic regression analysis revealed that emergency call made awayfrom the scene is one of independent factors associated with poor outcomes. Conclusions Emergency calls made away from the OHCAs scene are frequently classified as an uninformative “hearsay call” and associated with poor outcomes due to low incidences of telephone-CPR and bystander CPR. We should make it known to laypersons in society that they should make an emergency call by themselves as close as to the scene where someone becomes unresponsive.

Abstract 71: Diagnosis of Cardiac Arrest by 911 Call Takers Improved with Education Without Changing Bystander CPR Rates

Context: In most out-of-hospital cardiac arrest (OHCA) events, a telephone call to 911 is the first action by bystanders. Because the 911 call taker cannot see the victim, accurate diagnosis of cardiac arrest depends on the caller's verbal description. If cardiac arrest is not suspected, then no telephone CPR instructions will be given. Objective: We measured the impact of a change in the EMS call taker question sequence on the accuracy of diagnosis of cardiac arrest by 911 call takers. Methods: We retrospectively reviewed the Cardiac Arrest Registry to Enhance Survival (CARES) dataset for Jan 1, 2009 through Dec 31, 2010 from a single Midwestern US city, population 750,000 with a longstanding telephone CPR instruction program (APCO). We included OHCA cases of any age who were in arrest prior to the arrival of EMS and for whom resuscitation was attempted. In early 2010, 911 call takers were retrained to follow a revised telephone script that emphasized minimal questioning, assertive control of the callers, and provision of Hands-only telephone CPR instructions. In 2010, call recordings were reviewed regularly with feedback to the call taker. The main outcome measure was sensitivity of the 911 call taker in diagnosing cardiac arrest. We compared 2009 with 2010 using the χ 2 test and odds ratio (OR). Results: There were 509 OHCA cases in 2009 and 447 cases in 2010 (64/100,000 population). The mean age was 59 ± 18 years, and 60% were male. Only 26% of events were witnessed. Before the revision, 40% were identified by 911 dispatchers; and after the revised questioning sequence, 74% were identified (OR 4.3, CI95 3.2 - 5.6, p<0.01). The mean time to question callers was 58 seconds before and 54 seconds after (p=NS). False positive rates changed little (676 before and 861 after). Bystander CPR was performed in 37.5% of events before and 37.4% of events after the training (p=NS). Conclusion: Emphasis on scripted assessment improved sensitivity without loss of specificity in identifying OHCAs. However, it did not translate to an increase in patients receiving bystander CPR.

Réanimation cardiopulmonaire : nouvelles recommandations

A procedure for telephone CPR must be started since the call centres do the diagnosis of cardiac arrest. All the rescuers, trained or not, have to realize quality chest compressions (depths 5 in 6 cm, rhythm from 100 to 120 per minute) to the victims of cardiac arrest. Chest compressions must be interrupted only briefly in case of indispensable specific interventions. The trained rescuers have to realize insufflations during the CPR, with a ratio compression-ventilation of 30/2. The development of AE programs is encouraged. A more important deployment of AED is necessary in public places and residential areas. The use of the acetylsalicylic acid by witnesses, in case of cardiac arrest, is authorized with or without the assistance of the medical dispatcher of the EMS. The administration of medicines by endotracheal tube is not any more recommended. If the intravenous access cannot be used, it is the intra-osseous, which would be privileged. In case of children cardiac arrest, the non-professional rescuer have to use a ratio of 30 compressions for two ventilations if he is alone and 15/2 if they are working in team. All the citizens, and all the healthcare providers, should be trained in CPR and to keep their skills should follow all three to six months refresher courses to upgrade their knowledge. Une procédure de réanimation cardiopulmonaire (RCP) par téléphone doit être mise en route dès le diagnostic d’arrêt cardiaque fait par les centres de réception de l’alerte. Tous les sauveteurs, formés ou non, doivent réaliser des compressions thoraciques de qualité (profondeurs 5 à 6 cm, rythme de 100 à 120 par minute) aux victimes d’arrêt cardiaque. Les compressions thoraciques ne doivent être interrompues que brièvement en cas d’interventions spécifiques indispensables. Les sauveteurs formés doivent réaliser des insufflations lors de la RCP, à un ratio compression-ventilation de 30/2. Le développement des programmes de défibrillation automatique externe est encouragé. Un déploiement plus important des défibrillateurs automatiques externes (DAE) est nécessaire dans les lieux publics et les zones résidentielles. L’utilisation de l’acide acétylsalicylique par les témoins, en cas d’arrêt cardiaque, est autorisée avec ou sans l’assistance du médecin régulateur de l’aide médicale d’urgence. L’administration de médicaments par le tube endotrachéal n’est plus recommandée. Si l’accès intraveineux ne peut pas être utilisé, c’est la voie intra-osseuse qui est privilégiée. En cas d’arrêt cardiaque chez l’enfant, Les sauveteurs non professionnels doivent utiliser un ratio de 30 compressions pour deux ventilations, s’ils sont seuls et 15/2 s’ils sont en équipe. Tous les citoyens, et a fortiori tout professionnels de santé, devraient être formés à la RCP et afin de conserver leurs compétences devraient suivre tous les trois à six mois des formations de mise à niveau (recyclage).

Réanimation cardiopulmonaire : nouvelles recommandations

A procedure for telephone CPR must be started since the call centres do the diagnosis of cardiac arrest. All the rescuers, trained or not, have to realize quality chest compressions (depths 5 in 6cm, rhythm from 100 to 120 per minute) to the victims of cardiac arrest. Chest compressions must be interrupted only briefly in case of indispensable specific interventions. The trained rescuers have to realize insufflations during the CPR, with a ratio compression-ventilation of 30/2. The development of AE programs is encouraged. A more important deployment of AED is necessary in public places and residential areas. The use of the acetylsalicylic acid by witnesses, in case of cardiac arrest, is authorized with or without the assistance of the medical dispatcher of the EMS. The administration of medicines by endotracheal tube is not any more recommended. If the intravenous access cannot be used, it is the intra-osseous, which would be privileged. In case of children cardiac arrest, the non-professional rescuer have to use a ratio of 30 compressions for two ventilations if he is alone and 15/2 if they are working in team. All the citizens, and all the healthcare providers, should be trained in CPR and to keep their skills should follow all three to six months refresher courses to upgrade their knowledge.

Bystander CPR in out-of-hospital cardiac arrest: The role of limited English proficiency

Background The proportion of non-native English speakers is increasing in the United States. We sought to determine if limited English proficiency in callers to 9-1-1 for out-of-hospital cardiac arrest is associated with provision of bystander cardiopulmonary resuscitation (CPR) and delays in telephone-assisted CPR. Materials and methods We completed a secondary analysis of cohort data collected as part of a randomized trial of emergency dispatcher bystander CPR instructions. Included patients suffered confirmed cardiac arrest treated by emergency medical services. Callers were identified as limited English proficient through review of the dispatcher report. Results Of 971 eligible cardiac arrest cases, 5.9% ( n = 57) of 9-1-1 callers were limited English proficient. Comparing arrest events of limited English proficient 9-1-1 callers with English-fluent callers, a lower proportion of limited English proficient arrest cases received bystander CPR (64.3% [36/56] vs. 77.5% [702/906]; p = 0.02) or survived to hospital discharge (8.8% [5/57] vs. 16.5% [151/914]; p = 0.12). Dispatchers took longer to recognize cardiac arrest with limited English proficient callers compared with English-fluent callers (median 84 vs. 50 s; p < 0.001). Among callers attempting bystander CPR, the interval from call receipt to initiation of CPR was longer for limited English proficient compared with English-fluent callers (median 237 vs. 163 s; p < 0.001). Conclusion In this observational study of dispatcher-identified cardiac arrest, limited English proficiency in 9-1-1 callers was associated with less frequent provision of bystander CPR and delays in arrest recognition and implementation of telephone CPR, underscoring the health challenges and potential disparities of pre-hospital care related to limited English proficiency.

Belgian dispatchers' telephone cardiopulmonary resuscitation protocol training: an evaluation study

Early bystander cardiopulmonary resuscitation (CPR) is one of the most effective interventions in improving outcome from sudden out-of-hospital cardiac arrest. However, despite large-scale community training programs, citizen-CPR rates have been persistently low. Therefore, a recent report of the 2010 European Resuscitation Council guidelines has re-emphasized the need for dispatchers to be specifically trained in starting telephone CPR protocol for suspected cardiac arrest. In accordance, 112 Belgian dispatchers have been trained for resuscitation assistance by telephone, using a specific protocol named ALERT (Algorithme Liegeois d'Encadrement a la Reanimation Telephonique). The present work evaluates the educational aspects of this recent implementation.

Dispatcher-assisted telephone cardiopulmonary resuscitation using a French-language compression-only protocol in volunteers with or without prior life support training: A randomized trial

ObjectivesDue to the recent interest in hands-only protocols for dispatcher-assisted cardiopulmonary resuscitation (CPR) and the lack of any validated algorithms in French, our primary objective was to evaluate a new French-language protocol in terms of its efficacy to help previously untrained volunteers in performing basic life support efforts of appropriate quality, and secondarily to investigate its potential utility in subjects with previous training. MethodsUntrained volunteers were recruited among adults in a public movie centre and previously trained volunteers among undergraduate nursing students. Participants were randomly assigned to ‘phone CPR’ versus ‘no phone CPR’ by drawing sets of envelopes. Primary outcome measures were the results of the Cardiff evaluation test; the secondary measures were global scoring of a complete 5min period of CPR, in a manikin model of cardiac arrest. ResultsOut of 146 volunteers assessed for eligibility, 36 previously untrained candidates declined participation. 110 participants, distributed into four groups, completed the study: the previously untrained non-guided group (group A, n=30), the previously untrained guided group (group B, n=30), the previously trained non-guided group (group C, n=25) and the previously trained guided group (group D, n=25).Results of the Cardiff test and global evaluation of CPR performance revealed a significant improvement in group B as compared with group A, approaching the level of the group C. Previously trained guided bystanders had the best CPR scores, notably because of an improvement in the quality of airway management. ConclusionWhen used by dispatchers, this new French-language algorithm offers the opportunity to help previously untrained bystanders initiate CPR. The same protocol may serve to guide volunteers with prior basic life support training to reach their best CPR performance.

Why Bystanders Decline Telephone Cardiac Resuscitation Advice

The aim of this study was to evaluate the rate and reason for refusal of telephone-based cardiopulmonary resuscitation (CPR) instruction by bystanders after the implementation of the dispatch center's systematic telephone CPR protocol. Over a 15-month period the authors prospectively collected all case records from the emergency medical services (EMS) dispatch center when CPR had been proposed to the bystander calling in and recorded the reason for declining or not performing that the bystander spontaneously mentioned. All pediatric and adult traumatic and nontraumatic cases were included. Situations when resuscitation had been spontaneously initiated by bystanders were excluded. During the study period, dispatchers proposed CPR on 264 occasions: 232 adult nontraumatic cases, 17 adult traumatic cases, and 15 pediatric (traumatic and nontraumatic) cases. The proposal was accepted in 163 cases (61.7%, 95% confidence interval [CI] = 54.6% to 66.5%), and CPR was eventually performed in 134 cases (51%, 95% CI = 43.2% to 55.3%). In 35 of the cases where resuscitation was not carried out, the condition of the patient or conditions at the scene made this decision medically appropriate. Of the remaining 95 cases, 55 were due to physical limitations of the caller, and 33 were due to emotional distress. The telephone CPR acceptance rate of 62% in this study is comparable to those of other similar studies. Because bystanders' physical condition is one of the keys to success, the rate may not improve as the population ages.

Introducing systematic dispatcher-assisted cardiopulmonary resuscitation (telephone-CPR) in a non-Advanced Medical Priority Dispatch System (AMPDS): Implementation process and costs

Objective In order to improve the quality of our Emergency Medical Services (EMS), to raise bystander cardiopulmonary resuscitation rates and thereby meet what is becoming a universal standard in terms of quality of emergency services, we decided to implement systematic dispatcher-assisted or telephone-CPR (T-CPR) in our medical dispatch center, a non-Advanced Medical Priority Dispatch System. The aim of this article is to describe the implementation process, costs and results following the introduction of this new “quality” procedure. Methods This was a prospective study. Over an 8-week period, our EMS dispatchers were given new procedures to provide T-CPR. We then collected data on all non-traumatic cardiac arrests within our state (Vaud, Switzerland) for the following 12 months. For each event, the dispatchers had to record in writing the reason they either ruled out cardiac arrest (CA) or did not propose T-CPR in the event they did suspect CA. All emergency call recordings were reviewed by the medical director of the EMS. The analysis of the recordings and the dispatchers’ written explanations were then compared. Results During the 12-month study period, a total of 497 patients (both adults and children) were identified as having a non-traumatic cardiac arrest. Out of this total, 203 cases were excluded and 294 cases were eligible for T-CPR. Out of these eligible cases, dispatchers proposed T-CPR on 202 occasions (or 69% of eligible cases). They also erroneously proposed T-CPR on 17 occasions when a CA was wrongly identified (false positive). This represents 7.8% of all T-CPR. No costs were incurred to implement our study protocol and procedures. Conclusions This study demonstrates it is possible, using a brief campaign of sensitization but without any specific training, to implement systematic dispatcher-assisted cardiopulmonary resuscitation in a non-Advanced Medical Priority Dispatch System such as our EMS that had no prior experience with systematic T-CPR. The results in terms of T-CPR delivery rate and false positive are similar to those found in previous studies. We found our results satisfying the given short time frame of this study. Our results demonstrate that it is possible to improve the quality of emergency services at moderate or even no additional costs and this should be of interest to all EMS that do not presently benefit from using T-CPR procedures. EMS that currently do not offer T-CPR should consider implementing this technique as soon as possible, and we expect our experience may provide answers to those planning to incorporate T-CPR in their daily practice.

Evaluation of telephone-cardiopulmonary resuscitation advice for paediatric cardiac arrest

Introduction Telephone-cardiopulmonary resuscitation (CPR) advice aims to increase the quality and quantity of bystander CPR, one of the few interventions shown to improve outcome in cardiac arrest. We evaluated a current paediatric telephone protocol (AMPDS v11.1) to assess the effectiveness of verbal CPR instructions in paediatric cardiac arrest. Methods Consecutive emergency calls classified by the AMPDS as cardiac arrests in children <8 years old, over an 11 month period, were compared with their corresponding patient report forms (PRFs) to confirm the diagnosis. Audio recordings and PRFs were then evaluated to assess whether bystander CPR was given, and when it was, the time taken to perform CPR interventions, before paramedic arrival. Results Of the 42 calls reviewed, 19 (45.2%) were confirmed as cardiac arrest. CPR was already underway in two cases (10.5%). Of the remaining callers, 11 (64.7%) agreed to attempt T-CPR, resulting in an overall bystander-CPR rate of 68.4%. The median time to open the airway was 126 s (62–236 s, n = 11), deliver the first ventilation was 180 s (135–360 s, n = 11), and perform the first chest compression was 280 s (164–420 s, n = 9). Conclusion Although current telephone-CPR instructions improve the numbers of children in whom bystander CPR is attempted, effectiveness is likely to be limited by the significant delays in actually delivering basic life support.

Cell Phone Cardiopulmonary Resuscitation: Audio Instructions When Needed by Lay Rescuers: A Randomized, Controlled Trial

Given the ubiquitous presence of cellular telephones, we seek to evaluate the extent to which prerecorded audio cardiopulmonary resuscitation (CPR) instructions delivered by a cell telephone will improve the quality of CPR provided by untrained and trained lay rescuers. We randomly assigned both previously CPR trained and untrained volunteers to perform CPR on a manikin for 3 minutes with or without audio assistance from a cell telephone programmed to provide CPR instructions. We measured CPR quality metrics-pauses (ie, no flow time), compression rate (minute), depth (millimeters), and hand placement (percentage correct)-across the 4 groups defined by being either CPR trained or untrained and receiving or not receiving cell telephone CPR instructions. There was no difference in CPR measures for participants who had or had not received previous CPR training. Participants using the cell telephone aid performed better compression rate (100/minute [95% confidence interval (CI) 97 to 103/minute] versus 44/minute [95% CI 38 to 50/minute]), compression depth (41 mm [95% CI 38 to 44 mm] versus 31 mm [95% CI 28 to 34 mm]), hand placement (97% [95% CI 94% to 100%] versus 75% [95% CI 68% to 83%] correct), and fewer pauses (74 seconds [95% CI 72 to 76 seconds] versus 89 seconds [95% CI 80 to 98 seconds]) compared with participants without the cell telephone aid. A simple audio program that can be made available for cell telephones increases the quality of bystander CPR in a manikin simulation.

Effect of telephone CPR on the rate of bystander CPR for out-of-hospital cardiac arrest in a typical urban city in Japan

Today, the emergency medical service (EMS) system has been developing in each country. However, it is not known whether people are willing to perform CPR and whether they are prepared to perform CPR under telephone CPR advice. In this study, we examined how Japanese citizens are interested in the importance of immediate CPR and defibrillation, and how they understand this importance.

Dispatcher-assisted telephone cardiopulmonary resuscitation using a French compression-only protocol: performance of volunteers with or without prior life support training

Although early bystander-initiated cardiopulmonary resuscitation (CPR) is a key factor in survival improvement from out-of-hospital cardiac arrest, only one-third of victims actually receive CPR before arrival of emergency medical services. Dispatcher-assisted telephone CPR might improve the frequency and performance of bystanders' resuscitation efforts. Due to the recent interest in hands-only CPR protocol [1] and the lack of any French validated algorithm, we designed the present study in order to validate a new French protocol called ALERT (Algorithme Liegeois d'Encadrement a la Reanimation par Telephone).

A survey of factors associated with the successful recognition of agonal breathing and cardiac arrest by 9-1-1 call takers: design and methodology

BackgroundCardiac arrest victims most often collapse at home, where only a modest proportion receives life-saving bystander cardiopulmonary resuscitation. As many as 40% of all sudden cardiac arrest victims have agonal or abnormal breathing in the first minutes following cardiac arrest. 9-1-1 call takers may wrongly interpret agonal breathing as a sign of life, and not initiate telephone cardiopulmonary resuscitation instructions. Improving 9-1-1 call takers' ability to recognize agonal breathing as a sign of cardiac arrest could result in improved bystander cardiopulmonary resuscitation and survival rates for out-of-hospital cardiac arrest victims.Methods/DesignThe overall goal of this study is to design and conduct a survey of 9-1-1 call takers in the province of Ontario to better understand the factors associated with the successful identification of cardiac arrest (including patients with agonal breathing) over the phone, and subsequent administration of cardiopulmonary resuscitation instructions to callers. This study will be conducted in three phases using the Theory of Planned Behaviour. In Phase One, we will conduct semi-structured qualitative interviews with a purposeful selection of 9-1-1 call takers from Ontario, and identify common themes and belief categories. In Phase Two, we will use the qualitative interview results to design and pilot a quantitative survey. In Phase Three, a final version of the quantitative survey will be administered via an electronic medium to all registered call takers in the province of Ontario. We will perform qualitative thematic analysis (Phase One) and regression modelling (Phases Two and Three), to determine direct and indirect relationship of behavioural constructs with intentions to provide cardiopulmonary resuscitation instructions.DiscussionThe results of this study will provide valuable insight into the factors associated with the successful recognition of agonal breathing and cardiac arrest by 9-1-1 call takers. This will guide future interventional studies, which may include continuing education and protocol changes, in order to help increase the number of callers appropriately receiving cardiopulmonary resuscitation instructions, and save the lives of more cardiac arrest victims.Trial registrationClinicaltrials.gov NCT00848588

Can video mobile phones improve CPR quality when used for dispatcher assistance during simulated cardiac arrest?

BackgroundBecause mobile telephones may support video calls, emergency medical dispatchers may now connect visually with bystanders during pre-hospital cardio-pulmonary resuscitation (CPR). We studied the quality of simulated dispatcher-assisted CPR when guidance was delivered to rescuers by video calls or audio calls from mobile phones.MethodsOne hundred and eighty high school students were randomly assigned in groups of three to communicate via video calls or audio calls with experienced nurse dispatchers at a Hospital Emergency Medical Dispatch Center. CPR was performed on a recording resuscitation manikin during simulated cardiac arrest. Quality of CPR and time factors were compared depending on the type of communication used.ResultsThe median CPR time without chest compression (‘hands-off time’) was shorter in the video-call group vs. the audio-call group (303 vs. 331 s; P=0.048), but the median time to first compression was not shorter (104 vs. 102 s; P=0.29). The median time to first ventilation was insignificantly shorter in the video-call group (176 vs. 205 s; P=0.16). This group also had a slightly higher proportion of ventiliations without error (0.11 vs. 0.06; P=0.30).ConclusionVideo communication is unlikely to improve telephone CPR (t-CPR) significantly without proper training of dispatchers and when using dispatch protocols written for audio-only calls. Improved dispatch procedures and training for handling video calls require further investigation.

An evaluation of 9-1-1 calls to assess the effectiveness of dispatch-assisted cardiopulmonary resuscitation (CPR) instructions: design and methodology

BackgroundCardiac arrest is the leading cause of mortality in Canada, and the overall survival rate for out-of-hospital cardiac arrest rarely exceeds 5%. Bystander cardiopulmonary resuscitation (CPR) has been shown to increase survival for cardiac arrest victims. However, bystander CPR rates remain low in Canada, rarely exceeding 15%, despite various attempts to improve them. Dispatch-assisted CPR instructions have the potential to improve rates of bystander CPR and many Canadian urban communities now offer instructions to callers reporting a victim in cardiac arrest. Dispatch-assisted CPR instructions are recommended by the International Guidelines on Emergency Cardiovascular Care, but their ability to improve cardiac arrest survival remains unclear.Methods/DesignThe overall goal of this study is to better understand the factors leading to successful dispatch-assisted CPR instructions and to ultimately save the lives of more cardiac arrest patients. The study will utilize a before-after, prospective cohort design to specifically: 1) Determine the ability of 9-1-1 dispatchers to correctly diagnose cardiac arrest; 2) Quantify the frequency and impact of perceived agonal breathing on cardiac arrest diagnosis; 3) Measure the frequency with which dispatch-assisted CPR instructions can be successfully completed; and 4) Measure the impact of dispatch-assisted CPR instructions on bystander CPR and survival rates.The study will be conducted in 19 urban communities in Ontario, Canada. All 9-1-1 calls occurring in the study communities reporting out-of-hospital cardiac arrest in victims 16 years of age or older for which resuscitation was attempted will be eligible. Information will be obtained from 9-1-1 call recordings, paramedic patient care reports, base hospital records, fire medical records and hospital medical records. Victim, caller and system characteristics will be measured in the study communities before the introduction of dispatch-assisted CPR instructions (before group), during the introduction (run-in phase), and following the introduction (after group).DiscussionThe study will obtain information essential to the development of clinical trials that will test a variety of educational approaches and delivery methods for telephone cardiopulmonary resuscitation instructions. This will be the first study in the world to clearly quantify the impact of dispatch-assisted CPR instructions on survival to hospital discharge for out-of-hospital cardiac arrest victims.Trial RegistrationClinicalTrials.gov NCT00664443

Video quality of 3G videophones for telephone cardiopulmonary resuscitation

We simulated a cardiopulmonary resuscitation (CPR) scene with a manikin and used two 3G videophones on the caller's side to transmit video to a laptop PC. Five observers (two doctors with experience in emergency medicine and three paramedics) evaluated the video. They judged whether the manikin was breathing and whether they would give advice for CPR; they also graded the confidence of their decision-making. Breathing was only visible from certain orientations of the videophones, at distances below 150 cm with good illumination and a still background. Since the phones produced a degradation in colours and shadows, detection of breathing mainly depended on moving contours. Low camera positioning produced better results than having the camera high up. Darkness, shaking of the camera and a moving background made detection of breathing almost impossible. The video from the two 3G videophones that were tested was of sufficient quality for telephone CPR provided that camera orientation, distance, illumination and background were carefully chosen. Thus it seems possible to use 3G videophones for emergency calls involving CPR. However, further studies on the required video quality in different scenarios are necessary.