Possibilities of implementing dispatcher-assisted cardiopulmonary resuscitation in the community - An evaluation of 99 consecutive out-of-hospital cardiac arrests

Aim: By evaluating tape recordings of true cardiac arrest calls, to judge t he dispatchers ability to (a) identify cases as suspected cardiac arrest (C A), (b) give the case the right priority, (c) identify CA cases suitable fo r dispatcher-assisted, telephone-guided cardiopulmonary resuscitation (T-CP R) and (d) accomplish T-CPR. Methods: Evaluation of 99 tape recordings of c onsecutive cases that had been admitted to the two city hospitals in Gotebo rg after out-of-hospital CA. Results: In 70% of the interviews, the dispatc her demonstrated impeccable behaviour with short, distinct questions, quick ly resulting in a decision on how to handle the case. In 30%, serious criti cism could be voiced as the dispatcher displayed very stressful behaviour, or omitted to ask important questions such as whether the patient was consc ious and breathing. In 21%, the interviews indicated a clear opportunity to perform T-CPR. In another 10%, there was a possibility of performing T-CPR . Only in 8% was T-CPR actually accomplished. Conclusions: (1) In the major ity of the interviews, the quality was very high, while in one-third, serio us criticism could be voiced. (2) In our study, only one-third (95% confide nce interval, 22-41) of CA cases were suitable for T-CPR, and T-CPR was per formed in only 8% of the 99 cases. (3) To optimise the dispatcher ability t o identify suspected CA and initiate T-CPR, both medical knowledge and prac tical training are needed, preferably with protocols for pre-arrival instru ctions. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.