Strengthening the Chain of Survival

The Role of the Emergency Dispatcher

November, 2011
Tom Rea
Harborview Medical Center
King County EMS
 Strengthening the Chain of Survival
The Role of the Dispatcher
Overview: Emergency dispatchers can have a
meaningful impact on survival following cardiac arrest.
Objectives – Understand:
1. Public health perspective of cardiac arrest
2. Dispatcher interface with the chain of survival
3. Challenges of identification
4. Challenges of rescuer engagement
5. Details of CPR instruction
6. Summary
A Fundamental Principle

You must understand local circumstances

……….in order to achieve success.

Leonard Cobb Mickey Eisenberg Michael Copass

Is there an opportunity for your community?
The Public Health Toll
of Cardiac Arrest
The leading cause of death in the US is:
____ HIV
____ Stroke
____ Colon Cancer
____ Cardiac Arrest
____ Tuberculosis
The leading cause of death in the US is:
_1_ Cardiac Arrest
_2_ Stroke
_3_ Colon Cancer
_4_ HIV
_5_ Tuberculosis
How do we reduce death from cardiac arrest?
 Links in the Chain of Survival

• Prompt activation of emergency care 9-1-1

• Early CPR
• Early Defibrillation
• Timely advanced care
• Timely post-resuscitation care
Early (Bystander) CPR…….?
A. Improves blood flow to the brain
B. Improves blood flow to the left ventricle
C. Helps prevent deterioration of VF to asystole
D. Improves the chance of survival
Early (Bystander) CPR…….?
A. Improves blood flow to the brain
B. Improves blood flow to the left ventricle
C. Helps prevent deterioration of VF to asystole
D. Improves the chance of survival
The rate of bystander CPR in most communities is..?

A. 10%
B. 25%
C. 50%
D. 70%
The rate of bystander in most communities is ...?

A. 10%
B. 25%
C. 50%
D. 70%
The rate of bystander in most communities is ...?

A. 10%
B. 25%
C. 50%
D. 70%

An effective therapy that is only

partly implemented.
What are the roadblocks
to bystander CPR?

A. Cardiac arrest is hard to recognize.

B. Rescuers do not have confidence to act.
C. CPR is technically too difficult.
What are the roadblocks
to bystander CPR?

A. Cardiac arrest is hard to recognize

B. Rescuers do not have confidence - fearful
C. CPR is technically too difficult

………….What to do?
Option 1: CPR Training Programs
The rate of bystander in most communities is ...?

A. 10%
B. 25%
C. 50%
D. 70%
Option 2: Dispatcher-Assisted CPR
Yes……..but answer the question

Cardiac arrest is hard to recognize

Laypersons may not have confidence
CPR can be technically difficult
Cardiac Arrest Recognition
 Cardiac Arrest Recognition
A cardiac arrest patient is (True or False) :
1. Not responsive (not awake/ not conscious)
2. Not breathing
 Cardiac Arrest Recognition
True - Not responsive (not awake/not conscious)
Sometimes - Not breathing
 Cardiac Arrest Recognition
True - Not responsive (not awake/not conscious)
True - Not breathing……normally

Agonal gasps
 Cardiac Arrest Recognition

Not responsive (not awake/not conscious)

Not breathing normally
Are we casting the net too widely?

Post-ictal, Hypoglycemia, Intoxication

No………….so prove it
Let’s apply the 2 question approach:

Not responsive (not awake/not conscious)

Not breathing normally

True Arrest No arrest

For every 100 true cardiac arrests you identify
with the 2 question approach, you will also
identify ? not in arrest?
A. 5
B. 25
C. 50
True Arrest No arrest
D. 100
E. 500
For every 100 true cardiac arrests you identify
with the 2 question approach, you will also
identify ? not in arrest?
A. 5
B. 25
C. 50
True Arrest No arrest
D. 100
E. 500
Dispatcher Instructions: Who gets CPR?

Not responsive (not awake/not conscious)

Not breathing normally

True Arrest No Arrest

Dispatcher Instructions: Who gets CPR?

Not responsive (not awake/not conscious)

Not breathing normally

Minimal risk of
major injury
1 : 1000

True Arrest No Arrest

 Challenges of Early CPR

Cardiac arrest is hard to recognize

Laypersons may not have confidence
CPR can be technically difficult
Confidence predicts action
How do we gain confidence?

Education
Practice
Experience
How do we gain confidence?
Education
Practice
Experience

Encouragement
 Challenges of Early CPR

Cardiac arrest is hard to recognize

Laypersons may not have confidence
CPR can be technically difficult
The average time required to open the
airway and provide 2 breaths for
bystanders during the first cycle is…..?
A.10 seconds Initial airway management
B. 20 seconds
C. 30 seconds
D. 60 seconds
The average time required to open the
airway and provide 2 breaths for
bystanders during the first cycle is…..?
A.10 seconds Initial airway management
B. 20 seconds
C. 30 seconds
D. 60 seconds
During subsequent cycles of CPR by the
bystander, ventilations interrupt chest
compressions …..?
A. 5 seconds Subsequent CPR cycles
B. 10 seconds
C. 15 seconds
D. 20 seconds
During subsequent cycles of CPR by the
bystander, ventilations interrupt chest
compressions …..?
A. 5 seconds Subsequent CPR cycles
B. 10 seconds
C. 15 seconds
D. 20 seconds
 Eliminate ventilations
Focus on chest compressions

Mechanisms
 Eliminate ventilations
Focus on chest compressions
Survival
15% 10%
Hands Only Rescue Breathing
+ Chest Compressions
The Story of Dispatcher Assisted CPR

Seattle - King County experience (1978 - 1984)

50%

25%
Bystander-initiated
(no dispatch assist)
The Story of Dispatcher Assisted CPR
Dispatcher program increased the rates
of bystander CPR by……?
A. 5%
B. 10%
C. 15%
D. 20%
25%
Bystander-initiated
(no dispatch assist)
The Story of Dispatcher Assisted CPR
Bystander CPR since initiation of dispatcher
assistance (1985 - 2007)

50%
20% Dispatcher-assisted

25%
30% Bystander-initiated
(no dispatch assist)

Potential to nearly double proportion who receive CPR

 Conceptual Role of the Dispatcher
Passive Active
Transfer information Interpret information
Allocate Resources Engage Resources
Deliver Training
 Summary

Dispatchers have a critical role

in early activation and early CPR.
Dispatchers must:
- interpret information (recognize the arrest)
- engage the callers (instill confidence)
- provide training (deliver CPR instructions)

Dispatchers can save lives.