Emergency call processing and survival from out-of-hospital ventricular fibrillation☆,☆☆
Introduction
Dispatching centre performance is a link in the chain of survival from which there is least outcome data available. Randomised controlled trials are difficult to carry out in the dispatching centre environment, although possible [1]. On the other hand, retrospective studies are commonly limited by the nature of cardiac arrest registries, which tend to have emphasis on on-scene and post-resuscitation data collection. Telephone guided cardiopulmonary resuscitation (CPR) instructions are one of the only dispatching centre procedures with published outcome data. They have been shown to have a positive impact on survival from out-of-hospital cardiac arrest [2]. We could find no previous outcome data of call processing times or of cardiac arrest call numbers handled per dispatcher. The purpose of the study was to report the effect of the emergency call processing (including call processing times and numbers, cardiac arrest recognition and telephone guided CPR) in the dispatching centre on survival from out-of-hospital ventricular fibrillation (VF).
Section snippets
Material and methods
The Helsinki dispatching centre serves the city of Helsinki (population 560,000) and six neighbouring cities and communities (population 467,000). In the dispatching centre emergency medical calls are prioritised into four urgency categories from A to D. Medical prioritising criteria are found in the dispatcher's guidebook. Prioritising is based on the seriousness of the patient's chief complaint (e.g. chest pain, abdominal pain, fall, haemorrhage) and on the patient's current condition (e.g.
Results
The total number of out-of-hospital cardiac arrests considered for resuscitation was 2247. Of those 374 were cases with bystander witnessed VF of cardiac origin in whom resuscitation was attempted. In one case a private ambulance company first processed the call and this case was excluded. Thus, the study population comprised 373 cases in which the call was processed from the beginning in the dispatching centre by a qualified dispatcher. Cardiac arrest was recognised in 296 cases (79.4%) by the
Principal findings
The most important findings of the study were related to cardiac arrest call numbers and to telephone guided CPR. We found an association between a low call number handled by a dispatcher and decreased survival. This study included only a subset of all cardiac arrests and only arrests within the city of Helsinki. If we extrapolate the results to all cardiac arrest calls received in the dispatching centre area the total number of cardiac arrest calls per dispatcher rises 11-fold, compared to
Conclusions
We have shown that low cardiac arrest call numbers per dispatcher is associated with a decreased probability of survival from out-of-hospital VF. Giving telephone guided CPR instructions should be promoted as they influence the outcome. Further studies are needed to determine optimal call processing times.
Conflict of interest statement
We confirm that none of the authors have any financial or personal relationships with other people or organisations that could inappropriately influence or bias this work.
Acknowledgement
We wish to thank Teuvo Määttä, M.D., for his comments in the final preparation of the manuscript.
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Preliminary results have been presented in the Resuscitation 2004 Congress, Budapest, Hungary, 9–11 September 2004.
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A Spanish translated version of the Abstract of this article appears as Appendix at 10.1016/j.resuscitation.2005.04.008.