Telecommunicator cardiopulmonary resuscitation performance metrics and barriers to implementation in Birmingham,...

The bystander CPR (CPR) rate in Birmingham, Alabama is just 15.5%, contributing to one of the lowest out-of-hospital cardiac arrest (OHCA) survival rates in the United States. The utilization of telecommunicator CPR (T-CPR) in Birmingham is unknown. We aimed to evaluate existing T-CPR performance and compare local metrics to recently published American Heart Association (AHA) T-CPR guidelines.

We retrospectively reviewed all 9-1-1 audio recordings for adult (≥18 years) non-traumatic Emergency Medical Services (EMS)-treated OHCA in Birmingham during 2023. EMS-witnessed events or those occurring within healthcare or correctional facilities were excluded. T-CPR metrics were manually extracted and compared to the AHA T-CPR benchmarks using descriptive statistics.

Among 236 included OHCA cases, 94 (39.8%) were correctly recognized by telecommunicators (AHA goal: >75%). Of cases recognizable by AHA definitions, 50.0% were identified correctly by telecommunicators (AHA goal: >95%), with a median recognition time of 60 s (AHA goal: <90 s). T-CPR instructions were provided to 72.7% of recognizable cases (AHA goal: >75%), with a median time to first chest compression of 172 s (AHA goal: <150 s). When T-CPR instructions were offered to callers who were willing and able to perform CPR, chest compressions were initiated in 97.9% of cases.

Despite low rates of telecommunicator recognition of OHCA and T-CPR instruction in Birmingham, nearly all callers who received T-CPR instructions began chest compressions. Targeted improvements in T-CPR implementation represent a high-impact opportunity to increase CPR rates in Birmingham and other communities with low bystander engagement.