Improving Cardiac Arrest Diagnostic Accuracy of Emergency Medical Dispatchers

Improving the Cardiac Arrest Diagnostic Accuracy of 9-1-1 Emergency Medical Dispatchers

The main goal of this project is to help 9-1-1 emergency medical dispatchers save the lives of more cardiac arrest victims. The investigators will develop teaching tools to help the dispatchers recognize abnormal breathing that may indicate a victim as having a cardiac arrest. After training sessions, the investigators will see if dispatchers can get better at recognizing abnormal breathing, how often they give CPR instructions, and if use of the teaching tool will increase bystander CPR and the number of victims leaving the hospital alive.

Study Overview

• Status: Completed
• Conditions: Cardiac Arrest
• Intervention / Treatment: Behavioral: Education

Detailed Description

Cardiac arrest is a leading cause of death in Canada; it is defined as the sudden cessation of cardiac mechanical activity. It is uniformly fatal if not treated within minutes. More than 85% of out-of-hospital cardiac arrest (OOHCA) occur in residential locations so public access to automatic external defibrillators, to restart the heart, are not helpful. The overall rate of survival for OOHCA rarely exceeds 8%.

Bystander cardiopulmonary resuscitation (CPR) is chest compression and ventilations provided by someone not on the emergency response team. A victim or cardiac arrest is almost 4 times more likely to survive when receiving bystander CPR. However, despite various attempts to improve bystander rates they have remained low, not exceeding 15% in Ontario. It has been shown that since the ambulance dispatch centres in Ontario implemented dispatch-assisted CPR instructions (given to callers while emergency vehicles were on the way), there was a significant increase in use.

Emergency medical dispatchers can identify about 70% of OOHCA cases over the phone. Agonal breathing (laboured breathing preceding death) may be misinterpreted as a sign of life, and is responsible for as much as 50% of missed diagnoses. There is no specific training on the significance of this sign, and minimal information about recognizing cardiac arrest. An educational intervention designed to better understand the significance of agonal breathing and to clarify the existing CPR instruction protocol will most likely increase the frequency of CPR instructions, bystander CPR rates, and potentially survival of victims of cardiac arrest.

• Study Type: Observational
• Enrollment (Actual): 1076

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Ottawa, Ontario, Canada, K1Y 4E9
      • Ottawa Hospital Research Institute

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

All patients with out-of-hospital cardiac arrest

Description

Inclusion Criteria:

• presumed cardiac origin
• event occurs in the catchment area of Training or Control Site
• resuscitation is attempted by a bystander and/or the emergency responders

Exclusion Criteria:

• patients younger than 16 years old
• patients who are "obviously dead" as defined by the Ambulance Act of Ontario (decomposition, rigor mortis, decapitation, or other)
• trauma victims including hanging and burns
• cardiac arrest of non-cardiac origin including drug overdose, carbon monoxide poisoning, drowning, exsanguination, electrocution, asphyxia, hypoxia related to respiratory disease, cerebrovascular accident, and documented terminal illness

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Training site; All emergency medical dispatchers at a central ambulance communication centre in Ontario will participate in an educational program designed to improve cardiac arrest diagnostic accuracy.	Behavioral: Education; An education program will be developed using behaviour change techniques specifically mapped to address modifiable factors identified in a previous study. These techniques will include: information about the significance of agonal breathing, modeling/demonstration of desired behavioural skills, rehearsal of desired skills, and monitoring/reinforcement and feedback.
Control site; All emergency medical dispatchers at a central ambulance communications centre geographically remote from the Training Site and has a similar rate to the Training Site for cardiac arrests, bystander CPR rate, and survival

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants With Agonal Breathing	By reviewing recordings of all cardiac arrest calls, including missed cases retrieved from a registry, document presence or absence of agonal breathing.	At the time of the cardiac arrest event

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Cases Where Cardiac Arrest Was Recognized by the Ambulance Dispatcher	By reviewing recordings of all cardiac arrest calls, collect information on dispatcher recognition of cardiac arrest to bystander implementation of chest compressions	At the time of the cardiac arrest event

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants Who Received Bystander CPR	The first member of the emergency response team to arrive at scene will document whether or not chest compressions have been initiated by someone prior to the arrival of emergency team	At the time of the cardiac arrest event
Number of Participants Surviving to Hospital Discharge	Accessing hospital medical records or coroner's reports, assess survival of cardiac arrest victim as being discharged alive from hospital	At the time of the cardiac arrest event to discharge alive from hospital (varies, depending on length of hospital stay)

Collaborators and Investigators

• Sponsor: Ottawa Hospital Research Institute
• Investigators: Principal Investigator: Christian Vaillancourt, MD,MSc,FRCPC, The Ottawa Hospital Research Institute and University of Ottawa

Study record dates

Study Major Dates

• Study Start: June 1, 2013
• Primary Completion (Actual): September 1, 2014
• Study Completion (Actual): December 1, 2014

Study Registration Dates

• First Submitted: May 9, 2013
• First Submitted That Met QC Criteria: June 4, 2013
• First Posted (Estimate): June 7, 2013

Study Record Updates

• Last Update Posted (Actual): March 17, 2021
• Last Update Submitted That Met QC Criteria: February 23, 2021
• Last Verified: February 1, 2021

More Information

Terms related to this study

• Keywords: cardiac arrest; bystander cardiopulmonary resuscitation CPR; dispatch-assisted CPR instructions; agonal breathing
• Additional Relevant MeSH Terms: Pathologic Processes; Heart Diseases; Cardiovascular Diseases; Disease Attributes; Emergencies; Heart Arrest
• Other Study ID Numbers: 2012-0379-01H