Description and Recognition of an Out-of-Hospital Cardiac Arrest in an Emergency Call
The first link in the chain of survival,1 early call, includes the dispatchers’ recognition of a cardiac arrest. It takes a relatively long time for the emergency medical dispatcher to recognize a cardiac arrest. In Seattle, the average recognition time from the start of the call to the start of cardiopulmonary resuscitation (CPR) instructions is 75 seconds. Factors contributing to no or delayed recognition of cardiac arrest include vague description of breathing and agonal breathing, unnecessary questions, and little experience in call taking.2–5 As a result, dispatching may be unduly delayed, the wrong level of ambulance is sent, and no telephone CPR instructions are offered.6 Current guidelines call for CPR in unconscious patients when breathing is not normal.7 A similar rule is applied in dispatcher protocols to recognize a cardiac arrest for ambulance dispatch and telephone-instructed CPR. In 1986, Eisenberg et al8 suggested almost 100% sensitivity when those questions were asked to identify a cardiac arrest. However, this was never confirmed by other studies....