Evaluation of Out-of-Hospital Cardiac Arrest Recognition by Non-physicians Dispatchers in a French Emergency Dispatch Call Center

Out-of-hospital Cardiac Arrest Clinical Trial

— OCAR  

Official title:

Evaluation of Cardiac Arrest Recognition by Non-physicians Dispatchers in the Paris Fire Brigade Emergency Call Dispatch Center

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01992419
• Other study ID #: bspp2013
• Status: Completed
• Phase: N/A
• First received: November 7, 2013
• Last updated: December 6, 2013
• Start date: November 2013
• Est. completion date: December 2013

Study information

• Verified date: December 2013
• Source: Fire Brigade Of Paris Emergency Medicine Dept
• Contact: n/a
• Is FDA regulated: No
• Health authority: FRANCE : ANSM
• Study type: Observational [Patient Registry]

Clinical Trial Summary

The purpose of this study is to measure an improvement in the detection rate of cardiac arrest (CA) in the Dispatch Center as a result of debriefings and repeated trainings for non-medical operators who receive emergency calls.

Description:

1. . Justification

The performance of phone-guided chest compressions is recommended to minimize the No Flow risk (1). Pre-arrival instructions and dispatch-assisted chest compressions are the first link in the chain of survival, determining the effectiveness of subsequent links. This first link is only possible if a prior detection of cardiac arrest was made.

The Dispatch Center of the Fire Brigade of Paris receives more than 7,000 calls per day, including 8-10 calls for cardiac arrest. The establishment of specific training and experience feedback with emergency dispatchers should improve the detection of cardiac arrest (CA) by the same dispatchers.

2. . Objectives

The main objective is to measure an improvement in the detection rate of CA in the Dispatch Center as a result of debriefings and repeated trainings for non-medical operators who receive emergency calls.

The secondary objective is to identify risk factors for CA non-detection by those emergency dispatchers.

3. . Materials and Methods

Experimental design:

Observational prospective non-randomized controlled study. Type "before and after" study. Three observation periods are defined over a total period of 20 months.

Different actions before and during each period:

Period 1 Period 2 Period 3 Algorithm available to emergency dispatchers + + + New algorithm - - + Basic training for new operators - + + Daily briefing +/- +/- + Systematic Debreafing - - + Specific course before period - - + Table leaders training

• - + Heads of room training - - +

Period 1 is preceded and accompanied by the diffusion of a decision algorithm available to emergency dispatchers

Period 2 is accompanied by:

• Short briefings, twice daily, in the presence of operators on duty that day

• Debriefing immediately after the call with some operators (but not systematically, depending on their availability).

Period 3 is preceded by information to the Dispatch Center managers (heads of room and table leaders) and a short course about detection of CA (1 hour) for all operators. During this same period, a daily briefing for operators is established.

The study is based on the three CA call periods' audio recordings

For each period, all calls related to CA on the field were listened to and evaluated.

Each call had a double audition:

• one audition by an instructor, responsible for managing calls in the Dispatch Center, and

• one audition by two emergency physicians experienced in the management of emergency calls.

The second listening physician helped to verify, correct, and complete the variables collected during the first listening

The variables collected during listening were:

• "detectability of the CA"

• detection or not of the CA

• the causes of non-detection

• the occurrence of dispatch-assisted chest compression

• the time between the start of the call and the time the operator pronounces the words "cardiopulmonary Resuscitation" or "CPR" or "chest compressions"

• the time between the start of the call and the first real chest compression

• causes for non-realization of chest compressions

• the presence or absence of a public defibrillator

Other variables collected - Variables corresponding to the Utstein style:

• Epidemiological variables (age, sex, location, background)

• Specific backup system variables: time alert - use of an AED

• Specific first aid and medical management variables:

• type of rhythm detected by AED on the arrival of rescuers

• Success of first AED's shock (loss of ventricular fibrillaton (VF)5 seconds after shock)

• Number of shocks administered by the AED in the first 10 minutes of support by rescuers

• Recovery of a palpable pulse in the presence of rescuers, before the arrival of the medical team

• Resuscitation undertaken by the medical team YES/NO

• Injection of adrenaline: YES/NO

• Transport to the hospital with beating heart: YES/NO

• Released resuscitation YES/NO

• Survival to one year after the CA

• Quality of survival (CPC score) at 6 months, 1 year

Main judgment criteria:

• Detection of CA by the emergency dispatcher:

• Detection is considered positive if the dispatcher formalized the presence of a CA , either on the software, or orally with the words "CPR" or "chest compression" at any time during the recorded call.

• It is considered negative if the dispatcher never suggested, neither orally nor in writing, the possibility of the presence of a CA.

• Secondary endpoints:

• Median time between the start of the emergency call and the pronunciation of the words "chest compressions," by the dispatcher

• Median time elapsed between the start of the emergency call and the actual start of chest compressions by caller

• Evaluation of the ventilation mode (hand on abdomen YES/NO, count the interval between two ventilatory movements YES/NO)

4. . Statistics

Sample size We need 100 patients in each period group to observe an absolute 20% difference in the rate of CA detection, compared with the detection rate of the control group (period 1) estimated at 60%, with an alpha risk = 0.05 and an 80% power in bilateral situations.

For each period:

• Description of patient characteristics and outcome

Comparison of these periods:

• Comparison of detection rate between the reference period (P1) and each of the other periods

• The number of subjects included in each period allows the realization of a χ² test with an alpha risk retained at 5%

• Adjust the detection rate on the significantly different variables between the groups (age, sex, no flow, time of rescuer arrival)

• The period 1 and 2 will be grouped and compared with period 3.

In all periods:

• Search variables associated with successful detection

• Multivariate logistic regression analysis type

• Survival analysis.

• Description of the evolution of the detection rate over time

Recruitment information / eligibility

• Status: Completed
• Enrollment: 300
• Est. completion date: December 2013
• Est. primary completion date: December 2013
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 15 Years and older

Eligibility

Inclusion Criteria:

Patient over 15 years old (adult morphology) suffering Out-of-hospital Cardiac Arrest before or during the call to the Dispatch Center

• Patient who benefited from the installation of a automated external defibrillator (AED) before or at the time of arrival of the rescuers on the scene

Exclusion Criteria:

Patient conscious at the time of the call

• OHCA between the end of the phone call and the arrival of rescuers on site

• OHCA after the rescuers' arrival on site

• Dispatch Center alerted on "second line" from another institution (Police, SAMU), without the possibility of joining the first caller.

Study Design

Time Perspective: Prospective

Related Conditions & MeSH terms

• Heart Arrest
• Out-of-Hospital Cardiac Arrest

Locations

Country	Name	City	State
France	Paris Fire Brigade Emergency Dept	Paris

Sponsors (1)

Lead Sponsor	Collaborator
Fire Brigade Of Paris Emergency Medicine Dept

Country where clinical trial is conducted

France, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Median time elapsed between the start of the emergency call and the actual start of chest compressions by caller		one year	No
Other	Evaluation of the ventilation mode (hand on abdomen YES/NO, count the interval between two ventilatory movements YES/NO)	, all calls related to Out -of-hospital Cardiac Arrest were registered , and in the days after, listened to and evaluated.	one year	No
Primary	Ratio of CA Detected by the emergency dispatcher		one year	No
Secondary	o Median time between the start of the emergency call and the pronunciation of the words "chest compressions," by the dispatcher		one year	No