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
• Early CPR
• Early Defibrillation
• Timely advanced care
• Timely post-resuscitation care
9-1-1
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
D. 100
E. 500
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
D. 100
E. 500
True Arrest
No arrest
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
B. 20 seconds
C. 30 seconds
D. 60 seconds
Initial airway management
The average time required to open the
airway and provide 2 breaths for
bystanders during the first cycle is…..?
A.10 seconds
B. 20 seconds
C. 30 seconds
D. 60 seconds
Initial airway management
During subsequent cycles of CPR by the
bystander, ventilations interrupt chest
compressions …..?
A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 20 seconds
Subsequent CPR cycles
During subsequent cycles of CPR by the
bystander, ventilations interrupt chest
compressions …..?
A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 20 seconds
Subsequent CPR cycles
Eliminate ventilations
Focus on chest compressions
Mechanisms
Eliminate ventilations
Focus on chest compressions
Survival
15%
Hands Only
10%
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
30%
Bystander-initiated
(no dispatch assist)
25%
Potential to nearly double proportion who receive CPR
Conceptual Role of the Dispatcher
Passive
Transfer information
Allocate Resources
Active
Interpret information
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.