Dispatch codes of out-of-hospital cardiac arrest should be diagnosis related rather than symptom related
Christer Axelsson1, Jonas Borgström, Thomas Karlsson
1Göteborg EMS System, Göteborg, Sweden.
Insights
Dispatching out-of-hospital cardiac arrests (OHCA) as a diagnosis, rather than a symptom, significantly improves the speed of cardiopulmonary resuscitation (CPR) and bystander CPR rates. This coding strategy also shows a trend towards higher survival rates for OHCA patients.
Area of Science:
- Emergency Medicine
- Public Health
- Cardiology
Background:
- Out-of-hospital cardiac arrest (OHCA) outcomes are critically influenced by pre-hospital response times and interventions.
- The initial coding of an OHCA event by emergency dispatchers can impact the subsequent emergency response.
- Understanding the relationship between dispatcher coding and patient outcomes is crucial for optimizing emergency medical services.
Purpose of the Study:
- To analyze the characteristics and outcomes of OHCA patients based on dispatcher coding (diagnosis vs. symptom).
- To investigate the impact of dispatch center alert delays on OHCA patient outcomes.
- To evaluate the correlation between dispatcher coding, CPR initiation, bystander CPR, and survival rates.
Main Methods:
- Retrospective analysis of 250 OHCA cases in Göteborg over 17 months, excluding those involving rescue teams.
- Categorization of OHCA calls based on dispatcher coding: diagnosis (cardiac arrest - CA) versus symptom (e.g., unconsciousness, breathing problems).
- Comparison of CPR start times, bystander CPR rates, and survival to hospital discharge between coding groups and by alert delay.
Main Results:
- Only 20% of OHCA cases were coded as a diagnosis (CA); the majority (80%) were coded as symptoms.
- Calls coded as CA showed significantly earlier CPR initiation (median 2 vs. 10 min) and higher bystander CPR rates (86% vs. 42%).
- Patients coded as CA trended towards higher survival to hospital discharge (14.0% vs. 6.5%), though not statistically significant (P=0.09). Alert delays did not significantly impact survival.
Conclusions:
- Coding OHCA as a diagnosis by dispatchers is associated with faster CPR and increased bystander CPR.
- This diagnostic coding approach appears to improve patient outcomes, likely due to enhanced communication and response efficiency.
- Optimizing dispatcher communication and coding protocols for OHCA can potentially enhance survival rates.
Objective:
To describe the characteristics and outcome in out-of-hospital cardiac arrest (OHCA) in relation to (i) whether OHCA was coded by the dispatcher as a diagnosis or as a symptom and (ii) the delay until the first unit was alerted at the dispatch centre.
Methods:
OHCA patients in Göteborg, during 17 months, excluding OHCA after calling the rescue team.
Results:
Among 250 cases, 20% were coded as a diagnosis (i.e. CA) with or without ongoing cardiopulmonary resuscitation (CPR). Dispatch codes for the remaining 200 patients (80%) were mostly symptom related (unconsciousness in 61%, codes related to breathing problems in 10%, other codes in 24% and missing in 5%). Patients in whom the dispatchers coded the call as CA had an earlier start to CPR after collapse (median 2 vs. 10 min; P<0.0001) and a higher rate of bystander CPR (86% vs. 42%; P<0.0001). Furthermore, they tended to have a higher rate of survival to hospital discharge (14.0% vs. 6.5%; P = 0.09). The median delay until the first unit was alerted was 1.8 min. Survival to hospital discharge was 10.0% if the delay was below median and 6.7% if the delay was above median (P = 0.48).
Conclusion:
Patients with OHCA who were not coded by dispatchers as such had a long delay to the start of CPR and a low survival. Dispatching according to diagnosis, that is, CA seems to improve these parameters most likely reflecting a more optimal communication between the dispatcher and the caller as well as the rescue team.
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