Elsevier

Resuscitation

Volume 67, Issue 1, October 2005, Pages 89-93
Resuscitation

Emergency call processing and survival from out-of-hospital ventricular fibrillation,☆☆

https://doi.org/10.1016/j.resuscitation.2005.04.008Get rights and content

Abstract

Objectives:

Our aim was to report the effect of the emergency call processing in the dispatching centre on survival from out-of-hospital ventricular fibrillation (VF).

Methods:

This retrospective cohort study was conducted in Helsinki Emergency Medical Services. All consecutive cases with out-of-hospital bystander witnessed VF of cardiac origin between 1 January 1997 and 31 December 2002 were included. Data were collected prospectively. Call processing times, call numbers per dispatcher and telephone guided cardiopulmonary resuscitation (CPR) were studied. Discharge alive from hospital was used as primary end point.

Results:

The study population consisted of 373 cases. Cardiac arrest (CA) was recognised in 296 cases (79.4%) by the dispatcher. Survival to discharge was 37.2% (110/296) if CA was recognised and 28.6% (22/77) if it was not recognised (p = 0.1550). When the dispatcher handled <4 VF calls during the study period survival to discharge was 22.1% (17/77) compared to 38.2% (50/131) and 39.4% (65/165) when the call volume was 4–9 or >9 (p = 0.0227). The mean time to dispatch a first responding unit (FRU) was 77.1 ± 44.3 s. Survival to discharge was 39.4% (65/165) when the FRU dispatching time was <60 s and 32.2% (67/208) when dispatching took ≥60 s (p = 0.1496). The mean time to CA recognition was 170.2 ± 130.1 s. Spontaneous circulation was achieved more rapidly when the time was <150 s (p = 0.0426), but there was no difference in survival to discharge. Telephone guided CPR instructions were given in 123 cases (35.5%). Survival to discharge was 43.1% (53/123) when CPR instructions were given and 31.7% (72/223) when they were not given (p = 0.0453).

Conclusions:

We showed that low CA call numbers per dispatcher is associated with a decreased probability of survival. Giving telephone guided CPR instructions should be promoted as they influence the outcome. Further studies are needed to determine optimal call processing times.

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.

References (8)

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Preliminary results have been presented in the Resuscitation 2004 Congress, Budapest, Hungary, 9–11 September 2004.

☆☆

A Spanish translated version of the Abstract of this article appears as Appendix at 10.1016/j.resuscitation.2005.04.008.

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