Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, TaoYuan, Taiwan.
Department of Emergency Medicine, Ton-Yen General Hospital, Hsinchu, Taiwan.
Emerg Med J. 2019 Oct;36(10):595-600. doi: 10.1136/emermed-2018-208353. Epub 2019 Aug 22.
This study determined the impact of the caller's emotional state and cooperation on out-of-hospital cardiac arrest (OHCA) recognition and dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) performance metrics.
This was a retrospective study using data from November 2015 to October 2016 from the emergency medical service dispatching centre in northern Taiwan. Audio recordings of callers contacting the centre regarding adult patients with non-traumatic OHCA were reviewed. The reviewers assigned an emotional content and cooperation score (ECCS) to the callers. ECCS 1-3 callers were graded as cooperative and ECCS 4-5 callers as uncooperative and highly emotional. The relation between ECCS and OHCA recognition, time to key events and DA-CPR delivery were investigated.
Of the 367 cases, 336 (91.6%) callers were assigned ECCS 1-3 with a good inter-rater reliability (=0.63). Dispatchers recognised OHCA in 251 (68.4%) cases. Compared with callers with ECCS 1, callers with ECCS 2 and 3 were more likely to give unambiguous responses about the patient's breathing status (adjusted OR (AOR)=2.6, 95% CI 1.1 to 6.4), leading to a significantly higher rate of OHCA recognition (AOR=2.3, 95% CI 1.1 to 5.0). Thirty-one callers were rated uncooperative (ECCS 4-5) but had shorter median times to OHCA recognition and chest compression (29 and 122 s, respectively) compared with the cooperative caller group (38 and 170 s, respectively). Nevertheless, those with ECCS 4-5 had a significantly lower DA-CPR delivery rate (54.2% vs 85.9%) due to 'caller refused' or 'overly distraught' factors.
The caller's high emotional state is not a barrier to OHCA recognition by dispatchers but may prevent delivery of DA-CPR instruction. However, DA-CPR instruction followed by first chest compression is possible despite the caller's emotional state if dispatchers are able to skilfully reassure the emotional callers.
本研究旨在确定来电者的情绪状态和配合程度对院外心脏骤停（OHCA）识别和调度员辅助心肺复苏（DA-CPR）性能指标的影响。
这是一项回顾性研究，使用了 2015 年 11 月至 2016 年 10 月来自台湾北部紧急医疗服务调度中心的数据。审查了来电者拨打中心报告非创伤性 OHCA 成年患者的音频记录。审查员为来电者分配了情绪内容和配合评分（ECCS）。ECCS 1-3 分的来电者被评为配合，ECCS 4-5 分的来电者被评为不配合和高度情绪化。研究了 ECCS 与 OHCA 识别、关键事件时间和 DA-CPR 实施之间的关系。
在 367 例病例中，336 例（91.6%）来电者的 ECCS 评分为 1-3，具有良好的组内一致性（=0.63）。调度员识别出 251 例（68.4%）OHCA。与 ECCS 为 1 的来电者相比，ECCS 为 2 和 3 的来电者更有可能对患者的呼吸状态做出明确的回应（调整后的比值比（OR）=2.6，95%置信区间 1.1-6.4），导致 OHCA 识别率显著提高（OR=2.3，95%置信区间 1.1-5.0）。31 名来电者被评为不配合（ECCS 4-5），但 OHCA 识别和胸部按压的中位数时间明显短于配合的来电者组（分别为 29 和 122s）。然而，由于“来电者拒绝”或“过度心烦意乱”因素，ECCS 为 4-5 的来电者 DA-CPR 实施率显著较低（54.2% 对 85.9%）。
来电者的高度情绪化并不是调度员识别 OHCA 的障碍，但可能会阻止 DA-CPR 指令的实施。然而，如果调度员能够熟练地安抚情绪激动的来电者，那么在来电者情绪激动的情况下，仍然可以在下达 DA-CPR 指令后立即进行第一次胸部按压。
