Since the initial release of the Dispatcher-Directed CPR (DD-CPR) course in April 2022, the International Academies of Emergency Dispatch® (IAED™) now celebrates the amazing milestone of training and certifying over 20,000 Emergency Medical Dispatchers (EMDs)—each equipped to provide critical CPR instructions confidently in the nonvisual environment.
The DD-CPR course is not intended to replace the in-person, hands-on-chest CPR training required for initial EMD certification. Rather, it serves as an enhancement uniquely designed to connect the practice of physically giving compressions with the EMD’s role of remotely guiding a caller through instructions they may not have ever done before. This course addresses the essential skill set of the first, first responder in these lifesaving efforts.
Certified EMDs are offered the two-hour online CPR recertification course at no cost through the College of Emergency Dispatch, based on the protocol tools they already operate at the console. This online course officially replaces the physical (hands-on) CPR recertification training usually required every two years. The DD-CPR course provides lessons with the latest research and recommendations from the cardiac community—in accordance with the American Heart Association and other international resuscitation councils—while allowing EMDs to practice simulations on ProQA® software. This combination encourages mastery of both the knowledge and experience EMDs need to handle these critically stricken lives on the line.
The benefit of certifying 20,000 EMDs in DD-CPR impacts a much broader population of cardiac arrest patients, a crucial focus recognized by EMDs putting their training into everyday practice. Their voices add to the growing evidence that the DD-CPR course is a new step in the right direction for a greater dispatch potential for impact in critical patient care.
Franklin County Regional Communication Center (Maine, USA)
“The DD-CPR course gives you earlier recognition of what to look for in a potential cardiac arrest patient,” said Dispatch Supervisor Jace Poulin. “You learn to listen for verbiage the caller might use like ‘gasping for air,’ ‘barely breathing,’ and, most often, ‘strange or abnormal snoring.’” These key phrases help EMDs go directly to CPR instructions rather than lose precious time.
Brett Patterson, IAED Medical Council of Standards Chair, agrees that helping Emergency Dispatchers recognize what to pick up on is vital, including the clinical significance of the caller’s description of “snoring”:
While normal snoring is easily recognized by most lay people, snoring associated with agonal or ineffective breathing is most often described as being different, with terms like “some sort of snoring sound,” “kinda like he’s snoring,” or “it sounds like a snoring noise.” This is because the “snoring-like” sounds associated with cardiac arrest are irregular and inconsistent, and they rapidly get worse/diminish with time, whereas “normal” snoring is generally regular and not alarming to the caller. Just as important to recognition is that cardiac arrest scenarios typically involve a sudden, unexplained collapse followed by unresponsiveness, which is atypical of regular snoring. This is why finding out exactly what happened is so integral to cardiac arrest recognition, just as it is to any complaint in our nonvisual realm.
“I’d rather err on having hands-on-chest if there is uncertainty,” Poulin said. Relying upon the caller’s descriptions can be challenging when the typical layperson may not be familiar with signs of cardiac or respiratory arrest. Doubt or panic can also overwhelm logic, but the DD-CPR training takes away the guesswork.
“This class has made me more confident in the entire CPR process,” Poulin said. “It’s not always at the forefront of my thoughts as I’m giving instructions, but it plays a vital role of preparing me to guide the caller through one of their worst moments and give them tools and hope.”
The Franklin County Regional Communication Center has incorporated the DD-CPR course into their required annual training. “As a supervisor, I’m thrilled with this course and more confident in my people learning what I’ve learned and practicing what I’ve practiced,” he said.
That practice came into play for Poulin in February when a caller initially reported that his wife was not breathing well. The caller’s calm demeanor and complaint description didn’t initially indicate a cardiac arrest situation, but, through questioning, he recognized that the ineffectively breathing patient required CPR.
“It’s hard to help a caller recognize that their loved one isn’t breathing effectively,” Poulin said. With repetitive persistence, he encouraged the caller to begin and keep up compressions until help could take over. Occasionally the man would report that the patient had begun breathing again, but her inconsistent gasps indicated to Poulin that this was agonal or ineffective breathing and they needed to keep going. He later discovered compressions kept the woman alive.
“It’s absolutely incredible to know that your training and instructions could help save a life, and that day it did,” he said.
Charleston County Public Safety Consolidated 9-1-1 Dispatch Center (South Carolina, USA)
Logan Turner, PST II and Call Taking CTO, has already taken the DD-CPR course a couple of times, refreshing his knowledge on evolving recommendations. “There was a recent update about being able to do CPR on a patient’s back in cases where the caller lacks the strength to flip the patient over,” he said. “The DD-CPR course has helped me pinpoint my focus on keeping that patient’s blood pumping in any form, rather than expending all of the caller’s energy on getting into the optimal positioning.”
While the hands-on-chest CPR training is a valuable tool to help EMDs understand the efforts behind consistent compressions, the DD-CPR course specifically gives EMDs trained ears and a voice to help guide the caller’s actions. “I like to understand the background of how and why emergency practices change,” Turner said. “For instance, the DD-CPR course helped me recognize respiratory arrest, which is treated nearly the same way as cardiac arrest, but I learned why ventilations are performed first only in certain cases.”
Specific training also helps combat the intimidation factor, especially for beginners. “If you’re new to this field, it’s natural to feel the gravity and responsibility of trying to save a person’s life for the first time,” he said. “Giving CPR instructions was pretty scary when I first started nearly five years ago, but additional training and experience improved my confidence.”
In January, Turner had the opportunity to talk an elderly woman through lifesaving CPR for her husband after his sudden collapse. Initially, the woman was too panicked to focus, but Turner helped her breathe through the emotion and begin compressions. When responders took over, they administered two defibrillation shocks. The patient returned to consciousness, attempting to speak in the ambulance after a severe and deadly ST-elevation myocardial infarction (STEMI). He left the hospital a short time afterward.
“My instructions helped give this man more time on this earth with his wife,” Turner said.
Turner likes to envision his role as verbally putting his arm around the caller to reassure and direct what needs to be done for the patient. His DD-CPR training helps him translate the caller’s panic, hesitation, and uncertainty into immediate action. “I’d rather have the patient deal with an unnecessary broken rib than have them die while waiting to do something,” Turner said.
REMSA Health Regional Emergency Communications Center (Nevada, USA)
EMDs from REMSA Health had a lot to say about the DD-CPR course.
Communications Education/QI Coordinator Marcy Kearns loves how the DD-CPR course provides EMDs with a pathophysiological perspective, like recognizing how agonal breathing can lead the caller to believe the patient is breathing, while it is not effective enough to keep the person alive for very long.
For Kendra Davis, Manager, it’s meaningful to know a patient’s positive outcome wouldn’t have been possible without the Emergency Dispatcher’s and caller’s cohesive efforts.
Rayanne Smith-Looman, Communications Specialist II, feels the DD-CPR training is successful if it only bridges those few extra minutes until EMS arrives.
Kearns agrees and appreciates the tools included in the course. “The DD-CPR course prompts EMDs to begin CPR before we lose that opportunity, providing tools to explain to the caller how the patient is benefiting from what they are doing,” she said. “The lessons include a really great visual of the impact to the person’s brain the longer CPR is delayed.”
The influence of that knowledge is significant and measurable. “When reviewing calls as a Q, I can clearly identify the EMDs who have benefitted from the DD-CPR course,” Kearns said.
In her role as Manager, Airelle Romo appreciates how the DD-CPR course puts the caller’s descriptions into dispatch language. “A lot of our EMDs have not seen these incidents in the field, so this training helps them grab onto the words necessary to start CPR.”
In the case of an undesired outcome, Romo points out that performing compressions perfuses the patient’s organs enough to allow the possibility of organ donation, always focused on the preservation of life, even if it’s not the patient’s.
Conclusion
Ultimately, the IAED’s widely praised DD-CPR course gives informed EMDs, invested callers, and desperate patients a fighting chance with immediate help. Jeff Clawson, M.D., Chair of the Rules Group of the IAED Medical Council of Standards and Medical Director of the Research, Standards, and Academics Division, has often stated, "Remember, in cardiac arrest, Emergency Dispatchers are truly the ‘first,’ first responders with an unbeatable ‘zero-minute’ response time. These now more precisely trained professionals are there the second the phone stops ringing—they’re just there by remote control."
The confidence inspired by the DD-CPR course provides reassurance through every compression. Dr. Clawson brings to light just how valuable that is with his experience from many years ago:
“I heard a new EMD named Jennie Greenwood working in the Greater Manchester UK Centre tell an unconsolable, crying wife of an elderly man in cardiac arrest, ‘It’s okay, we can do this together!’ And, together with the IAED’s novel, new DD-CPR special course, ‘We can now all do this together—and even better!!’”
