A talk by Theresa Olasvengen at the 2017 Scandinavian Society of Anaestesiology and Intensive Care Medicine. All of the conference content can be found here: https://scanfoam.org/ssai2017/ Developed in collaboration between scanFOAM, SSAI and SFAI.

1. Timely and adequate allocation
of prehospital medical assistance
to cardiac arrest patients
-how to do it.
Theresa M. Olasveengen MD, PhD
Dept. of Anaesthesiology Oslo University Hospital

2. Conflict of interest
• Receipient of Bjørn Lind stipend from the
Laerdal Foundation 2015-16
• ILCOR Basic Life Support Chair 2016-

3. What will I talk about?
• Three tings you should know about cardiac
arrest and dispatch
• How our dispatch was looking in Oslo
• How we improved

4. Chain of survival

5. Dispatch in the chain of survival
Help identify
arrest
Provide telephone
Instructions for CPR
Guide bystander
To defibrillator
1
32

6. #1
Does it matter whether the
dispatcher recognizes cardiac
arrest?

7. #1 Dispatch recognition matters

9. #2
Does telephone-assisted CPR
matter?

10. #2 T-CPR matters

11. 2
Functional outcome 6.3% 8.5% 12.4%
Adj. functional outcome Ref ORadj 1.56
(1.06, 2.31)
ORadj 1.58
(1.05, 2.39)

12. #3
Do we need to dispatch automatic
defibrillators?

13. #3 Defibrillators can be dispatched

14. (21)
(71%)

15. 3
Approx. 90% PAD to homes
Approx. 2,5 min saved
1536 arrests
893 alerts
184
PADs
167

16. How were we doing in Oslo?

17. Recognition of cardiac arrest (%)
68%
11%
21% Recognized
Not recognized
Delayed
recognition

18. Median time to CPR performed
Compressions
performed
3,3 minutes
Cardiac arrest
recognised
2,6 minutes
Delayed recognition
of cardiac arrest
5,1 minutes

19. What is going on?

20. Interviews
19 interviews
• From three different centers
• Paramedics and nurses
• Dispatchers with calls that were recognized, not
recognized, or where recognition was delayed
• Listened and discussed their cardiac arrest call
• What was their strategy for cardiac arrest calls?
• What determined the outcome of the particular
call?

21. Interviews
• Protocol use and platform of knowledge
 Varying attitudes to clinical intuition vs. protocol
 Varying knowledge about agonal respiration
 Need for more education/training
• Interrogration strategy/assessment of breathing
 19 different strategies
 Little guidance on assessing breathing
 Useless definition of cardiac arrest

22. How do we improve?

23. Intervention
• Seminar: traditional education, practical tips
og presentation of their own quality metrics
(4 hours)
• E-leaning program
– Borrowed e-leaning from Medic One Program
(Seattle)

24. Intervention
• Practical training
– Scenario simulations with dispatchers as both
callers and calltakers
• Feedback on cardiac arrest call performance
– Personal written feedback on all cardiac arrest
calls

25. 89
21
71
95
6
83
0
10
20
30
40
50
60
70
80
90
100
Recognized
arrest
Delayed
recognition
Telephone
assisted CPR
Before
After
p<0.001
p=0.002
p=0.024

26. Time to chest compression
Time to CPR instructions
Before
After
p=0.042
p=0.015
2,6
2,3
3,3
2,8

27. Take-home message
• High quality dispatch matters!
• Tips for optimizing dispatch
– Spesific > general training
– Measure quality!
– Monitoring/feedback is difficult!
Remember: trust, respect, and maybe a little bit
of coercion…

28. Thank you!