By Scott Freitag
A review of the 2015 American Heart Association (AHA) guidelines for CPR proves the visionary work of the Academy and its Medical Priority Dispatch System (MPDS). The recommendations, which the AHA updates for release every five years, include greater recognition of an EMD’s vital role with initiating CPR and, also, the importance of information an EMD collects and provides to EMS crews arriving on scene. The role is one the Academy has long advocated. The EMD’s role in giving lifesaving instructions to the caller and gathering information for use in response is the essence of protocol.
The “2015 AHA Guidelines Update” marks 49 years since the first set of guidelines were published in 1966 and focuses on topics with significant new science. For example, “Part 4: Systems of Care and Continuous Quality Improvement” is new to 2015, with its concentration on integrated processes necessary to create systems of care for both in-hospital and out-of-hospital resuscitation. This section is especially relevant to emergency dispatch in its separation of the AHA adult chain of survival into two chains—one for in-hospital and one for out-of-hospital care systems.
AHA’s credit to dispatch is implicit in updated section 4.5. However, not only do the guidelines address the importance of bystander instructions but, also, the significance of educating dispatchers to “identify unconsciousness with abnormal and agonal gasps across a range of clinical presentations and descriptions.”
Evidence supporting the recommendation points to the
“In systems that currently have protocols to aid dispatchers in the recognition of cardiac arrest, the sensitivity when using protocols ranged from 38 percent to 96.9 percent, with a specificity exceeding 99 percent. Use of these scripted protocols has been shown to increase the rate of dispatcher-guided CPR. The identification of abnormal breathing or agonal gasps is particularly important in the recognition of cardiac arrest by emergency dispatchers.”
The MPDS EMD certification course has long taught emergency dispatchers to recognize agonal breathing (gasping), and the Agonal Breathing Diagnostic Tool provides real-time EMD support. Changes to the airway and breathing panels in MPDS v12.2 further enhanced compliance to de-emphasizing the breathing check and removing the old “Look, Listen, and Feel” method from the BLS algorithm.
The AHA also cited research (section 4.6.1) showing an absolute survival benefit of 2.45 with the use of dispatcher instructions for continuous compressions over traditional CPR. These recommendations are incorporated into the MPDS (and have been since 2004), with a caveat allowing for eventual ventilations in cases of extended response times. Beginning with version 11.2, a Compressions 1st pathway was introduced to facilitate rapid delivery of compressions.
The Academy stays far ahead of the curve ball because, again consistent with AHA 2015 guidelines, the Academy relies on a system of care approach for developing “consistent, clear goals aimed at decreasing incidence of and improving survival from cardiac arrest” based on “high-quality data measurement, feedback, and comparison.”
Members can look forward to a much more detailed and dispatch-specific article in a later issue of the Journal, integrating discussion from the Emergency Cardiovascular Care Update (ECCU) 2015 Conference held in December. The ECCU meeting—The New Resuscitation Guidelines: Translating Science into Survival—detailed the new guidelines, which were presented by the actual researchers, and, in addition, elaborated on how the guidelines should be applied.
Brett Patterson, IAED Medical Council of Standards Chair, attended the annual meeting in the interest of evolving the MPDS. At the 2015 conference, he presented the IAED’s abstract: “Dispatcher-assisted bystander cardiopulmonary resuscitation increases when using the Medical Priority Dispatch System’s standardized Pre-Arrival Instructions: Kansas City experience.”
Watch the “Hands-on-Chest” video at www.prioritydispatch.net/cpr-video-act-fast-save-a-life/.