Dispatcher-Assisted CPR: Low-Dose, High-Frequency Simulation-Based Training

Dispatcher-Assisted Cardiopulmonary Resuscitation: A Randomized Controlled Trial of Low-Dose, High-Frequency Simulation-Based Training and the Impact on Real Out-of-Hospital Cardiac Arrest Calls

Clear, concise, yes, and no answers can be challenging to achieve in the assessment of consciousness and breathing in out-of-hospital cardiac arrest (OHCA) calls. Often callers will provide an unclear response, and this can lead to hesitation on the part of the Emergency Medical Dispatcher (EMD). Further, the relatively small proportion OHCA calls represent might demand the need for simulation training in the dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) guiding itself. Therefore, the investigators investigate whether low-dose, high-frequency (LDHF) simulation-based training of EMDs can increase the quality of DA-CPR in a simulation setting. Additionally, the investigators measure whether the effect of the training will be transferred to real OHCA calls.

The study is a randomised controlled trial comparing LDHF simulation-based training to standard quality improvement of the EMD in a single centre. The study protocol is structured according to the SPIRIT 2013 statement, and the study will be reported in compliance with the CONSORT 2010 Statement. The investigators chose EMDs receiving standard quality improvement as the comparator group, to reflect a representative cohort of the EMDs not exposed to the LDHF simulation-based training program.

The aims of this study are:

1. To measure the effect of LDHF simulation-based training on the quality of DA-CPR in a simulation setting.
2. To measure the effect of LDHF simulation-based training on the quality of DA-CPR in real OHCA calls.

The investigators hypothesise that LDHF simulation-based training will increase the quality of DA-CPR in the intervention group in a simulation setting and that this improvement is transferred to real OHCA calls - although the effect in real OHCA calls might be smaller due to the complexity of some calls. The investigators hypothesise that this improvement can be detected as a decrease in time to first bystander compression (TTFC), an increase in clarification of consciousness and breathing without asking additional questions, a decrease in time to recognition of cardiac arrest, and an increase in calls where the EMD provide DA-CPR instructions on patients in cardiac arrest.

Study Overview

• Status: Completed
• Conditions: Out-Of-Hospital Cardiac Arrest
• Intervention / Treatment: Behavioral: Low-Dose, High-Frequency Simulation-Based Training

• Study Type: Interventional
• Enrollment (Actual): 52
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Denmark
  • Copenhagen, Denmark
    • Copenhagen Emergency Medical Services

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion criteria:

- EMD employed at the Copenhagen EMS at the time of enrolment.

Exclusion criteria:

• Mean working time as call taker at Copenhagen EMS < 8 hours/week.
• Planned employment cessation at the Copenhagen EMS during the data collection period.
• Planned leave from work longer than four weeks during the data collection period.
• Starting employment at the Copenhagen EMS during the study period.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention; The intervention group begins LDHF dispatcher training with one introduction week followed by twelve weeks of LDHF training. During the study period, all regular quality improvement (QI) activities, such as self-audits, case reviews, mentor groups, and status meetings will continue for all EMDs.	Behavioral: Low-Dose, High-Frequency Simulation-Based Training; Twelve weeks of LDHF training The simulation-based training sessions take place at the EMDC, at extra workstations set-up as ordinary EMD workstations in an out-of-the-way area. Before each session, the EMD is informed about the simulation call and receives instructions concerning technical differences from a regular call. The instructor acts as a "standardised caller", guided by a computer program. This program, the Danish version of Resuscitation Quality Improvement for Telecommunicators (Laerdal Medical AS, Stavanger, Norway), is a training program for DA-CPR based on the simulation platform Laerdal Learning Application. This modified version of the RQI-T program has, one test scenario, one data collection scenario and six different cardiac arrests scenarios as well as a feedback checklist based on the Danish dispatcher protocol Danish Index for Emergency Care. Each simulation session takes approximately 20 minutes, including introduction and feedback
No Intervention: Comparison; During the study period, all regular quality improvement (QI) activities, such as self-audits, case reviews, mentor groups, and status meetings will continue for all EMDs.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time from a call is taken by EMD to first bystander compression	(seconds)	During cardiac arrest calls, up to 1 hour

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
EMD clarifies status of consciousness and breathing before asking any additional questions	(yes/no)	During cardiac arrest calls, up to 1 hour
Time from a call is taken by EMD to the recognition of cardiac arrest	(seconds)	During cardiac arrest calls, up to 1 hour
EMD starts DA-CPR instructions	(yes/no)	During cardiac arrest calls, up to 1 hour
Time from a call is taken by EMD to EMD starts DA-CPR instructions	(seconds)	During cardiac arrest calls, up to 1 hour
EMD is assertive when starting CPR instructions	(yes/no)	During cardiac arrest calls, up to 1 hour
EMD starts DA-CPR instructions on patient without cardiac arrest	(yes/no)	During cardiac arrest calls, up to 1 hour

Collaborators and Investigators

• Sponsor: Emergency Medical Services, Capital Region, Denmark
• Collaborators: TrygFonden, Denmark
• Investigators: Principal Investigator: Freddy Lippert, MD, Emergency Medical Services, Capital Region, Denmark; Study Director: Oscar Rosenkrantz, Emergency Medical Services, Capital Region, Denmark

Study record dates

Study Major Dates

• Study Start (Actual): September 12, 2019
• Primary Completion (Actual): December 25, 2019
• Study Completion (Actual): December 25, 2019

Study Registration Dates

• First Submitted: September 2, 2019
• First Submitted That Met QC Criteria: September 6, 2019
• First Posted (Actual): September 11, 2019

Study Record Updates

• Last Update Posted (Actual): January 23, 2020
• Last Update Submitted That Met QC Criteria: January 17, 2020
• Last Verified: January 1, 2020

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Heart Diseases; Cardiovascular Diseases; Heart Arrest; Out-of-Hospital Cardiac Arrest
• Other Study ID Numbers: DTP

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Individual participant data that underlie the results reported in the article, after deidentification (text, tables, figures, and appendices).
• IPD Sharing Time Frame: Immediately following publication. Until 31st of December 2021
• IPD Sharing Access Criteria: Researchers who provide a sound proposal and gets approval from the Danish authorities.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No