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Improving Cardiac Arrest Diagnostic Accuracy of Emergency Medical Dispatchers

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ClinicalTrials.gov Identifier: NCT01872325
Recruitment Status : Completed
First Posted : June 7, 2013
Last Update Posted : March 14, 2017
Sponsor:
Information provided by (Responsible Party):
Ottawa Hospital Research Institute

Brief Summary:
The main goal of this project is to help 9-1-1 emergency medical dispatchers save the lives of more cardiac arrest victims. The investigators will develop teaching tools to help the dispatchers recognize abnormal breathing that may indicate a victim as having a cardiac arrest. After training sessions, the investigators will see if dispatchers can get better at recognizing abnormal breathing, how often they give CPR instructions, and if use of the teaching tool will increase bystander CPR and the number of victims leaving the hospital alive.

Condition or disease Intervention/treatment
Cardiac Arrest Behavioral: Education

Detailed Description:

Cardiac arrest is a leading cause of death in Canada; it is defined as the sudden cessation of cardiac mechanical activity. It is uniformly fatal if not treated within minutes. More than 85% of out-of-hospital cardiac arrest (OOHCA) occur in residential locations so public access to automatic external defibrillators, to restart the heart, are not helpful. The overall rate of survival for OOHCA rarely exceeds 8%.

Bystander cardiopulmonary resuscitation (CPR) is chest compression and ventilations provided by someone not on the emergency response team. A victim or cardiac arrest is almost 4 times more likely to survive when receiving bystander CPR. However, despite various attempts to improve bystander rates they have remained low, not exceeding 15% in Ontario. It has been shown that since the ambulance dispatch centres in Ontario implemented dispatch-assisted CPR instructions (given to callers while emergency vehicles were on the way), there was a significant increase in use.

Emergency medical dispatchers can identify about 70% of OOHCA cases over the phone. Agonal breathing (laboured breathing preceding death) may be misinterpreted as a sign of life, and is responsible for as much as 50% of missed diagnoses. There is no specific training on the significance of this sign, and minimal information about recognizing cardiac arrest. An educational intervention designed to better understand the significance of agonal breathing and to clarify the existing CPR instruction protocol will most likely increase the frequency of CPR instructions, bystander CPR rates, and potentially survival of victims of cardiac arrest.


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Study Type : Observational
Actual Enrollment : 1076 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Improving the Cardiac Arrest Diagnostic Accuracy of 9-1-1 Emergency Medical Dispatchers
Study Start Date : June 2013
Actual Primary Completion Date : September 2014
Actual Study Completion Date : December 2014

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Cardiac Arrest

Group/Cohort Intervention/treatment
Training site
All emergency medical dispatchers at a central ambulance communication centre in Ontario will participate in an educational program designed to improve cardiac arrest diagnostic accuracy.
Behavioral: Education
An education program will be developed using behaviour change techniques specifically mapped to address modifiable factors identified in a previous study. These techniques will include: information about the significance of agonal breathing, modeling/demonstration of desired behavioural skills, rehearsal of desired skills, and monitoring/reinforcement and feedback.

Control site
All emergency medical dispatchers at a central ambulance communications centre geographically remote from the Training Site and has a similar rate to the Training Site for cardiac arrests, bystander CPR rate, and survival



Primary Outcome Measures :
  1. Frequency and impact of agonal breathing on cardiac arrest diagnosis [ Time Frame: Change between a 3 year period before and after education component ]
    By reviewing recordings of all cardiac arrest calls, including missed cases retrieved from a registry, document presence or absence of agonal breathing.


Secondary Outcome Measures :
  1. Completion of dispatch assisted cardiopulmonary resuscitation instructions [ Time Frame: Change between a 3 year period before and after education component ]
    By reviewing recordings of all cardiac arrest calls, collect information on dispatcher recognition of cardiac arrest to bystander implementation of chest compressions


Other Outcome Measures:
  1. Presence of ongoing bystander cardiopulmonary resuscitation [ Time Frame: Change between a 3 year period before and after education component ]
    The first member of the emergency response team to arrive at scene will document whether or not chest compressions have been initiated by someone prior to the arrival of emergency team

  2. Survival of cardiac arrest victim [ Time Frame: Change between a 3 year period before and after education component ]
    Accessing hospital medical records or coroner's reports, assess survival of cardiac arrest victim as being discharged alive from hospital



Information from the National Library of Medicine

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Ages Eligible for Study:   16 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population
All patients with out-of-hospital cardiac arrest
Criteria

Inclusion Criteria:

  • presumed cardiac origin
  • event occurs in the catchment area of Training or Control Site
  • resuscitation is attempted by a bystander and/or the emergency responders

Exclusion Criteria:

  • patients younger than 16 years old
  • patients who are "obviously dead" as defined by the Ambulance Act of Ontario (decomposition, rigor mortis, decapitation, or other)
  • trauma victims including hanging and burns
  • cardiac arrest of non-cardiac origin including drug overdose, carbon monoxide poisoning, drowning, exsanguination, electrocution, asphyxia, hypoxia related to respiratory disease, cerebrovascular accident, and documented terminal illness

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01872325


Locations
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Canada, Ontario
Ottawa Hospital Research Institute
Ottawa, Ontario, Canada, K1Y 4E9
Sponsors and Collaborators
Ottawa Hospital Research Institute
Investigators
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Principal Investigator: Christian Vaillancourt, MD,MSc,FRCPC The Ottawa Hospital Research Institute and University of Ottawa

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Responsible Party: Ottawa Hospital Research Institute
ClinicalTrials.gov Identifier: NCT01872325     History of Changes
Other Study ID Numbers: 2012-0379-01H
First Posted: June 7, 2013    Key Record Dates
Last Update Posted: March 14, 2017
Last Verified: March 2017

Keywords provided by Ottawa Hospital Research Institute:
cardiac arrest
bystander cardiopulmonary resuscitation CPR
dispatch-assisted CPR instructions
agonal breathing

Additional relevant MeSH terms:
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Emergencies
Heart Arrest
Disease Attributes
Pathologic Processes
Heart Diseases
Cardiovascular Diseases