Dispatcher Assisted CPR Linda Culley

Dispatcher Assisted CPR
Linda Culley
King County EMS
Chain of Survival
Access to 911
CPR
Defibrillation
ALS
Hospital Care
First Link
Early Access to 911
Dispatchers are the
first contact the
patient or reporting
party has
with EMS system.
Second Link
Early CPR
Dispatchers
help bystanders
perform CPR prior
to arrival of
EMS Responders
Third Link
Early Defibrillation
Dispatchers tell
bystanders that
an AED is nearby
and offer help, as
needed.
Fourth Link
Early ACLS
Dispatchers
must
quickly
triage to
determine
if ALS is
needed.
Fifth Link
Post Resuscitative Care
Can Dispatchers Help??
4 out of 5
BLS
ALS
Correct Answer?
 None of
the Above
BLS
Early CPR
Early Defib
Early ALS (maybe)
ALS
Early CPR (maybe)
Early ALS
Early Post
Resuscitative Care
Should we institute
Dispatcher Assisted CPR?
250,000
die from cardiac arrest in the US each
year, making it a leading cause of death
That’s equal to the capacity
of Safeco field times four.
Time is Critical
Survival decreases by
10% for every
survival
minute treatment is delayed
time to cpr and shock
How often is CPR performed
by bystanders?
Much less than we might imagine...
Only
25%
of the time
DISPATCH
Keys to
Success
Quick and efficient call
handling
Rapid Dispatch BLS
Immediate recognition
of cardiac arrest
Dispatch of ALS
Recognize presence of
Public Access AED
Quick and efficient
delivery of CPR
Identification of Patients
in Cardiac Arrest
Sounds easy….right??
Patient is turning blue?
Chest is not rising or falling?
No sounds of breathing?
No pulse?
Patient is turning blue?
Chest is not rising or falling?
No sounds of breathing?
No pulse?
Get location info;
All Caller
Interview
Identify patients
in cardiac arrest:
- Unconscious
- Not breathing
“normally”
Determine if
AED is at scene:
- ask caller;
or
- use Premise
Info
14 seconds:
“Is he conscious?”
All Caller
Interview
26 seconds:
Is he breathing
normally?”
Good Example
35 seconds:
Identified Cardiac
Arrest and the
need for CPR
40 seconds:
Positions the patient
54 seconds: Starting CPR
Common
Delays
Research has shown that delays are
COMMON and PREDICTABLE!
Most frequent causes of DELAY:
1) Asking
unnecessary
questions
2) Omitting the
word “normally”
3) Patient
positioning issues
Good training can help!!
Agonal Respirations
“The Spoiler”
• Agonal respirations frequently mistaken
for breathing by the caller
• Agonal respirations occur in 40% of out of
hospital cardiac arrests.
- 56% in cases in VF
- 34% in cases in non VF
• Survival is higher for patients who show
signs of agonal respirations
Clark, et.al., Annals of Emerg Med, 1992
Agonal Breathing Sounds
Agonal Respirations
RP’s often give
many clues
Call Receiver missed need for
CPR and did not explore
numerous descriptions of agonals
breathing:
- “she’s making a lot of noise”
- “she’s out of it”
- “not coherent”
- “moaning right now”
- “staring into space”
- “making all kinds of weird noises”
- “moaning and everything else”
Excellent Call Example
14 Seconds – Conscious? Barely Breathing.
24 Seconds - Snoring Sounds?
33 Seconds – We are going to start CPR…
46 Seconds – Positioning the patient
1 Minute – Chest Compression Only CPR
Brothers, Olympic Mountains - Washington
Dispatcher Assisted CPR is Safe!
Injuries are
NOT
frequent.
Encourage dispatchers to be aggressive.
Protocol
Quality
Improvement
Training
Return what you learn
In Summary
Dispatchers Must Be:
• Fast
• Aggressive
• Not Afraid
Your System Must:
• Review Everything
• Train to a high
standard
Celebrate
your
Survivors!!