Barriers to Optimizing Time to Recognition During 911 Out-of-Hospital Cardiac Arrest Calls

Madeline Chiola

Pronouns: she/her

Research Mentor(s): Amanda Missel
Co-Presenter:
Research Mentor School/College/Department: DLHS / Medicine
Presentation Date: April 20
Presentation Type: Poster
Session: Session 2 – 11am – 11:50am
Room: League Ballroom
Authors: Madeline Chiola, Stephen R. Dowker, Michelle Williams, Jodyn Platt, Amanda L. Missel
Presenter: 97

Abstract

Background: Over 356,000 EMS-assessed out-of-hospital cardiac arrests (OHCA) occur each year in the United States. Nationwide, the average survival rate is 9.6%, but is as high as 22% in high-performing communities. The high rate of survival in these high-performing communities suggests potential for national performance improvement. Optimizing the interactions between telecommunicators and bystanders may improve the accuracy and time to cardiac arrest identification. The aim of this research is to examine how 911 telecommunicators recognize cardiac arrest. Methods: Our sample included 65 EMS-treated 911 OHCA calls. We examined the interactions between telecommunicators and bystanders during the level of consciousness and breathing assessment. We coded the use of different questions used by telecommunicators and how this related to bystander responses during cardiac arrest identification. Preliminary Results: Telecommunicators used multiple techniques to assess level of consciousness. Confusion and uncertainty were common responses among bystanders. To assess breathing, we observed the highest number of confident reports of “not breathing” from bystanders when telecommunicators used the “look, listen, and feel” method when compared to other methods, including questions about “breathing normally”. In calls during which the “look, listen, feel” method was used to assess breathing, 100% of cardiac arrests were identified. Conclusions: Using the “look, listen, and feel” method resulted in more confident patient status reporting compared with other assessment methods. This may be due to the instructional component of this method, which coached the bystander on breathing assessment performance. To assess level of consciousness we recommend a follow-up question, such as “tap their shoulder, do they respond to you?” after the initial assessment to ensure that unconscious patients are not being missed. Future studies could test different phrases to assess level of consciousness and breathing in a simulation setting to determine which phrases are more likely to quickly and accurately recognize an OHCA.

Presentation link

Biomedical Sciences, Interdisciplinary