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Understanding cardiac arrest dispatch of physician-paramedic critical care prehospital teams: a survey-based
Sarah Morton1,2, Chris Eagle3, Scott Wallman3
1Essex and Herts Air Ambulance, Colchester, UK sarah.morton@doctors.org.uk.
Insights
Dispatchers prioritize witnessed cardiac arrest for critical care teams in out-of-hospital cardiac arrest (OHCA) calls. Decisions involve nuanced factors beyond simple age, aiming to improve emergency care outcomes.
Area of Science:
- Emergency Medicine
- Prehospital Care
- Critical Care Paramedicine
Background:
- Out-of-hospital cardiac arrest (OHCA) response is a key UK emergency care research priority.
- Optimizing the dispatch of critical care teams to OHCA is crucial for improving patient survival.
- This study investigates the criteria used for dispatching physician-paramedic teams to OHCA events.
Purpose of the Study:
- To identify and analyze the criteria influencing the dispatch of critical care physician-paramedic teams to OHCA.
- To understand dispatcher decision-making processes in a specific UK region.
- To inform potential improvements in prehospital emergency care protocols.
Main Methods:
- An anonymised online survey was distributed to dispatchers at the East of England Ambulance Service NHS Trust.
- Participants included clinicians and non-clinicians involved in critical care dispatch.
- The survey assessed the impact of 15 predetermined criteria on dispatch decisions for OHCA, including free-text responses.
Main Results:
- A 79% response rate was achieved among clinical dispatchers (19 paramedics) and 17% among non-clinical dispatchers (1 dispatcher).
- 'Witnessed cardiac arrest' and 'return of spontaneous circulation' were universally used dispatch criteria (100%).
- Ten of fifteen criteria were deemed important by at least 75% of respondents, with 'age' considered contextually (paediatric, frailty, physiological reserve).
Conclusions:
- 'Witnessed arrest' was the sole criterion with unanimous agreement among dispatchers.
- Dispatcher decisions involve nuanced considerations beyond predefined criteria, such as identifying frailty.
- Further UK-wide research is recommended to identify common factors in OHCA dispatch and enhance survival rates.
Background:
Appropriate dispatch of critical care teams to out-of-hospital cardiac arrest (OHCA) has been identified as a research priority emergency care in the UK. The study aimed to understand the criteria informing the decision to dispatch a critical care physician-paramedic prehospital team to OHCA in one UK region.
Methods:
An invitation to participate in an anonymised online survey was sent by email to clinicians and non-clinicians working on the critical care (physician-paramedic) dispatch desk for the East of England Ambulance Service NHS Trust between June and July 2023. Demographic data relating to the experience of the dispatchers were collected alongside evaluating the effect of 15 predetermined criteria on OHCA dispatch (based on a pilot survey) on their decision to dispatch a physician-paramedic team. Responses to closed-end questions were calculated as percentages. A compulsory free text question on dispatching the physician-paramedic team was included. Free text data were interpreted by one author and the interpretation reviewed by all authors.
Results:
20 respondents (19 critical care paramedics and one non-clinical dispatcher) participated, yielding a 79% response rate for clinical and 17% for non-clinical dispatchers. 'Witnessed cardiac arrest' and return of spontaneous circulation achieved on scene were criteria used by 100% of respondents in informing dispatch of a physician-paramedic team to OHCA. 10 of the 15 preidentified criteria were considered important in their decision-making by at least 75% of respondents. 'Age' was considered as more than just a number, instead incorporating both the nuances of a paediatric cardiac arrest and the importance of physiological reserve and frailty.
Conclusion:
The only 100% agreement in dispatch criteria was 'witnessed arrest'. Otherwise, variation existed and additional information, like identification of frailty, was gathered to support nuanced decision-making. Wider research across the UK would help identify factors and commonalities in OHCA physician-paramedic dispatch to target improved survival rates.
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