Do health care professionals report sudden cardiac arrest better than laymen?

doi:10.1016/S0300-9572(01)00422-1

Resuscitation

Volume 51, Issue 3, December 2001, Pages 265-268

https://doi.org/10.1016/S0300-9572(01)00422-1 Get rights and content

Abstract

Objective: To compare the emergency calls made by health care providers and by laymen reporting a non-traumatic cardiac arrest, and to evaluate the handling of these calls by dispatchers. Methods: The study was conducted prospectively over a 1-year period in 1996. The callers (N=328) where divided in to three groups based on profession: I, doctors and nurses (N=33); II, other health care providers (N=19); and III, laymen (N=276). Main outcome measures where the information given by the caller, use of the dispatching protocol, recognition of the cardiac arrest, and survival to hospital. Results: Doctors and nurses told the dispatcher spontaneously what had happened in 67% of the calls when total strangers to the patient told it in 72%. Group I gave no information about the vital signs in 24% of the calls, group II in 0% and group III in 6%. Of the 52 phone calls made by groups I and II, in six cases the patient was not in cardiac arrest, in four the patient had already irreversible signs of death and in four only transportation to another hospital was requested for a patient in cardiac arrest. Of the professionals calling, 49 (94%) were on duty at the time of the call. The cardiac arrest was recognized by the dispatcher in group I in 70%, in group II in 74% and in group III in 73%. There where no statistical differences between the groups. Conclusions: Our data do suggest that health care professionals, excluding those in emergency medicine, are not better than laymen in evaluating an emergency situation correctly, and when the caller is a doctor or a nurse the dispatcher seems to trust the evaluation of the situation to be correct and rarely asks any clarifying questions about vital signs of the patient.

Introduction

The Helsinki EMS (emergency medical services) system reported, in 1996, a 33% discharge rate for bystander witnessed cardiac arrests of cardiac origin with ventricular fibrillation as the initial rhythm, and a 17% discharge rate in all attempted resuscitations (Helsinki EMS cardiac arrest registry). This is comparable with reports from Seattle, King County, USA (34 and 16%, respectively) [1], one of the most sophisticated EMS systems in the world. The first link of survival, recognition of the situation and the emergency phone call is crucial for survival of the cardiac arrest victim. Most of the previous studies [2], [3], [4] have excluded the professional health care providers as callers. Calle et al. [5] included all callers in their study in Belgium, and one of the most important reasons why the mobile intensive care unit was not sent immediately was the fact that general practitioners underestimated the pre-alarm signs of a cardiac arrest. This result made us include all the phone calls made by health care professionals, police officers, etc. Listening to these specific calls showed the need to further analyze how the professionals perform as compared with laymen when making an emergency call concerning a patient in cardiac arrest. Special interest was focused on the dispatchers way of dealing with calls made by professional health care providers. The first link of the chain of survival is crucial in the prevention of death from sudden unexpected cardiac arrest, and the impression that health care professionals perform well in recognition of an emergency situation and calling for help might be invalid.

Section snippets

Methods

Helsinki is the capital of Finland with a population of 525 000 in 1996. In Helsinki 112 Dispatching Center, the dispatch is criteria based, computer aided and all calls are taped by law. The dispatchers are full-time employees and have passed a medical dispatching course. They dispatch annually 34 000 urgent medical calls. Cardiac arrest should be recognized via telephone with three simple questions presuming the caller co-operates: 1, what has happened?; 2, is the patient awake/can she be

Results

In 1996, 776 emergency calls reported a possible non-traumatic cardiac arrest. In 328 calls, the collapse was witnessed or bystander-initiated CPR was going on. Of these callers, 33 were doctors and nurses (group I), 19 other health care professionals or police (group II) and 276 laymen (group III). In group I 70% of the cardiac arrests were recognized correctly by the dispatchers, in group II 74% and in group III 73%. Survival to the hospital was 21% in group I, 32% in group II and 28% in

Discussion

In earlier studies analyzing emergency phone calls, the calls made by professionals have been excluded. There has been no explanation why, but we think that the reason has been the belief that health care providers can recognize emergencies and make better emergency phone calls than laymen. Our study showed that this is not always the case. For years, people in Helsinki have been instructed to report what has happened, to give some simple information about vital signs and to have the person

Acknowledgements

This work was supported by the Laerdal Foundation for Acute Medicine, Norway and Helsinki City, Finland.

Portuguese Abstract and Keywords

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To identify and appraise evidence relating to the features of an Emergency Medicine System call interaction that enable, or inhibit, an Emergency Medical Dispatcher’s recognition that a patient is in out-of-hospital cardiac arrest, or at imminent risk of out-of-hospital cardiac arrest.
All study designs were eligible for inclusion. Data sources included Medline, BNI, CINAHL, EMBASE, PubMed, Cochrane Database of Systematic Reviews, AMED and OpenGrey. Stakeholder resources were screened and experts in resuscitation were asked to review the studies identified. Studies were appraised using the Mixed Methods Appraisal Tool. Synthesis was completed using a segregated mixed research synthesis approach.
Thirty-two studies were included in the review. Three main themes were identified: Key features of the Emergency Medical Service call interaction; Managing the Emergency Medical Service call; Emotional distress.
A dominant finding is the difficulty in recognising abnormal/agonal breathing during the Emergency Medical Service call. The interaction between the caller and the Emergency Medical Dispatcher is critical in the recognition of patients who suffer an out-of-hospital cardiac arrest. Emergency Medical Dispatchers adapt their approach to the Emergency Medical Service call, and regular training for Emergency Medical Dispatchers is recommended to optimise out-of-hospital cardiac arrest recognition. Further research is required with a focus on the Emergency Medical Service call interaction of patients who are alive at the time of the Emergency Medical Service call and who later deteriorate into OHCA.
PROSPERO registration: CRD42019155458.
European Resuscitation Council Guidelines 2021: Systems saving lives
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Citation Excerpt :
ILCOR also recommends that dispatch centres look for ways to optimise their sensitivity to recognise cardiac arrest (minimise false negatives).11 This strong recommendation was based on very-low certainty evidence drawn from 46 observational studies which included 789,004 adult OHCAs reporting recognition of arrest varying between 46% and 98% and a specificity varying between 32% and 100%.27,28,79,131–172 The review concluded that the studies were too heterogeneous for head-to-head comparisons of different criteria, algorithms, dispatcher background or training, and the diagnostic capabilities varied greatly within all the various categories with no clear patterns emerging.
The European Resuscitation Council (ERC) has produced these Systems Saving Lives guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include chain of survival, measuring performance of resuscitation, social media and smartphones apps for engaging community, European Restart a Heart Day, World Restart a Heart, KIDS SAVE LIVES campaign, lower-resource setting, European Resuscitation Academy and Global Resuscitation Alliance, early warning scores, rapid response systems, and medical emergency team, cardiac arrest centres and role of dispatcher.
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Citation Excerpt :
This was most apparent in comparing studies that included unconscious patients to studies including all emergency calls. For the critical outcome of sensitivity of cardiac arrest diagnosis in a general population of cardiac arrest patients we identified very low certainty evidence (downgraded for serious risk of bias, inconsistency and imprecision) from 46 observational studies examining OHCA in general cardiac arrest patients (n = 84,534).3,6,10–53 The median sensitivity for recognizing OHCA was 0.79 (interquartile range (IQR) 0.69, 0.83) and ranged from a low of 0.46 (95% CI 0.45, 0.46) to a high of 0.98 (95% CI 0.96, 0.98) (Fig. 2).
Cardiac arrest is a time-sensitive condition requiring urgent intervention. Prompt and accurate recognition of cardiac arrest by emergency medical dispatchers at the time of the emergency call is a critical early step in cardiac arrest management allowing for initiation of dispatcher-assisted bystander CPR and appropriate and timely emergency response. The overall accuracy of dispatchers in recognizing cardiac arrest is not known. It is also not known if there are specific call characteristics that impact the ability to recognize cardiac arrest.
We performed a systematic review to examine dispatcher recognition of cardiac arrest as well as to identify call characteristics that may affect their ability to recognize cardiac arrest at the time of emergency call. We searched electronic databases for terms related to “emergency medical dispatcher”, “cardiac arrest”, and “diagnosis”, among others, with a focus on studies that allowed for calculating diagnostic test characteristics (e.g. sensitivity and specificity). The review was consistent with Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method for evidence evaluation.
We screened 2520 article titles, resulting in 47 studies included in this review. There was significant heterogeneity between studies with a high risk of bias in 18 of the 47 which precluded performing meta-analyses. The reported sensitivities for cardiac arrest recognition ranged from 0.46 to 0.98 whereas specificities ranged from 0.32 to 1.00. There were no obvious differences in diagnostic accuracy between different dispatching criteria/algorithms or with the level of education of dispatchers.
The sensitivity and specificity of cardiac arrest recognition at the time of emergency call varied across dispatch centres and did not appear to differ by dispatch algorithm/criteria used or education of the dispatcher, although comparisons were hampered by heterogeneity across studies. Future efforts should focus on ways to improve sensitivity of cardiac arrest recognition to optimize patient care and ensure appropriate and timely resource utilization.
Adult Basic Life Support: International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations
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This 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care Science With Treatment Recommendations on basic life support summarizes evidence evaluations performed for 20 topics that were prioritized by the Basic Life Support Task Force of the International Liaison Committee on Resuscitation. The evidence reviews include 16 systematic reviews, 3 scoping reviews, and 1 evidence update. Per agreement within the International Liaison Committee on Resuscitation, new or revised treatment recommendations were only made after a systematic review.
Systematic reviews were performed for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, sequence for starting CPR (compressions-airway-breaths versus airway-breaths-compressions), CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest.
The topics that resulted in the most extensive task force discussions included CPR during transport, CPR before calling for help, resuscitation care for suspected opioid-associated emergencies, feedback for CPR quality, and analysis of rhythm during chest compressions. After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.
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Citation Excerpt :
Among adults and children who are in cardiac arrest outside of a hospital (P), does the description of any specific symptoms to the dispatcher (I), compared with the absence of any specific description (C), change the likelihood of cardiac arrest recognition (O)? For the critical outcome of cardiac arrest recognition, we identified very-low-quality evidence (downgraded for risk of bias, indirectness, and imprecision) from 1 cluster RCT,12 as well as very-low-quality evidence from 26 non-RCTs comprising 8 before–after observational studies,13–20 9 prospective single-arm observational studies,13,21–28 8 retrospective single-arm observational studies,29–36 and 1 case–control study.11 A total of 17 420 patients were included in these 27 studies.

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Portuguese Abstract and Keywords

Objectivo: Comparar as chamadas de emergência efectuadas por profissionais de saúde relativamente aos leigos, relatando a ocorrência de paragem cardio-respiratória (PCR) de etiologia não traumática e avaliar a reacção dos operadores de telecomunicações das centrais de emergência relativamente a estas chamadas. Métodos: Estudo prospectivo que decorreu durante todo o ano de 1996. As chamadas (n=328) foram divididas em três grupos em função da profissão: I, médicos e enfermeiros (n=33); II, outros profissionais de saúde (n=19); III, leigos (n=276). A avaliação foi feita em termos da qualidade da informação telefónica fornecida; do cumprimento de protocolos pelo operador; reconhecimento de PCR e sobrevivência até ao hospital. Resultados: O grupo dos profissionais de saúde forneceu ao operador dados concretos sobre a ocorrência de forma espontânea em 67% dos casos. O leigos fizeram-no em 72% dos casos. O grupo I não forneceu dados sobre os sinais vitais em 15% dos casos; o grupo II em 5% e o III em 6%. Das 52 chamadas efectuada pelos grupos I e II, em 6 casos não se confirmou PCR. Em 4 casos a vı́tima apresentava já sinais óbvios de morte. Noutros 4 foi apenas solicitado transporte para doentes que se encontravam em PCR. Dos profissionais englobados nos grupos I e II, 49 (94%), encontrava-se em serviço no momento da chamada. O operador reconheceu PCR em 70% das chamadas correspondentes ao grupo I, por comparação com 74% no grupo II e 73% no grupo III. As diferenças entre os grupos não tiveram significado estatı́stico. Conclusões: Esta amostra revela que os profissionais de saúde, com excepção dos envolvidos na medicina de emergência, não são mais eficazes do que os leigos na avaliação correcta duma situação de emergência, e que o operador atribui um crédito acrescido quando a chamada provém dum médico ou enfermeiro, não colocando em causa a informação fornecida e não formulando questões que esclareçam o verdadeiro estado dos sinais vitais.

Palavras chave: Chamadas de emergência; Paragem cardı́aca; Ressuscitação; EMS; Operados de emergência; Leigo; Profissionais de saúde

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Do health care professionals report sudden cardiac arrest better than laymen?

Abstract

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgements

Am. J. Emerg. Med.

Ann. Emerg. Med.

Resuscitation