Dispatching More than an Ambulance
Dispatcher-Assisted CPR Saves Lives in an Emergency
You just finished shopping for groceries on a routine Saturday. It’s nice out, and your mind is far from your workplace stresses. Then, right in front of you, another shopper collapses as they’re packing their car. You walk over to check on her, unsure of what specifically to do. You look around, and you’re the only one in sight.
Perhaps you’ve had CPR training in the past, but you aren’t thinking clearly, jarred by the stress of the situation. Instinct kicks in, and you dial 911. What now? For each minute we stand idly by waiting for EMS to arrive, the woman on the ground loses a 10% chance of ever seeing her family again.
Out-of-hospital cardiac arrest (OHCA) occurs without warning; the first sign or symptom is collapse, and the outcome is fatal unless bystanders immediately intervene. Life can be prolonged with high-quality CPR, and 911 dispatchers play a crucial role in helping transform inactive, often “frozen,” bystanders into ad hoc emergency responders.
“In trauma, the ‘golden hour’ refers to a window of time in which a victim is thought to have the greatest chance of survival if given definitive medical care. For someone in cardiac arrest, we do not have the luxury of a golden hour. For a victim of sudden cardiac arrest (SCA), what happens in the immediate minutes following the onset of arrest will determine who may live, and who may die,” according to the Resuscitation Academy.
With OHCA patients, every second count, and victims lose a 7-10% chance of survival with every minute that passes. Proper CPR can double – or triple – the rates of survival and buy time to defibrillation – an electric “shock” with a defibrillator that can restart the victim’s heart, putting it back into a normal rhythm.
“It is the telecommunicator who has the first opportunity to identify a patient is in cardiac arrest, and it is the telecommunicator who will provide the initial level of patient care by delivering telephone CPR instructions to the caller. It is through these actions that the telecommunicator will make the difference between life and death.” – Resuscitation Academy.
After calmly instructing you to call out for additional help, the 911-operator immediately asks you some questions, per their EMD protocol, to help assess the patient: “Lay the woman on her back and give her a shake on her shoulder; is she responsive to you when you’re talking to her or touching her?”
You give it a try – nothing.
“Ok. Does she appear to be breathing normally?”
You lay your head over hers and look at her chest; there’s a grunting sound that you report to the operator. Recognizing that the woman isn’t responsive and that her breathing isn’t normal, the dispatcher replies, “Ok, now I’m going to instruct you in how to perform CPR until help arrives.”
The American Heart Association and others have recommendations for administering CPR by bystanders. Using a simple assessment, dispatchers can instruct people of all ages over the telephone how to apply chest compressions to patients in cardiac arrest. In fact, dispatchers helped 10-year-old Hayley McKinley save her unconscious mother after calling 911 and being talked through CPR and, in one of every parent’s worse nightmares, an 18-month-old baby found unconscious and floating in a family swimming pool was resuscitated with CPR while an ambulance was en route.
The dispatcher must calmly engage in Recognition, Engagement, and Instruction to help the caller to do what they can to save the person in need.
Apart from applying chest compressions, the dispatcher may ask the caller to find the nearest Automated External Defibrillator (AED) if one is available. An AED “shocks” the heart back to a properly functioning rhythm restoring blood flow to the heart and brain, increasing the victim’s chances of survival. Effective CPR and quick defibrillation with an AED at the earliest stage of cardiac arrest can save the majority of OHCA victims.
Just as one of the grocery store’s employees runs up with their AED, a police cruiser rushes into the parking lot. Perfect timing because you’re dripping with sweat after your impromptu workout and your voice is hoarse from counting your compressions out to the operator per their instructions. But sore throat and arms are well worth the effort of keeping the woman alive long enough for police to deliver defibrillation therapy. An unlikely response you wouldn’t have made without the instructions of the 911 operator on the other end of the phone.
Dispatch’s protocols are varied based on local community environments, including whether or not a given community has an active AED program. If so, dispatch may instruct callers to find the nearest AED unit while other members of the rescue team continue providing CPR. Similarly, AED availability may affect whom dispatch sends to the scene of the emergency. In many communities, police/sheriff vehicles have AEDs, and they’re increasingly being dispatched to suspected OHCA calls simultaneously with EMS.
Thousands of people are thankful to EMS dispatchers for saving their lives through CPR instruction, however, with median time between the 911 call-to-OHCA recognition of 2 minutes versus the goal of one-minute, it must be pointed out that more work can be done. Data indicate that most of the time (43%), a revised workflow could have helped dispatchers reach the one-minute target. Other delays are associated with the caller’s emotional state (30%), the caller being a 3rd party caller who is not physically with the patient (13%), or a language barrier (7%).
Marion Leary, M.S.N., M.P.H., director of innovation research at the University of Pennsylvania’s Center for Resuscitation Science, has simple advice for bystanders when people – regardless of their gender – fall unconscious:
“If you see someone collapse, call 911, begin CPR, and if there is an AED around, use it,” Leary said. “Doing something is better than doing nothing. You have the power to help save someone’s life.”
Supporters and dispatchers say dispatcher-assisted CPR bills must be passed to help dispatchers aid cardiac arrest victims until paramedics arrive. And, while many volunteers are already getting trained in CPR, dispatch plays a crucial role in helping those without training or those too emotionally charged to respond.
The Resuscitation Academy Dispatcher-Assisted CPR Toolkit is an invaluable resource for dispatch centers looking for more information on how to build, test, implement, and refine their OHCA protocols.
If you think our fictitious story sounds too fanciful, make sure to read how, on his way to work, Bill came across an unresponsive Jeff Utzinger and worked with the 911 operator to perform CPR and save Jeff’s life.