Telecommunicator Cardiopulmonary Resuscitation: A Policy Statement From the American Heart Association.

Every year in the United States, >350 000 people have sudden cardiac arrest outside of a hospital environment. Sudden cardiac arrest is the unexpected loss of heart function, breathing, and consciousness and is commonly the result of an electric disturbance in the heart. Unfortunately, only ≈1 in 10 victims survives this dramatic event. Early access to 9-1-1 and early cardiopulmonary resuscitation (CPR) are the first 2 links in the chain of survival for out-of-hospital cardiac arrest. Although 9-1-1 is frequently accessed, in the majority of cases, individuals with out-of-hospital cardiac arrest do not receive lay rescuer CPR and wait for the arrival of professional emergency rescuers. Telecommunicators are the true first responders and a critical link in the cardiac arrest chain of survival. In partnership with the 9-1-1 caller, telecommunicators have the first opportunity to identify a patient in cardiac arrest and provide initial care by delivering CPR instructions while quickly dispatching emergency medical services. The telecommunicator and the caller form a unique team in which the expertise of the telecommunicator is provided just in time to a willing caller, transforming the caller into a lay rescuer delivering CPR. The telecommunicator CPR (T-CPR) process, also previously described as dispatch CPR, dispatch-assisted CPR, or telephone CPR, represents an important opportunity to improve survival from sudden cardiac arrest. Conversely, failure to provide T-CPR in this manner results in preventable harm. This statement describes the public health impact of out-of-hospital cardiac arrest, provides guidance and resources to construct and maintain a T-CPR program, outlines the minimal acceptable standards for timely and high-quality delivery of T-CPR instructions, and identifies strategies to overcome common implementation barriers to T-CPR.

Evaluating barriers to community CPR education.

OBJECTIVE: The primary objective of this study is to better understand the preferences of the general public regarding cardiopulmonary resuscitation (CPR) education as it relates to both format and the time and place of delivery. METHODS: Survey data were collected from a convenience sample at large public gatherings in Baltimore, Maryland, between May 23, 2015, and February 11, 2017. The survey was a 23-item single-page instrument administered at fairs and festivals. RESULTS: A total of 516 surveys were available for analysis. Twenty-four percent of the total population reported being very confident in performing CPR (scoring 8 to 10 on a Likert scale). Thirty-two percent of respondents who had previously taken a CPR class reported being very confident in performing CPR. A stepwise decline in reported confidence in performing CPR was observed as the time from last CPR class increased. Among all respondents the most favored instruction style was an instructor-led class. Least favorable was a local learning station at an event. The most favored location for instruction were libraries, while community festivals were least favored. CONCLUSION: Respondent preferences regarding the location and style of the training differed little between socioeconomic groups. Instructor-led instruction at local libraries was the most preferred option. CPR education offered at local learning stations during events and at community festivals were least favored among respondents. This study's findings can be used to more effectively structure CPR outreach and educational programs in an attempt to increase rates of bystander CPR.

Evaluating Barriers to Bystander CPR among Laypersons before and after Compression-only CPR Training.

OBJECTIVE: Bystander CPR is an essential part of out-of-hospital cardiac arrest (OHCA) survival. EMS and public safety jurisdictions have embraced initiatives to teach compression-only CPR to laypersons in order to increase rates of bystander CPR. We examined barriers to bystander CPR amongst laypersons participating in community compression-only CPR training and the ability of the training to alleviate these barriers. The barriers analyzed include fear of litigation, risk of disease transmission, fear of hurting someone as a result of doing CPR when unnecessary, and fear of hurting someone as a result of doing CPR incorrectly. METHODS: Laypersons attending community compression-only CPR training were administered surveys before and after community CPR training. Data were analyzed via standard statistical analyses. RESULTS: A total of 238 surveys were collected and analyzed between September 2015 and January 2016. The most common reported motivation for attending CPR training was "to be prepared/just in case" followed by "infant or child at home." Respondents reported that they were significantly more likely to perform CPR on a family member than a stranger in both pre-and post-training responses. Nevertheless, reported self-confidence in and likelihood of doing CPR on both family and strangers increased from pre-training to post-training. There was a statistically significant decrease in reported likelihood of all four barriers to prevent respondents from performing bystander CPR when pre-training responses were compared to post-training responses. Previous CPR training and history of having witnessed a sudden cardiac arrest (SCA) were both associated with decreased barriers to CPR, but previous training had no effect on reported likelihood of or confidence in performing CPR. CONCLUSION: The training initiative studied significantly reduced the reported likelihood of all barriers studied to prevent respondents from performing bystander CPR and also increased the reported confidence in doing CPR and likelihood of doing CPR on both strangers and family. However, it did not alleviate the pre-training discrepancy between likelihood of performing CPR on strangers versus family. Previous CPR training or certification had no impact on likelihood of or confidence in performing CPR.

The Price of a Helping Hand: Modeling the Outcomes and Costs of Bystander CPR.

OBJECTIVE: Early, high-quality, minimally interrupted bystander cardio-pulmonary resuscitation (BCPR) is essential for out-of-hospital cardiac arrest survival. However, rates of bystander intervention remain low in many geographic areas. Community CPR programs have been initiated to combat these low numbers by teaching compression-only CPR to laypersons. This study examined bystander CPR and the cost-effectiveness of a countywide CPR program to improve out-of-hospital cardiac arrest survival. METHODS: A 2-year retrospective review of emergency medical services (EMS) run reports for adult nontraumatic cardiac arrests was performed using existing prehospital EMS quality assurance data. The incidence and success of bystander CPR to produce prehospital return of spontaneous circulation and favorable neurologic outcomes at hospital discharge were analyzed. The outcomes were paired with cost data for the jurisdiction's community CPR program to develop a cost-effectiveness model. RESULTS: During the 23-month study period, a total of 371 nontraumatic adult out-of-hospital cardiac arrests occurred, with a 33.4% incidence of bystander CPR. Incremental cost-effectiveness analysis for the community CPR program demonstrated a total cost of $22,539 per quality-adjusted life-year (QALY). A significantly increased proportion of those who received BCPR also had an automated external defibrillator (AED) applied. There was no correlation between witnessed arrest and performance of BCPR. A significantly increased proportion of those who received BCPR were found to be in a shockable rhythm when the initial ECG was performed. In the home setting, the chances of receiving BCPR were significantly smaller, whereas in the public setting a nearly equal number of people received and did not receive BCPR. Witnessed arrest, AED application, public location, and shockable rhythm on initial ECG were all significantly associated with positive ROSC and neurologic outcomes. A home arrest was significantly associated with worse neurologic outcome. CONCLUSIONS: Cost-effectiveness analysis demonstrates that a community CPR outreach program is a cost-effective means for saving lives when compared to other healthcare-related interventions. Bystander CPR showed a clear trend toward improving the neurologic outcome of survivors. The findings of this study indicate a need for additional research into the economic effects of bystander CPR.

A poor association between out-of-hospital cardiac arrest location and public automated external defibrillator placement.

INTRODUCTION: Much attention has been given to the strategic placement of automated external defibrillators (AEDs). The purpose of this study was to examine the correlation of strategically placed AEDs and the actual location of cardiac arrests. METHODS: A retrospective review of data maintained by the Maryland Institute for Emergency Medical Services Systems (MIEMSS), specifically, the Maryland Cardiac Arrest Database and the Maryland AED Registry, was conducted. Location types for AEDs were compared with the locations of out-of-hospital cardiac arrests in Howard County, Maryland. The respective locations were compared using scatter diagrams and r2 statistics. RESULTS: The r2 statistics for AED location compared with witnessed cardiac arrest and total cardiac arrests were 0.054 and 0.051 respectively, indicating a weak relationship between the two variables in each case. No AEDs were registered in the three most frequently occurring locations for cardiac arrests (private homes, skilled nursing facilities, assisted living facilities) and no cardiac arrests occurred at the locations where AEDs were most commonly placed (community pools, nongovernment public buildings, schools/educational facilities). CONCLUSION: A poor association exists between the location of cardiac arrests and the location of AEDs.

A human factors analysis of an EMS crew's exposure to carbon monoxide.

The safety of personnel and resources is considered to be a cornerstone of prehospital Emergency Medical Services (EMS) operations and practice. However, barriers exist that limit the comprehensive reporting of EMS safety data. To overcome these barriers, many high risk industries utilize a technique called Human Factors Analysis (HFA) as a means of error reduction. The goal of this approach is to analyze processes for the purposes of making an environment safer for patients and providers. This report describes an application of this approach to safety incident analysis following a situation during which a paramedic ambulance crew was exposed to high levels of carbon monoxide.

Mass-Gathering Medical Care in Electronic Dance Music Festivals.

Introduction Electronic dance music (EDM) festivals represent a unique subset of mass-gathering events with limited guidance through literature or legislation to guide mass-gathering medical care at these events. Hypothesis/Problem Electronic dance music festivals pose unique challenges with increased patient encounters and heightened patient acuity under-estimated by current validated casualty predication models. METHODS: This was a retrospective review of three separate EDM festivals with analysis of patient encounters and patient transport rates. Data obtained were inserted into the predictive Arbon and Hartman models to determine estimated patient presentation rate and patient transport rates. RESULTS: The Arbon model under-predicted the number of patient encounters and the number of patient transports for all three festivals, while the Hartman model under-predicted the number of patient encounters at one festival and over-predicted the number of encounters at the other two festivals. The Hartman model over-predicted patient transport rates for two of the three festivals. CONCLUSION: Electronic dance music festivals often involve distinct challenges and current predictive models are inaccurate for planning these events. The formation of a cohesive incident action plan will assist in addressing these challenges and lead to the collection of more uniform data metrics. FitzGibbon KM , Nable JV , Ayd B , Lawner BJ , Comer AC , Lichenstein R , Levy MJ , Seaman KG , Bussey I . Mass-gathering medical care in electronic dance music festivals. Prehosp Disaster Med. 2017;32(5):563-567.