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Discrepancies in Bystander CPR Documentation: Comparing the Birmingham CARES Data with 9-1-1 Audio Review.
Ryan A Coute1,2, Timothy Smith1, Brian H Nathanson3
1Department of Emergency Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Prehospital Emergency Care
|November 17, 2025
Summary
Emergency medical services (EMS) documentation of bystander cardiopulmonary resuscitation (B-CPR) in out-of-hospital cardiac arrest (OHCA) cases shows fair agreement with 9-1-1 audio review. Discrepancies highlight the need for continuous telecommunicator CPR instruction.
Area of Science:
- Emergency Medicine
- Public Health
- Cardiology
Background:
- Bystander cardiopulmonary resuscitation (B-CPR) is crucial for improving survival rates in out-of-hospital cardiac arrest (OHCA).
- Accurate documentation of B-CPR by emergency medical services (EMS) is essential for quality improvement and research.
Purpose of the Study:
- To evaluate the agreement between B-CPR documented by EMS in the Birmingham Cardiac Arrest Registry to Enhance Survival (CARES) and B-CPR identified through 9-1-1 audio review.
- To identify discrepancies in B-CPR documentation and their potential causes.
Main Methods:
- Retrospective observational analysis of adult non-traumatic OHCA cases in Birmingham (2023).
- Comparison of B-CPR status from EMS documentation in CARES versus B-CPR identified through 9-1-1 audio review.
- Agreement assessed using percent agreement, Cohen's kappa, Gwet's AC, and McNemar's test.
Main Results:
- EMS documented a B-CPR rate of 12.3%, while audio review indicated 27.5%.
- Overall agreement was fair to moderate (Cohen's kappa = 0.28).
- Discrepancies occurred in 23.7% of cases, primarily due to early termination of B-CPR by callers or potential EMS misclassification.
Conclusions:
- A significant portion of OHCA cases showed discrepancies between EMS documentation and 9-1-1 audio review regarding B-CPR provision.
- Most discrepancies stemmed from B-CPR termination before EMS arrival.
- Sustained telecommunicator CPR instruction until EMS arrival is critical.
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