The document discusses the implementation of dispatcher-assisted CPR in Singapore, aiming to improve survival rates from cardiac arrests. It highlights challenges in compliance with key questions during emergency calls and presents data on outcomes related to initiating CPR. A multipronged approach is suggested to enhance CPR education and implementation among the public and healthcare providers.

1. Dispatch Assisted CPR in
Singapore
Dr Benjamin Leong
National University Health System
Ministry of Health
Singapore

2. Chain of Survival

3. Solution!

4. Fail….

6. True First Responder
• First point of contact

7. 995 Call
Centre

8. Why DA CPR?
• Circulation 2001
• 17 year population-based cohort study (1983-
2000)
• King’s County, Washington
• 7265 cases of cardiac arrest from EMS
• DA CPR - ventilation and compression

10. What’s the worst that could happen?
• Fear – CPR in an ALIVE patient?
• White L, Rogers J et al (Circulation 2010)
– 1700 received dispatcher instructions
– 762 of 1700 NOT in arrest
– 247 of 762 had complete outcome
ascertained

11. Of those 247…..
• Pain - 22 (8.9%)
• Rib fractures – 2 (0.8%)
• Possible rib fractures – 2 (0.8%)
• Possible internal bleeding – 1 (0.4%)
• Visceral organ damage – 0 (0%)

12. Is a 2% injury rate a good trade off to save
agonal cardiac arrest cases?
Save agonal cases
Fracture ribs of
respiratory cases
Agonal cases not
saved
No rib fracture of
Respiratory cases
Sensitive
Specific
“Is he breathing normally?” “Is he breathing?”

13. 2013
• Number of suspected OHCA cases = 1,847
– Standby for cardiac arrest
– “P0”
• Number audited = 1,122 (60.1%)

14. Compliance to Key Qns
• “Is the patient conscious?”
– 924/1,122 (82.4%)
• “Is the patient breathing normally?”
– 905/1,122 (80.7%)
• Both Qns asked
– 846/1,122 (75.4%)

15. Reasons for “non-compliance”
• Calls routed from other PSAPS
– 999
– Public transport communications centres
• Caller not with patient
• Caller uncooperative / distressed
• Language barrier
• Failure to recognise

16. Patient response to Key Qns
• Not conscious
– 800/924 (86.6%)
• Not breathing normally
– 618/905 (68.3%)

17. Patient response to Key Qns
• Not conscious AND not breathing normally
495/846 (58.5%)

18. Successfully started compressions
• Both key questions satisfied
–246/495 (49.7%)
• CPR started without both Qns
–Additional 50 cases
• Total DACPR rate
–296/1,122 (26.4%)

19. Reasons for not starting compressions
• Bystander already doing CPR
• Caller uncooperative / distressed
• Caller not with patient
• Language barrier
• Difficulty understanding instructions
• Unable to position patient
• EMS arrived really quickly

20. Example case

21. Case Example 2

22. Dispatcher CPR course

25. Multipronged appoach
• EMS
– Continuing education
– Audits / Reviews
• Public
– CPR training, recertification
– Schools, military, workplace
– Public education
– Media
• Hospitals
– Promote CPR skills
– Off duty healthcare workers as volunteers

26. Multipronged appoach
• Hospitals
– Promote CPR skills
– Off duty healthcare workers as volunteers
• Technology
– Smart phone apps
– Wearable tech
– Telemedicine