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Dispatcher Identification of Out-of-Hospital Cardiac Arrest and Neurologically Intact Survival: A Retrospective Cohort Study

  • Julian G. Mapp (a1) (a2), Anthony M. Darrington (a1), Stephen A. Harper (a1) (a2), Chetan U. Kharod (a1) (a2), David A. Miramontes (a2), David A. Wampler (a2) and Prehospital Research and Innovation in Military and Expeditionary Environments (PRIME) Research Group...



To date, there are no published data on the association of patient-centered outcomes and accurate public-safety answering point (PSAP) dispatch in an American population. The goal of this study is to determine if PSAP dispatcher recognition of out-of-hospital cardiac arrest (OHCA) is associated with neurologically intact survival to hospital discharge.


This retrospective cohort study is an analysis of prospectively collected Quality Assurance/Quality Improvement (QA/QI) data from the San Antonio Fire Department (SAFD; San Antonio, Texas USA) OHCA registry from January 2013 through December 2015. Exclusion criteria were: Emergency Medical Services (EMS)-witnessed arrest, traumatic arrest, age <18 years old, no dispatch type recorded, and missing outcome data. The primary exposure was dispatcher recognition of cardiac arrest. The primary outcome was neurologically intact survival (defined as Cerebral Performance Category [CPC] 1 or 2) to hospital discharge. The secondary outcomes were: bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) use, and prehospital return of spontaneous return of circulation (ROSC).


Of 3,469 consecutive OHCA cases, 2,569 cases were included in this analysis. The PSAP dispatched 1,964/2,569 (76.4%) of confirmed OHCA cases correctly. The PSAP dispatched 605/2,569 (23.6%) of confirmed OHCA cases as another chief complaint. Neurologically intact survival to hospital discharge occurred in 99/1,964 (5.0%) of the recognized cardiac arrest group and 28/605 (4.6%) of the unrecognized cardiac arrest group (OR = 1.09; 95% CI, 0.71–1.70). Bystander CPR occurred in 975/1,964 (49.6%) of the recognized cardiac arrest group versus 138/605 (22.8%) of the unrecognized cardiac arrest group (OR = 3.34; 95% CI, 2.70–4.11).


This study found no association between PSAP dispatcher identification of OHCA and neurologically intact survival to hospital discharge. Dispatcher identification of OHCA remains an important, but not singularly decisive link in the OHCA chain of survival.


Corresponding author

Julian G. Mapp, MD, MPH Department of Emergency Health Sciences University of Texas Health Science Center at San Antonio San Antonio, Texas 78229 USA E-mail:


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1.Writing Group Members, Mozaffarian, D, Benjamin, EJ, et al.Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation. 2016;133(4):e38360.
2.Hazinski, MF, Nolan, JP, Aickin, R, et al.Part 1: Executive Summary: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Circulation. 2015;132(16 Supp 1):S239.
3.Bobrow, BJ, Panczyk, M, Subido, C.Dispatch-assisted cardiopulmonary resuscitation: the anchor link in the chain of survival. Curr Opin Crit Care. 2012;18(3):228233.
4.Nordberg, P, Jonsson, M, Forsberg, S, et al.The survival benefit of dual dispatch of EMS and fire-fighters in out-of-hospital cardiac arrest may differ depending on population density--a prospective cohort study. Resuscitation. 2015;90:143149.
5.Malta Hansen, C, Kragholm, K, Pearson, DA, et al.Association of bystander and first-responder intervention with survival after out-of-hospital cardiac arrest in North Carolina, 2010–2013. JAMA. 2015;314(3):255264.
6.Saner, H, Morger, C, Eser, P, von Planta, M.Dual dispatch early defibrillation in out-of-hospital cardiac arrest in a mixed urban-rural population. Resuscitation. 2013;84(9):11971202.
7.Husain, S, Eisenberg, M.Police AED programs: a systematic review and meta-analysis. Resuscitation. 2013;84(9):11841191.
8.Nakahara, S, Tomio, J, Ichikawa, M, et al.Association of bystander interventions with neurologically intact survival among patients with bystander-witnessed out-of-hospital cardiac arrest in Japan. JAMA. 2015;314(3):247254.
9.Song, KJ, Shin, SD, Park, CB, et al.Dispatcher-assisted bystander cardiopulmonary resuscitation in a metropolitan city: a before-after population-based study. Resuscitation. 2014;85(1):3441.
10.Lerner, EB, Rea, TD, Bobrow, BJ, et al.Emergency medical service dispatch cardiopulmonary resuscitation prearrival instructions to improve survival from out-of-hospital cardiac arrest: a scientific statement from the American Heart Association. Circulation. 2012;125(4):648655.
11.Bohm, K, Vaillancourt, C, Charette, ML, Dunford, J, Castren, M.In patients with out-of-hospital cardiac arrest, does the provision of dispatch cardiopulmonary resuscitation instructions as opposed to no instructions improve outcome: a systematic review of the literature. Resuscitation. 2011;82(12):14901495.
12.Vaillancourt, C, Charette, ML, Bohm, K, Dunford, J, Castren, M.In out-of-hospital cardiac arrest patients, does the description of any specific symptoms to the emergency medical dispatcher improve the accuracy of the diagnosis of cardiac arrest: a systematic review of the literature. Resuscitation. 2011;82(12):14831489.
13.Vaillancourt, C, Charette, M, Kasaboski, A, et al.Cardiac arrest diagnostic accuracy of 9-1-1 dispatchers: a prospective multi-center study. Resuscitation. 2015;90:116120.
14.Travers, S, Jost, D, Gillard, Y, et al.Out-of-hospital cardiac arrest phone detection: those who most need chest compressions are the most difficult to recognize. Resuscitation. 2014;85(12):17201725.
15.Moller, TP, Andrell, C, Viereck, S, Todorova, L, Friberg, H, Lippert, FK.Recognition of out-of-hospital cardiac arrest by medical dispatchers in emergency medical dispatch centers in two countries. Resuscitation. 2016;109:18.
16.Hiltunen, PV, Silfvast, TO, Jantti, TH, Kuisma, MJ, Kurola, JO.Emergency dispatch process and patient outcome in bystander-witnessed out-of-hospital cardiac arrest with a shockable rhythm. Eur J Emerg Med. 2015;22(4):266272.
17.Berdowski, J, Beekhuis, F, Zwinderman, AH, Tijssen, JG, Koster, RW.Importance of the first link: description and recognition of an out-of-hospital cardiac arrest in an emergency call. Circulation. 2009;119(15):20962102.
18.Viereck, S, Moller, TP, Ersboll, AK, et al.Recognizing out-of-hospital cardiac arrest during emergency calls increases bystander cardiopulmonary resuscitation and survival. Resuscitation. 2017;115:141147.
19.von Elm, E, Altman, DG, Egger, M, et al.The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344349.
20.Jacobs, I, Nadkarni, V, Bahr, J, et al.Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa). Circulation. 2004;110(21):33853397.
21.Chen, H, Cohen, P, Chen, S.How big is a big odds ratio? Interpreting the magnitudes of odds ratios in epidemiological studies. Communications in Statistics – Simulation and Computation. 2010;39:860864.
22.Uber, A, Sadler, RC, Chassee, T, Reynolds, JC.Bystander cardiopulmonary resuscitation is clustered and associated with neighborhood socioeconomic characteristics: a geospatial analysis of Kent County, Michigan. Acad Emerg Med. 2017;24(8):930939.
23.Fosbol, EL, Dupre, ME, Strauss, B, et al.Association of neighborhood characteristics with incidence of out-of-hospital cardiac arrest and rates of bystander-initiated CPR: implications for community-based education intervention. Resuscitation. 2014;85(11):15121517.
24.Sasson, C, Magid, DJ, Chan, P, et al.Association of neighborhood characteristics with bystander-initiated CPR. N Engl J Med. 2012;367(17):16071615.
25.Renkiewicz, GK, Hubble, MW, Wesley, DR, et al.Probability of a shockable presenting rhythm as a function of EMS response time. Prehosp Emerg Care. 2014;18(2):224230.
26.Hardeland, C, Sunde, K, Ramsdal, H, et al.Factors impacting upon timely and adequate allocation of prehospital medical assistance and resources to cardiac arrest patients. Resuscitation. 2016;109:5663.
27.Dami, F, Heymann, E, Pasquier, M, Fuchs, V, Carron, PN, Hugli, O.Time to identify cardiac arrest and provide dispatch-assisted cardio-pulmonary resuscitation in a criteria-based dispatch system. Resuscitation. 2015;97:2733.
28.Hardeland, C, Olasveengen, TM, Lawrence, R, et al.Comparison of Medical Priority Dispatch (MPD) and Criteria Based Dispatch (CBD) relating to cardiac arrest calls. Resuscitation. 2014;85(5):612616.
29.Plodr, M, Truhlar, A, Krencikova, J, et al.Effect of introduction of a standardized protocol in dispatcher-assisted cardiopulmonary resuscitation. Resuscitation. 2016;106:1823.
30.Stipulante, S, Tubes, R, El Fassi, M, et al.Implementation of the ALERT algorithm, a new dispatcher-assisted telephone cardiopulmonary resuscitation protocol, in non-Advanced Medical Priority Dispatch System (AMPDS) Emergency Medical Services centers. Resuscitation. 2014;85(2):177181.


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Dispatcher Identification of Out-of-Hospital Cardiac Arrest and Neurologically Intact Survival: A Retrospective Cohort Study

  • Julian G. Mapp (a1) (a2), Anthony M. Darrington (a1), Stephen A. Harper (a1) (a2), Chetan U. Kharod (a1) (a2), David A. Miramontes (a2), David A. Wampler (a2) and Prehospital Research and Innovation in Military and Expeditionary Environments (PRIME) Research Group...


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