To the Editor,
Emergencies and life-threatening incidents require a rapid professional response, and in cardiac arrest incidents, every minute of delay in the resuscitation effort reduces the survival rate.
1.
Emergency call centers offer a special type of telemedicine, where qualified dispatchers identify clinical conditions and instruct lay people in immediate life-saving procedures until emergency responders arrive. In Israel, Magen David Adom, Israeli national emergency medical services (EMS), the approach to shortening the response time to medical emergencies is twofold: First, all calls to the call center are answered by a trained medic or paramedic, who was qualified as a dispatcher after gaining field experience in the ambulance service. Second, all emergency calls are received directly at a dedicated dial-in number where the call is answered and handled by the qualified dispatcher (in contrast to some countries where the emergency call is transferred from a general public-safety answering point).2.
We report the evaluation of out-of-hospital cardiac arrest (OHCA) emergency calls that were responded to by Israeli dispatchers. For this evaluation, experienced paramedics listened to recordings of 381 calls for cardiac arrest that were received in Magen David Adom call centers between December 2015 and April 2016. Measurements of the time it took the emergency dispatcher to identify the cardiac arrest and to start instructing the caller in performing CPR, an intervention that needs to be performed immediately, before the arrival of the professional responders, were recorded. The study was approved by Magen David Adom’s research committee.
The median time to OHCA recognition was 40 s [interquartile range (IQR), 18, 61 s]. The first dispatch-directed compression was performed at a median time of 125 s [IQR, 78, 176 s]. Both of these times are shorter than the American Heart Association guidelines, <60 s and <90 s, respectively.
3.
Our report indicates that by directly dialing the EMS call center, the call reaches a qualified dispatcher within the guidelines – a goal that might not be reached if the call had to be transferred from a general public-safety answering point. Saving this extra step that shortens the time until the dispatcher starts providing lifesaving instructions improves the chances of survival without long-term damage to those needing urgent help. Table 1 compares the main differences between the two models.
Table 1Emergency services call center models.
| Time until qualified response | Probability for error | |
|---|---|---|
| EMS call center with a dedicated dial-in number | The call reaches a qualified dispatcher right away | Small – only one person handles the call |
| General public-safety answering point that transfers the call to the relevant service | The call is transferred from a call taker at the public-safety answering point to a qualified dispatcher at the EMS, adding precious time until the dispatcher can instruct the caller in providing immediate care | The call is handled by an extra person (the call taker), adding to the probability for error in the process |
The increasing use of mobile applications for video
4.
and advanced two-way communication with bystanders and technologies that are based on machine learning algorithms5.
would improve the dispatchers’ abilities to provide better treatment during emergencies, making it even more important link in the chain of survival.6.
But the key to a quick and effective response will always rely on a qualified dispatcher who receives the call and uses their experience and technology to instruct bystanders to provide immediate care.Conflicts of interest
All authors declare that they have no conflicts of interest to disclose.
Acknowledgements
The authors would like to thank Shaked Arazi and Raphael Herbst for their support in preparing the first draft of this manuscript.
References
- Incidence, duration and survival of ventricular fibrillation in out-of-hospital cardiac arrest patients in Sweden.Resuscitation. 2000; 44: 7-17https://doi.org/10.1016/S0300-9572(99)00155-0
- A centralized system for providing dispatcher assisted CPR instructions to 9-1-1 callers at multiple municipal public safety answering points.Resuscitation. 2019; 142: 46-49
- Telecommunicator cardiopulmonary resuscitation: a policy statement from the American Heart Association.Circulation. 2020; 141: e686-e700
- Using a filming protocol to improve video-instructed cardiopulmonary resuscitation.Technol Health Care. 2020; 28: 213-220
- Machine learning can support dispatchers to better and faster recognize out-of-hospital cardiac arrest during emergency calls: a retrospective study.Resuscitation. 2021; 162: 218-226
- Comparison of the effects of audio-instructed and video-instructed dispatcher-assisted cardiopulmonary resuscitation on resuscitation outcomes after out-of-hospital cardiac arrest.Resuscitation. 2020; 147: 12-20
Article info
Publication history
Published online: July 13, 2022
Accepted:
July 10,
2022
Received:
July 7,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
