Telecommunicator CPR (T-CPR): Meaning, Challenges & Outcomes

For people who experience Sudden Cardiac Arrest (SCA), the first line of help is often the person who witnesses the event- it could be a bystander or stranger, but more often, it will be a person in the home who sees their loved one in trouble and calls 911. Since cardiac arrest usually occurs suddenly, often the first people to help are laypeople with no medical training. Even without medical training, anyone who can recognize the signs of cardiac arrest can help save lives. In fact, bystanders who witness and respond to a cardiac arrest emergency can make the biggest difference in whether a person survives or not.

Time is of the essence when a cardiac arrest occurs, and a person’s chances of survival decrease with every passing minute, so bystanders have only a few minutes to act and optimize that person’s chances of survival and recovery.

In many cases, when a bystander encounters a SCA emergency and calls 911, they may be afraid and not know exactly what to do. Telecommunicators are trained to ask questions to identify what is going on and where it is happening. Calling 911 is the first key step in responding to a SCA.

What is Telecommunicator CPR (T-CPR)?

Giving CPR assistance to callers over the phone has come to be known as telecommunicator cardiopulmonary resuscitation, or T-CPR for short. T-CPR is a frontline means of coaching a 911 caller to help a cardiac arrest victim. When someone calls 911, the telecommunicator will ask a series of questions to figure out what is happening and where the emergency is located. 

If a person collapses and is not breathing normally, they need immediate CPR. In recent years, the survivability of out-of-hospital cardiac arrest (OHCA) has sadly been only about 7.6%. The single most significant factor in increasing the likelihood of survival is immediate CPR and early defibrillation with use of an Automated External Defibrillator (AED).

Telecommunicator coaching, combined with willing bystanders, can double the number of people saved, which is why T-CPR is vitally important. 

What is a Telecommunicator?  

At Emergency Communications Centers (ECC’s), telecommunicators are the first line of defense, and the literal first responders during emergencies. They are a critical link in the chain of survival. 

Telecommunicators, also known as 911 Dispatchers, are the initial points of contact for a person who witnesses an emergency. They are the heroes who answer 911 calls. They obtain essential information, remain calm, and coach people in crisis. Telecommunicators use the information provided by callers to initiate the appropriate response from the police, firefighters, and EMS personnel, depending upon the nature of the emergency. They send the right type of help to where it is needed. They often ask callers to stay on the line with them until field personnel arrive. If the emergency is determined to be a SCA, they can guide the caller in providing CPR, ask if there is an AED present, and help them to remain calm.

What Does T-CPR Training Include?

T-CPR programs often follow the American Heart Association’s (AHA) telephone CPR guidelines. These guidelines were designed to provide 911 callers who witness a SCA with coaching through a trained telecommunicator, enabling them to perform CPR on a victim of cardiac arrest.

T-CPR starts with recognizing the signs and symptoms of SCA, and empowers untrained bystanders with the ability to act.  Every year, hundreds of thousands of unexpecting Americans experience OHCA, and without intervention, they are likely to die.

The appropriate workflow related to T-CPR and cardiac arrest for telecommunicators, according to the American Heart Association is as follows:

1. Verify the address
2. Dispatch EMS response as soon as it’s determined that the call is for a medical emergency
3. Begin cardiac arrest assessment

The cardiac arrest assessment is designed to be simple and and quick since time is of the essence. If the caller answers “No” to the Telecommunicator asking these two questions, “Is the patient conscious?” and “Are they breathing normally?” the Telecommunicator is advised to move forward with CPR instructions without delay.

Challenges with Implementing T-CPR

As you might imagine, 911 calls are often frantic. Sometimes, things are made more complicated by poor phone connections, a lack of information, and unclear situations.  Language barriers can also pose an issue. If a telecommunicator can’t obtain enough reliable information from the 911 caller, they may not be able to recognize SCA.

Sometimes, callers decline to follow certain instructions, or they may be too upset to follow basic commands. In those cases, the dispatcher won’t be able to provide CPR instructions–  willing bystanders are vital!

An article which appeared in The Atlantic cited other potential challenges with T-CPR, including that instructions may not always be delivered consistently, and there may not be strict quality-improvement measures in place in some locations.

Telecommunicators are first responders, and they should be empowered as such! Funding for high quality and ongoing training for telecommunicators is critical. However, when resources are constrained it can be challenging to obtain and designate funds for this purpose.

Addressing T-CPR Challenges – American Heart Association’s T-CPR Taskforce

The AHA created a taskforce of resuscitation experts to address the challenges of providing T-CPR. This task force created recommendations, resources for performing T-CPR, and tools for agencies. The goal of the taskforce is that every 911 call be answered by a telecommunicator ready to provide lifesaving T-CPR.

Bystander CPR rates are highest in communities where public safety answering points (PSAPs), or dispatch centers, provide telephone CPR (T-CPR) instructions. In these communities, as much as 50% of bystander CPR is directly attributable to those just-in-time T-CPR directions.

–Michael Christopher Kurz, MD, MS-HES, FACEP, FAHA American Heart Association Vice Chair – Emergency Cardiovascular Care Systems of Care Subcommittee, Volunteer Chair, T-CPR Taskforce

T-CPR Survival Stories & Exemplary Dispatcher Performance

In this video, Kristin Flanary describes all of the things that went through her mind as a young person unexpectedly called upon to provide 10 minutes of CPR in the middle of the night. With T-CPR coaching, Kristin ultimately saved her husband’s life. She credits her telecommunicator with recognizing SCA symptoms and instructing her on CPR.

Here are a few other recent examples of the heroism of telecommunicators who provided exemplary performance under stressful conditions, empowering untrained bystanders to save lives with T-CPR: 

• A mother in North Texas administered CPR to her baby with the help of a MedStar 911 dispatcher. The telecommunicator coached the mother on child CPR and together they saved the child’s life.
• A St. Johns County, Florida telecommunicator, helped talk Julie Martin through CPR after her husband, Jamie, collapsed in SCA. 

“She was like an angel in my ear,” explained Julie about the dispatcher who kept her calm and told her where to place her hands, and how hard and fast to push down on her husband’s chest. “It was her voice and me knowing that she’s helping me to save him.”

• A terrified mother called 911 in Mentor, Ohio. A calm and skilled telecommunicator named Tim Johns, a father himself, coached her through CPR over the phone. The dramatic 911 call captured the rescue. 

State Laws on T-CPR Training for Dispatchers

There is currently no universal requirement across all states for telecommunicators to be trained to recognize signs of SCA, and then subsequently direct and guide callers in initiating CPR.

Some states do require telecommunicators to have training in T-CPR. Those states include:

• Louisiana
• Kentucky
• Wisconsin
• Indiana
• West Virginia
• Maryland
• Minnesota
• Rhode Island
• Tennessee
• Texas
• Virginia

This list continues to grow each year, and many states already strongly encourage T-CPR training for 911 telecommunicators but have not yet mandated it

“The new Telecommunicator CPR law for 911 operators in Rhode Island is vital in the survival of those experiencing Sudden Cardiac Arrest. The new law will allow 911 operators to provide CPR instructions to callers.  Getting bystanders to start CPR prior to the arrival of first responders will have a significant increase in the survivability of a Sudden Cardiac Arrest.  What saves lives is early CPR and readily-available AEDs.  Having this mechanism in place will save lives.”

-Chief Craig E. Stanley, South Kingstown, Rhode Island EMS

T-CPR is Vitally Important 

Instead of waiting idly for trained EMS professionals like EMTs and paramedics to arrive, the public can take a more active role in providing help to those who need it with T-CPR. Pairing T-CPR with quick thinking bystanders and readily-available AEDs will improve SCA outcomes!

The Future of Response to SCA Emergencies 

Avive has partnered with  RapidSOS to develop innovative solutions that aim to take a new approach at improving the status quo of OHCA response. Through this partnership, Emergency Communication Centers (ECCs) with access to RapidSOS will be able to dispatch Avive’s intelligent AEDs to the location of a cardiac arrest emergency. Once dispatched, Avive’s AEDs nearby the incident will audibly alert and display a map to navigate willing everyday people to the location of the person in cardiac arrest, creating the potential to greatly increase the likelihood of AEDs being used before EMS arrives on scene. 

Beyond dispatching Avive’s AEDs to cardiac arrest emergencies,  911 telecommunicators will also be able to use RapidSOS Portal during the emergency to view incident data from Avive’s AEDs. This incident data includes the location of AEDs as they are en route to the emergency, data from the AED while it’s being used – which is designed to provide 911 dispatchers with insights on if and how they can help a person use the device more quickly and effectively –  and much more.