Validation of a Dispatch Protocol with Continuous Quality Control for Cardiac Arrest: A Before-and-After Study at a City Fire Department-Based Dispatch Center

Publication date: Available online 21 September 2017
Source:The Journal of Emergency Medicine
Author(s): Chien-Hsiung Huang, Hsuan-Jui Fan, Cheng-Yu Chien, Chen-June Seak, Chan-Wei Kuo, Chip-Jin Ng, Wen-Cheng Li, Yi-Ming Weng
BackgroundAn optimized protocol to help dispatchers identify potential cases of cardiac arrest and provide phone instructions for cardiopulmonary resuscitation (CPR) may increase the provision of bystander CPR, further improving the survival rate and neurological outcomes.ObjectiveWe assessed a revised dispatcher-assisted (DA)-CPR protocol with a continuous quality-improvement feature in a county fire department-based emergency medical services system.MethodsThis was a before-and-after intervention prospective study conducted in Taoyuan City, Taiwan. The participants were out-of-hospital cardiac arrest (OHCA) patients from November 2014 to February 2016. Interventional quality control started in August 2015. Approximately 10% of the telephone calls from these OHCA patients were reviewed.ResultsIn total, 66 and 64 cases were included in the before- and after-intervention groups, respectively. No significant differences were observed in sex, age, day, and time of events, or languages spoken by the callers. After the intervention, we found significant improvements in the rates at which cardiac arrests were recognized (54.5% vs. 68.8%; p = 0.007) and normal breathing was checked (51.5% vs. 76.6%, p = 0.003). Moreover, the frequency with which DA-CPR was provided by the dispatchers improved significantly (50.0% vs. 72.7%; p = 0.046). Significant improvement in patient outcomes was observed with regard to 24-h survival (7.6% vs. 20.3%, p = 0.036) but not with regard to survival to discharge (3.0% vs. 10.9%, p = 0.076).ConclusionsThe study found this DA-CPR protocol, which includes continuous quality control, is promising as it improved the successful recognition of cardiac arrests.



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