EMS World

FEB 2019

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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Page 31 of 53

30 FEBRUARY 2019 | EMSWORLD.com ISSUE FOCUS: CARDIAC AND STROKE CARE lance dispatch was noted to be faster in MPDS. Interestingly, there was a delay of approximately four minutes to chest compressions in both systems. While this study provided some good data points, it did not definitively prove one system's ef ficiency over the other, especially in regard to what most would consider the most important component: initiation of bystander chest compressions. B o t h D e n m a r k a n d Sweden have adopted C B D - b a s e d s y s t e m s of their own—the Dan- ish and Swedish Index for Emergency Care, respectively. Both s ystems are ba sed on the Nor wegian Index for Emergency Care, which in turn is adapted from CBD. The slight advan- tage the Danish hold is an electronic link between the dispatch and a network of public AEDs. A study conducted by Dan- ish physician Thea Møller, MD, et al., found no statistical significance between the two CBD-based systems with regard to recognition of cardiac arre s t. The cases that were not initially recognized as OHCA still received relatively alarm- ing diagnoses (breathlessness, etc.) so as to initiate early dispatch of advanced resources regardless. 11 Recommendations and Measures Clear limitations exist among all these s t u d i e s , i n c l u d i n g t h e d i f f e r e n c e s between countries, EMS systems, popu- lations, and possibly comorbidities. Most of these differences are well highlighted in the Møller study. The background of the dispatchers can slightly dif fer: Danish dispatchers were either regis tered nur ses or paramed- ics, whereas Swedish dispatchers were either paramedics or persons without a formal medical background. Additionally, dispatch s ystems have cropped up at various points over the last few decades: The Swedish system has been in place since 1997, the Danish system only since 2011. Countries such as Denmark have the potential to activate AEDs in the field—a possible confounder in poor communica- tion of CPR instructions to the bystander. Ultimately these studies leave us with one common denominator: Each system appears able to accurately recognize OHCA, at least in those cases that are unmistakably cardiac arrest. The imple- mentation of protocol-based dispatch systems has enabled this, though perfor- mance measurement is the way for ward. In re sp ons e to this , the AHA p ub - lished recommendations for the "timely and high-quality deliver y" of telephone CPR (T-CPR) instructions by telecom- municators. 12 As dispatchers are of ten the first to identif y cardiac arrest, the A H A p r o v i d e s f o c u s e d p r o g r a m r e co m m e n d a - tions and measures. Pro- gram re co m m en datio n s include 1) commitment to implementation of T-CPR, 2) provision of continuing education for dispatchers, 3) quality improvement for all confirmed cardiac arrest calls, 4) communication with the EMS agency, 5) establishment of a designated communications center medical director for issuance of dispatch protocols, and 6) a recognition program for identif ying outstanding staff. Per formance goal s include 1) 75% correctly identified ca ses of OHCA by tele co m m unic ato r, 2) 95% co r re c tly identified cases of OHCA by telecom- municator that were deemed recogniz- able, 3) 75% call-taker-recognized OHCA cases receiving T-CPR, 4) less than 120 The slight advantage the Danish hold is an electronic link between the dis- patch and a network of public AEDs. The MPDS assigns a priority level to each call based on a series of questions designed to triage the caller's complaint. MPDS is used in the majority of the United States. Photo: Aaron Webster

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