Stress and distress: the art and science of dispatcher’s assisted cardiopulmonary resuscitation.

2016 ◽  
Vol 2 (8) ◽  
Author(s):  
Régine Zandona ◽  
Aline Gillet ◽  
Céline Stassart ◽  
Laura Nothelier ◽  
Anne-Sophie Delfosse ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Coping Strategies ◽  
Negative Impact ◽  
Post Traumatic Stress ◽  
Psychological Burden ◽  
Key Factor ◽  
Chain Of Survival ◽  
Bystander Cpr ◽  
The Cost

<p>Chances of survival following a cardiac arrest are very low and inversely proportional to the duration of cardiovascular arrest. It is of critical importance to perform cardiopulmonary resuscitation (CPR) as soon as possible, even before the arrival of emergency medical team (EMT) on the scene. Therefore, early bystander CPR is a key factor in improving survival from out-of-hospital cardiac arrest (OOH-CA). In Belgium, the ALERT algorithm (Algorithme Liégeois d’Encadrement à la Réanimation par Téléphone<a title="" href="#_ftn1">[1]</a> offers the opportunity to help bystanders perform CPR. Dispatchers’ assisted telephone CPR has introduced a new link in the chain of survival, that contributes to a reduced OOH-CA mortality rate but at the cost of increased responsibilities and stress. ALERT also gives a new role to bystanders; they are no longer just spectators but become actors when they witness a cardiac arrest. Our team was interested in the psychological burden of ALERT. Therefore, we evaluated the effects of CPR performed by untrained persons. We studied the potential influence of different coping strategies on this impact, as well as the possible correlation with the degree of attachment to the victim and the risk of developing PTSD (Post Traumatic Stress Disorder). We noticed that some psychological negative impact on the bystanders could be recognized. We also identified beneficial and detrimental coping strategies.  In the future, we wonder if Video-CPR (V-CPR) might improve the quality of resuscitation.</p><div><br clear="all" /><hr align="left" size="1" width="33%" /><div><p><a title="" href="#_ftnref1">[1]</a> Algorithm for CPR guidance over the phone originating from Liege, Belgium</p></div></div>

scholarly journals Effectiveness of Mechanical Chest Compression Devices over Manual Cardiopulmonary Resuscitation: A Systematic Review with Meta-analysis and Trial Sequential Analysis

2021 ◽  
Vol 22 (4) ◽  
pp. 810-819
Author(s):  
Mack Sheraton ◽  
John Columbus ◽  
Salim Surani ◽  
Ravinder Chopra ◽  
Rahul Kashyap
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Relative Effectiveness ◽  
Sufficient Evidence ◽  
Mechanical Compression ◽  
Mechanical Chest Compression ◽  
Significant Difference ◽  
Bystander Cpr ◽  
Meta Regression

Introduction: Our goal was to systematically review contemporary literature comparing the relative effectiveness of two mechanical compression devices (LUCAS and AutoPulse) to manual compression for achieving return of spontaneous circulation (ROSC) in patients undergoing cardiopulmonary resuscitation (CPR) after an out-of-hospital cardiac arrest (OHCA). Methods: We searched medical databases systematically for randomized controlled trials (RCT) and observational studies published between January 1, 2000–October 1, 2020 that compared mechanical chest compression (using any device) with manual chest compression following OHCA. We only included studies in the English language that reported ROSC outcomes in adult patients in non-trauma settings to conduct random-effects metanalysis and trial sequence analysis (TSA). Multivariate meta-regression was performed using preselected covariates to account for heterogeneity. We assessed for risk of biases in randomization, allocation sequence concealment, blinding, incomplete outcome data, and selective outcome reporting. Results: A total of 15 studies (n = 18474), including six RCTs, two cluster RCTs, five retrospective case-control, and two phased prospective cohort studies, were pooled for analysis. The pooled estimates’ summary effect did not indicate a significant difference (Mantel-Haenszel odds ratio = 1.16, 95% confidence interval, 0.97 to 1.39, P = 0.11, I2 = 0.83) between mechanical and manual compressions during CPR for ROSC. The TSA showed firm evidence supporting the lack of improvement in ROSC using mechanical compression devices. The Z-curves successfully crossed the TSA futility boundary for ROSC, indicating sufficient evidence to draw firm conclusions regarding these outcomes. Multivariate meta-regression demonstrated that 100% of the between-study variation could be explained by differences in average age, the proportion of females, cardiac arrests with shockable rhythms, witnessed cardiac arrest, bystander CPR, and the average time for emergency medical services (EMS) arrival in the study samples, with the latter three attaining statistical significance. Conclusion: Mechanical compression devices for resuscitation in cardiac arrests are not associated with improved rates of ROSC. Their use may be more beneficial in non-ideal situations such as lack of bystander CPR, unwitnessed arrest, and delayed EMS response times. Studies done to date have enough power to render further studies on this comparison futile.

scholarly journals Bystander Cardiopulmonary Resuscitation Quality: Potential for Improvements in Cardiac Arrest Resuscitation

2021 ◽  
Author(s):  
Richard Chocron ◽  
Julia Jobe ◽  
Sally Guan ◽  
Madeleine Kim ◽  
Mia Shigemura ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Performance Metrics ◽  
Medical System ◽  
Emergency Medical System ◽  
Compression Rate ◽  
Emergency Medical ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Background Bystander cardiopulmonary resuscitation (CPR) is a critical intervention to improve survival following out‐of‐hospital cardiac arrest. We evaluated the quality of bystander CPR and whether performance varied according to the number of bystanders or provision of telecommunicator CPR (TCPR). Methods and Results We investigated non‐traumatic out‐of‐hospital cardiac arrest occurring in a large metropolitan emergency medical system during a 6‐month period. Information about bystander care was ascertained through review of the 9‐1‐1 recordings in addition to emergency medical system and hospital records to determine bystander CPR status (none versus TCPR versus unassisted), the number of bystanders on‐scene, and CPR performance metrics of compression fraction and compression rate. Of the 428 eligible out‐of‐hospital cardiac arrest, 76.4% received bystander CPR including 43.7% unassisted CPR and 56.3% TCPR; 35.2% had one bystander, 33.3% had 2 bystanders, and 31.5% had ≥3 bystanders. Overall compression fraction was 59% with a compression rate of 88 per minute. CPR differed according to TCPR status (fraction=52%, rate=87 per minute for TCPR versus fraction=69%, rate=102 for unassisted CPR, P <0.05 for each comparison) and the number of bystanders (fraction=55%, rate=87 per minute for 1 bystander, fraction=59%, rate=89 for 2 bystanders, fraction=65%, rate=97 for ≥3 bystanders, test for trend P <0.05 for each metric). Additional bystander actions were uncommon to include rotation of compressors (3.1%) or application of an automated external defibrillator (8.0%). Conclusions Bystander CPR quality as gauged by compression fraction and rate approached guideline goals though performance depended upon the type of CPR and number of bystanders.

scholarly journals Strengthening Links in the “Chain of Survival”: A Singapore Perspective

2002 ◽  
Vol 9 (3) ◽  
pp. 121-125 ◽  
Author(s):  
Ra Charles ◽  
F Lateef ◽  
V Anantharaman
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Life Support ◽  
Advanced Cardiac Life Support ◽  
Basic Cardiac Life Support ◽  
Chain Of Survival ◽  
Bystander Cpr ◽  
Mean Time ◽  
Hospital Cardiac Arrest ◽  
Ambulance Crew

Introduction The concept of the chain of survival is widely accepted. The four links viz. early access, early cardiopulmonary resuscitation (CPR), early defibrillation and early Advanced Cardiac Life Support (ACLS) are related to survival after pre-hospital cardiac arrest. Owing to the dismal survival-to-discharge figures locally, we conducted this study to identify any weaknesses in the chain, looking in particular at bystander CPR rates and times to Basic Cardiac Life Support (BCLS) and ACLS. Methods and materials A retrospective cohort study was conducted in the Emergency Department of an urban tertiary 1500-bed hospital. Over a 12-month period, all cases of non-trauma out-of-hospital cardiac arrest were evaluated. Results A total of 142 cases of non-trauma out-of-hospital cardiac arrest were identified; the majority being Chinese (103/142, 72.5%) and male (71.8%) with a mean age of 64.3±7.8 years (range 23–89 yrs). Most patients (111/142, 78.2%) did not receive any form of life support until arrival of the ambulance crew. Mean time from collapse to arrival of the ambulance crew and initiation of BCLS and defibrillation was 9.2±3.5 minutes. Mean time from collapse to arrival in the Emergency Department (and thus ACLS) was 16.8±7.1 minutes. Three patients (2.11%) survived to discharge. Conclusion There is a need to (i) facilitate layperson training in bystander CPR, and (ii) enhance paramedic training to include ACLS, in order to improve the current dismal survival outcomes from out-of-hospital cardiac arrest in Singapore.

scholarly journals Persepsi Perlindungan Hukum dan Aspek Etik terhadap Keinginan Perawat IGD Melakukan CPR pada Out-of-Hospital Cardiac Arrest (OHCA)

2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Wiwin Winarti ◽  
Rosiana Rosiana
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Cardiopulmonary Resuscitation ◽  
Ethical Issues ◽  
Legal Protection ◽  
The Elderly ◽  
Legal Aspects ◽  
Cross Sectional ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

ABSTRAKKejadian henti jantung dapat terjadi dimana saja baik di rumah sakit maupun di luar rumah sakit atau Out-of-Hospital Cardiac Arrest (OHCA). Usaha untuk meningkatkan survival rate kejadian henti jantung adalah pemberian Cardiopulmonary resuscitation (CPR)/ resusitasi jantung paru (RJP) yang berkualitas. Faktor yang mempengaruhi seseorang untuk mau menjadi bystander CPR bukan hanya terkait pengetahuan dan teknik melakukan CPR namun juga dipengaruhi oleh faktor sosial, kerelaan melakukan, kesiapan psikologis dan faktor lainnya seperti aspek etik dan hukum. Tujuan penelitian ini untuk mengetahui pengaruh persepsi perlindungan hukum dan aspek etik terhadap keinginan perawat dalam memberikan tindakan CPR pada kejadian Out-of-Hospital Cardiac Arrest. Penelitian menggunakan desain cross-sectional dengan metode kuisioner yang dikembangkan oleh peneliti dan menggunakan total sampling yang melibatkan seluruh perawat IGD RSUD Budhi Asih sebanyak 30 orang. Analisis menggunakan uji Fisher’s Exact dan Cochran-Mantel Haenszel. Hasil penelitian menunjukkan mayoritas responden (56,7%) memiliki persepsi yang negatif terhadap perlindungan hukum terhadap bystander CPR pada OHCA. Meskipun demikian, perawat cenderung memiliki persepsi yang positif ketika menjawab pertanyaan terkait isu etik CPR pada korban anak-anak, wanita maupun lansia. Sebanyak 43,33% (13 perawat) memiliki keinginan positif untuk melakukan CPR pada OHCA sementara 56,67% (17 perawat) lainnya memiliki keinginan negatif sebagai bystander CPR. Hasil uji Cochran-Mantel Haenszel menunjukkan persepsi terhadap perlindungan hukum mempengaruhi keinginan perawat dalam memberikan CPR pada OHCA dan akan diperbesar kemungkinan memberikan CPR apabila perawat tersebut berusia ≥ 30 tahun (p 0,014; OR 14,133; 95% CI 2,081-95,947) dan memiliki masa kerja ≥ 5 tahun (p 0,008; OR 25,667; 95% CI 2,253-292,462). Promosi mengenai aspek legal dan etik, serta landasan hukum perlindungan terhadap bystander CPR menjadi penting untuk dapat meningkatkan keinginan perawat dan jumlah bystander CPR. ABSTRACTCardiac arrest can occur anywhere in the hospital or outside the hospital, which is called Out-of-Hospital Cardiac Arrest (OHCA). An effort to increase the survival rate of cardiac arrest is the provision of quality Cardiopulmonary resuscitation (CPR). Factors that influence a person's willingness to become a bystander CPR are not only related to the knowledge and techniques of conducting CPR but are also influenced by social factors, willingness, psychological readiness, and other factors such as ethical and legal aspects. The purpose of this study is to determine the effect of perceptions of legal protection and ethical issues on the nurses' willingness to provide CPR in the OHCA incident. This study used a cross-sectional design using a questionnaire developed by researchers, conducted at Emergency Department Budhi Asih Regional Hospital in East Jakarta, and used a total sampling method involving 30 ED nurses. Fisher's Exact and Cochran-Mantel Haenszel tests were used to analyze the data. The study findings show that the majority of respondents (56.7%) have a negative perception of the legal protection of bystander CPR in OHCA. However, nurses have a positive perception when answering questions related to the ethical issue of CPR in victims of children, women, and the elderly. 43.33% (13 nurses) have a positive willingness to perform CPR on OHCA, while 56.67% (17 nurses) have a negative willingness as a bystander CPR. The results of the Cochran-Mantel Haenszel test show that perceptions of legal protection may influence nurses' willingness to provide CPPR to OHCA patient, and it will increase the likelihood of giving CPR if the nurse age is ≥ 30 years old (p 0.014; OR 14,133; 95% CI 2,081-95,947) and has been working for ≥ 5 years (p 0.008; OR 25,667; 95% CI 2,253-292,462). Promotion of the legal aspects, ethical issues, and protection to bystander CPR are essential to increase the willingness of nurses and the number of bystander CPR. 

scholarly journals Insights From the Ventricular Fibrillation Waveform Into the Mechanism of Survival Benefit From Bystander Cardiopulmonary Resuscitation

2021 ◽  
Vol 10 (19) ◽  
Author(s):  
Brooke Bessen ◽  
Jason Coult ◽  
Jennifer Blackwood ◽  
Cindy H. Hsu ◽  
Peter Kudenchuk ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Cardiopulmonary Resuscitation ◽  
Survival Benefit ◽  
Amplitude Spectrum ◽  
Peak Frequency ◽  
Spectrum Area ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Background The mechanism by which bystander cardiopulmonary resuscitation (CPR) improves survival following out‐of‐hospital cardiac arrest is unclear. We hypothesized that ventricular fibrillation (VF) waveform measures, as surrogates of myocardial physiology, mediate the relationship between bystander CPR and survival. Methods and Results We performed a retrospective cohort study of adult, bystander‐witnessed patients with out‐of‐hospital cardiac arrest with an initial rhythm of VF who were treated by a metropolitan emergency medical services system from 2005 to 2018. Patient, resuscitation, and outcome variables were extracted from emergency medical services and hospital records. A total of 3 VF waveform measures (amplitude spectrum area, peak frequency, and median peak amplitude) were computed from a 3‐second ECG segment before the initial shock. Multivariable logistic regression estimated the association between bystander CPR and survival to hospital discharge adjusted for Utstein elements. Causal mediation analysis quantified the proportion of survival benefit that was mediated by each VF waveform measure. Of 1069 patients, survival to hospital discharge was significantly higher among the 814 patients who received bystander CPR than those who did not (0.52 versus 0.43, respectively; P <0.01). The multivariable‐adjusted odds ratio for bystander CPR and survival was 1.6 (95% CI, 1.2, 2.1), and each VF waveform measure attenuated this association. Depending on the specific waveform measure, the proportion of mediation varied: 53% for amplitude spectrum area, 31% for peak frequency, and 29% for median peak amplitude. Conclusions Bystander CPR correlated with more robust initial VF waveform measures, which in turn mediated up to one‐half of the survival benefit associated with bystander CPR. These results provide insight into the biological mechanism of bystander CPR in VF out‐of‐hospital cardiac arrest.

scholarly journals Knee-Jerk Cardiopulmonary Resuscitation (CPR) Machine

2019 ◽  
Vol 8 (12) ◽  
pp. 1514-1517 ◽  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Brain Death ◽  
Low Cost ◽  
Knee Jerk ◽  
Neurological Problem ◽  
Arduino Microcontroller ◽  
The Cost

Cardiopulmonary resuscitation method is used to save more number of peoples from the neurological problem. In this case, the neurological problem denotes brain death. This brain death is mainly caused due to cardiac arrest and happen within 4 to 5 minutes. To avoid this problem we go for cardiopulmonary resuscitation method. It will be helpful to relieve the patient from cardiac arrest. The manual CPR is not that much efficient when compared to automatic CPR because, the experts who are giving CPR to the patient are cannot able to give the continuous CPR to the patient but, the automatic CPR machine is able to give the continuous CPR to the patient. The article reviews such kind of automatic devices. The automatic CPR machine already exists. But, the cost of that machine is high. So we intended to design the low cost CPR machine. This is achieved by replacing the component like Arduino microcontroller and solenoid lock. The replaced component also do the same work like in the high cost CPR machine

scholarly journals Caring for persons with drug use disorders in the Yangon Region, Myanmar: Socioeconomic and psychological burden, coping strategies and barriers to coping

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258183
Author(s):  
Khin Zar Khaing Thein ◽  
Chantal Herberholz ◽  
Win Pa Sandar ◽  
Yadanar
Keyword(s):  
Drug Use ◽  
Coping Strategies ◽  
Negative Impact ◽  
Informal Caregivers ◽  
Control Policy ◽  
Framework Analysis ◽  
Income Loss ◽  
Psychological Burden ◽  
Drug Law ◽  
The Government

Drug use disorder (DUD) is a serious health condition that imposes a heavy burden on the persons who have a drug addiction experience and their families, especially in countries, such as Myanmar, where few formal support mechanisms are in place and repressive drug laws exacerbate the situation. Yet, in Myanmar, little is known about how informal caregivers are affected. This qualitative study aims at exploring the socioeconomic and psychological burden that informal caregivers in Myanmar encounter, coping strategies they employ, as well as barriers to coping they face. Thirty primary informal caregivers were chosen purposively from a mental health hospital in Yangon for in-depth interviews. The recorded interviews were transcribed and the data were analysed using framework analysis. The results revealed that financial constraint, income loss, social limitation and negative impact on family cohesion are important dimensions of socioeconomic burden, whereas sadness, anger, helplessness, worry, fear and guilt are the main psychological distress factors encountered by caregivers of persons with DUD. Key coping strategies employed by caregivers include religious coping, financial coping, acceptance and planning. Moreover, perceived stigma towards persons with DUD and their caregivers was very high and caregivers received hardly any social support, inter alia because of the country’s drug law which reinforces stigma and discrimination. Neither the government nor any other organization in Myanmar provided financial support to the caregivers. The results of this study showed that caring for persons with DUD has devastating effects on caregivers and their families. While the 2018 National Drug Control Policy can potentially help alleviate the burden on substance users and their families, further amendments of the existing drug law are urgently needed. Moreover, strengthening prevention and harm reduction approaches, improving treatment and rehabilitation services, as well as stigma-reducing educational campaigns should be considered a priority.

scholarly journals Telecommunicator Cardiopulmonary Resuscitation: A Policy Statement From the American Heart Association

Circulation ◽  
2020 ◽  
Vol 141 (12) ◽  
Author(s):  
Michael Christopher Kurz ◽  
Bentley J. Bobrow ◽  
Julie Buckingham ◽  
Jose G. Cabanas ◽  
Mickey Eisenberg ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Sudden Cardiac Arrest ◽  
The United States ◽  
Hospital Environment ◽  
Policy Statement ◽  
Initial Care ◽  
Chain Of Survival ◽  
Lay Rescuer ◽  
Hospital Cardiac Arrest

Every year in the United States, >350 000 people have sudden cardiac arrest outside of a hospital environment. Sudden cardiac arrest is the unexpected loss of heart function, breathing, and consciousness and is commonly the result of an electric disturbance in the heart. Unfortunately, only ≈1 in 10 victims survives this dramatic event. Early access to 9-1-1 and early cardiopulmonary resuscitation (CPR) are the first 2 links in the chain of survival for out-of-hospital cardiac arrest. Although 9-1-1 is frequently accessed, in the majority of cases, individuals with out-of-hospital cardiac arrest do not receive lay rescuer CPR and wait for the arrival of professional emergency rescuers. Telecommunicators are the true first responders and a critical link in the cardiac arrest chain of survival. In partnership with the 9-1-1 caller, telecommunicators have the first opportunity to identify a patient in cardiac arrest and provide initial care by delivering CPR instructions while quickly dispatching emergency medical services. The telecommunicator and the caller form a unique team in which the expertise of the telecommunicator is provided just in time to a willing caller, transforming the caller into a lay rescuer delivering CPR. The telecommunicator CPR (T-CPR) process, also previously described as dispatch CPR, dispatch-assisted CPR, or telephone CPR, represents an important opportunity to improve survival from sudden cardiac arrest. Conversely, failure to provide T-CPR in this manner results in preventable harm. This statement describes the public health impact of out-of-hospital cardiac arrest, provides guidance and resources to construct and maintain a T-CPR program, outlines the minimal acceptable standards for timely and high-quality delivery of T-CPR instructions, and identifies strategies to overcome common implementation barriers to T-CPR.

Abstract P193: A Cardiopulmonary Resuscitation Training Program for Family Members of In-Hospital Patients at Risk for Cardiac Arrest

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Marion Leary ◽  
Lori Albright ◽  
Emily B Meshberg ◽  
Noah T Sugerman ◽  
Lance B Becker ◽  
...  
Keyword(s):  
At Risk ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Family Members ◽  
Care Hospital ◽  
Hospital Patients ◽  
Patients At Risk ◽  
Bystander Cpr ◽  
Self Instruction

Background: Resuscitation from cardiac arrest often depends on prompt cardiopulmonary resuscitation (CPR) from the lay public, yet bystander CPR rates in the US are low. One barrier to bystander CPR delivery is that most arrests occur in the home, where only family members may be available to provide care. Little data exist regarding the ability to target and train family members of “at-risk” patients in CPR. Objective: We sought to implement a CPR video self-instruction (VSI) program for family members of in-hospital patients at risk for cardiac arrest. After training in situ before hospital discharge, we tested the hypothesis that at-risk patient family members would be motivated to secondarily train others in the home after leaving the hospital setting. Methods: Family members of patients hospitalized for cardiac conditions at one tertiary-care hospital between 12/07 and 6/08 who met pre-defined inclusion criteria were offered CPR VSI training requiring 25–30 min. All trainees were assessed for skill competence and video recorded for analysis. Trainees were encouraged to take the VSI kit home, and follow-up surveys were conducted to gauge secondary training of other family members. Results: Among 36 enrollees, mean age (SD) was 50 (13) and 78% of trainees were female; only 17% had been CPR trained within the past 10 years, and 44% had never been trained. Most (67%) of the trainees were either children or spouses of the at-risk hospitalized patients. Most (78%) trainees rated their experience with learning CPR via VSI as “comfortable” or “very comfortable”. During 2 min of CPR skills assessment, mean (SD) chest compression rate was 100 (19), mean percentage (SD) adequate depth was 89% (15%), and mean (SD) time for two breaths was 10.8 (4.6) sec. Follow-up surveys revealed that 33% of recipients performed secondary training at home, with a mean (SD) of 1.8 (1.3) secondary trainees. Conclusions: CPR VSI training for family members of hospitalized cardiac patients may serve as a cost-effective model to disseminate resuscitation skills and allows for secondary training in the home of patients at risk for sudden cardiac arrest.

Abstract 13209: Law Enforcement-Initiated Cardiopulmonary Resuscitation in the Care of Out-of-Hospital Cardiac Arrest

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Luke A Wohlford ◽  
Bruce J Barnhart ◽  
Daniel W Spaite ◽  
Joshua B Gaither ◽  
Amber D Rice ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Law Enforcement ◽  
Cardiopulmonary Resuscitation ◽  
Patient Care ◽  
Hospital Discharge ◽  
System Response ◽  
Healthcare Facilities ◽  
Bystander Cpr ◽  
Provision Of Care ◽  
Hospital Cardiac Arrest

Background: Little is known about the provision of care by law enforcement (LE) personnel within modern EMS systems. We evaluated LE performance of bystander CPR (BCPR) and associated outcomes in OHCA across Arizona. Methods: A total of 5,654 OHCA cases (1/1/2019-12/31/2019) were evaluated using the Save Hearts in Arizona Registry and Education (SHARE) cardiac arrest registry. Data were abstracted from all EMS patient care records (PCRs). If two parties provided BCPR, the first to give compressions was considered the provider for this analysis. Cases identified as “Stranger” or “Unknown” BCPR were manually evaluated for narrative data to identify BCPR provider when possible. Results: BCPR was provided in 2285 cases [48.8%; (95% CIs 47.4%, 50.3%)] after excluding 850 cases that occurred in healthcare facilities where personnel are duty-bound to provide CPR. LE provided BCPR in 444 patients [19.4% (17.8%, 21.1%)], second only to family/spouse [1143 pts; 50.0% (48.0%, 52.1%)]. Overall, 279 patients survived to hospital discharge [12.2%, (10.9%, 13.6%)]. The Table shows the rates of BCPR in each provider category and the associated rates of survival. Of note is that the rate of bystander AED use was more than four times higher in LE BCPR [6.3% (4.23%, 8.99%)] than family-provided BCPR [1.5% (0.87%, 2.37%; p < 0.0001)], but was still very low. Conclusions: In this statewide study that included more than 130 EMS agencies from frontier to urban settings, LE personnel were frequently involved in the care of OHCA patients within the 911 system response. To our knowledge, this magnitude of provision of BCPR by LE (nearly one in five BCPR cases) has not been reported previously. Furthermore, the consequential rate of LE response to OHCA provides the opportunity to significantly increase AED use. Our findings support the widespread and intentional training of LE in CPR and AED use and has the potential to improve survival in diverse settings.

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