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
|Condition or disease||Intervention/treatment|
|Cardiac Arrest||Behavioral: Education|
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.
|Study Type :||Observational|
|Actual Enrollment :||1076 participants|
|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|
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.
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.
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
- 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.
- 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
- 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
- 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
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
|Ottawa Hospital Research Institute|
|Ottawa, Ontario, Canada, K1Y 4E9|
|Principal Investigator:||Christian Vaillancourt, MD,MSc,FRCPC||The Ottawa Hospital Research Institute and University of Ottawa|