Implementation of the Los Angeles Tiered Dispatch System is associated with an increase in telecommunicator-assisted CPR.
Dispatch
Emergency Medical Services
Telecommunicator-assisted CPR
Journal
Resuscitation
ISSN: 1873-1570
Titre abrégé: Resuscitation
Pays: Ireland
ID NLM: 0332173
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
04
11
2019
revised:
25
06
2020
accepted:
30
06
2020
pubmed:
30
7
2020
medline:
22
6
2021
entrez:
30
7
2020
Statut:
ppublish
Résumé
In 2015, the Los Angeles Fire Department (LAFD) replaced the Medical Priority Dispatch System® (MPDS) with a new, homegrown Los Angeles Tiered Dispatch System (LA-TDS). The objective of this study was to assess the impact of this new dispatch system on telecommunicator-assisted CPR (T-CPR). This was an interrupted time series study of out-of-hospital cardiac arrest (OHCA) cases where resuscitation was attempted with LAFD 9-1-1 telecommunicators using either MPDS® (January 1, 2014 to March 31, 2014) or LA-TDS (January 1, 2015 to March 31, 2015). Trained non-LAFD abstractors listened to all 9-1-1 calls and recorded if T-CPR was initiated, and the elapsed time from the start of the call until key events. The primary outcome was prevalence of T-CPR. Of 1027 calls during the study period, 597 9-1-1 calls met study inclusion/exclusion criteria (including 289 in MPDS cohort, 308 in LA-TDS cohort). The prevalence of T-CPR was significantly greater using LA-TDS (57%) vs. MPDS (43%) (OR 1.86, 95% CI 1.3-2.6). The LA-TDS cohort demonstrated a significant decrease (p < 0.001) in time to recognition of cardiac arrest, time to dispatch, and time to first T-CPR chest compression while there was no significant difference in the elapsed time to first description of agonal breathing. For cases where the telecommunicator had the opportunity to assess consciousness and breathing, there was a significant improvement in cardiac arrest recognition in < 1 min, prevalence of T-CPR (p < 0.001), and T-CPR started in <2 min (p < 0.001). Implementation of the new Los Angeles Tiered Dispatch System was associated with decreased time to recognition of cardiac arrest and an increased rate of T-CPR compared to the previously used Medical Priority Dispatch System®.
Sections du résumé
BACKGROUND
In 2015, the Los Angeles Fire Department (LAFD) replaced the Medical Priority Dispatch System® (MPDS) with a new, homegrown Los Angeles Tiered Dispatch System (LA-TDS). The objective of this study was to assess the impact of this new dispatch system on telecommunicator-assisted CPR (T-CPR).
METHODS
This was an interrupted time series study of out-of-hospital cardiac arrest (OHCA) cases where resuscitation was attempted with LAFD 9-1-1 telecommunicators using either MPDS® (January 1, 2014 to March 31, 2014) or LA-TDS (January 1, 2015 to March 31, 2015). Trained non-LAFD abstractors listened to all 9-1-1 calls and recorded if T-CPR was initiated, and the elapsed time from the start of the call until key events. The primary outcome was prevalence of T-CPR.
RESULTS
Of 1027 calls during the study period, 597 9-1-1 calls met study inclusion/exclusion criteria (including 289 in MPDS cohort, 308 in LA-TDS cohort). The prevalence of T-CPR was significantly greater using LA-TDS (57%) vs. MPDS (43%) (OR 1.86, 95% CI 1.3-2.6). The LA-TDS cohort demonstrated a significant decrease (p < 0.001) in time to recognition of cardiac arrest, time to dispatch, and time to first T-CPR chest compression while there was no significant difference in the elapsed time to first description of agonal breathing. For cases where the telecommunicator had the opportunity to assess consciousness and breathing, there was a significant improvement in cardiac arrest recognition in < 1 min, prevalence of T-CPR (p < 0.001), and T-CPR started in <2 min (p < 0.001).
CONCLUSION
Implementation of the new Los Angeles Tiered Dispatch System was associated with decreased time to recognition of cardiac arrest and an increased rate of T-CPR compared to the previously used Medical Priority Dispatch System®.
Identifiants
pubmed: 32721415
pii: S0300-9572(20)30281-1
doi: 10.1016/j.resuscitation.2020.06.039
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
74-81Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR001855
Pays : United States
Informations de copyright
Copyright © 2020 Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest The authors report no declarations of interest.