Barriers to the Initiation of Telecommunicator-CPR during 9-1-1 Out-of-Hospital Cardiac Arrest Calls: A Qualitative Study.

Autor:	Missel AL; Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan., Dowker SR; Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan.; Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, Michigan.; Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan., Chiola M; University of Michigan, Ann Arbor, Michigan., Platt J; Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan., Tsutsui J; University of Michigan, Ann Arbor, Michigan., Kasten K; Emergent Health Partners, Ann Arbor, Michigan., Swor R; Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan., Neumar RW; Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan.; Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, Michigan., Hunt N; Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan.; Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, Michigan., Herbert L; Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan., Sams W; Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan., Nallamothu BK; Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, Michigan.; Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, Michigan.; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan., Shields T; Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan., Coulter-Thompson EI; Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan.; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan., Friedman CP; Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan.
Jazyk:	angličtina
Zdroj:	Prehospital emergency care [Prehosp Emerg Care] 2024; Vol. 28 (1), pp. 118-125. Date of Electronic Publication: 2023 Mar 13.
DOI:	10.1080/10903127.2023.2183533
Abstrakt:	Introduction: Fewer than 10% of individuals who suffer out-of-hospital cardiac arrest (OHCA) survive with good neurologic function. Bystander CPR more than doubles the chance of survival, and telecommunicator-CPR (T-CPR) during a 9-1-1 call substantially improves the frequency of bystander CPR. Objective: We examined the barriers to initiation of T-CPR. Methods: We analyzed the 9-1-1 call audio from 65 EMS-treated OHCAs from a single US 9-1-1 dispatch center. We initially conducted a thematic analysis aimed at identifying barriers to the initiation of T-CPR. We then conducted a conversation analysis that examined the interactions between telecommunicators and bystanders during the recognition phase (i.e., consciousness and normal breathing). Results: We identified six process themes related to barriers, including incomplete or delayed recognition assessment, delayed repositioning, communication gaps, caller emotional distress, nonessential questions and assessments, and caller refusal, hesitation, or inability to act. We identified three suboptimal outcomes related to arrest recognition and delivery of chest compressions, which are missed OHCA identification, delayed OHCA identification and treatment, and compression instructions not provided following OHCA identification. A primary theme observed during missed OHCA calls was incomplete or delayed recognition assessment and included failure to recognize descriptors indicative of agonal breathing (e.g., "snoring", "slow") or to confirm that breathing was effective in an unconscious victim. Conclusions: We observed that modifiable barriers identified during 9-1-1 calls where OHCA was missed, or treatment was delayed, were often related to incomplete or delayed recognition assessment. Repositioning delays were a common barrier to the initiation of chest compressions.
Databáze:	MEDLINE
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