Clinical paperImplementation of the Los Angeles Tiered Dispatch System is associated with an increase in telecommunicator-assisted CPR
Introduction
Telecommunicator-assisted CPR (T-CPR), in which 9-1-1 dispatchers quickly identify cases of possible cardiac arrest and provide CPR instructions to callers, has been shown to significantly increase the rate of bystander CPR1, 2 and has been associated with improved survival.3, 4, 5
The Los Angeles Fire Department (LAFD)–the second largest municipal 9-1-1 response agency in the United States – used the Medical Priority Dispatch System® (MPDS) for over 25 years, from 1989–2014. MPDS is a commercial product that guides 9-1-1 telecommunicators to ask a series of scripted questions to determine the presence of an emergency medical condition. MPDS also prompts dispatchers to provide CPR instructions, though an internal evaluation of LAFD 9-1-1 calls using MPDS in October 2012 noted recurring delays in call-processing time due to the number of questions required, poor cardiac arrest recognition and prolonged total EMS response times. Among 9-1-1 calls where T-CPR was performed, it took on average 4:12 min to get the procedure started.6
In late 2014, LAFD developed a new series of scripted questions that decreased the number of questions needed to identify potential victims of cardiac arrest and lowered the threshold to provide T-CPR. This new telecommunicator dispatch system, called the Los Angeles Tiered Dispatch System (LA-TDS), went into use on December 1, 2014. LA-TDS has since been shown to decrease call processing time for time-critical 9-1-1 emergencies7 and decrease under-triage in cases of field-confirmed OHCA.8 The objective of this study was to determine if implementing LA-TDS was associated with increased provision of telecommunicator-assisted CPR in the City of Los Angeles.
Section snippets
Study overview and setting
This was an interrupted time series study (before–after design) comparing telecommunicator management of OHCA at the LAFD Dispatch Center during two separate 3-month periods occurring one year apart, either before (Jan–March 2014) or immediately after (Jan–March 2015) implementation of the new LA-TDS (December 2014).
LAFD is the sole 9-1-1 response agency for the City of Los Angeles – which is home to 4.1 million inhabitants and includes a catchment area of 480 square miles. The LAFD
Results
For the combined study period of January–March 2014 and January–March 2015, 597 9-1-1 calls met study criteria, including 289 in the MPDS cohort (2014Q1-3) and 308 in the LA-TDS cohort (2015Q1-3). A flow diagram and description of excluded cases are shown in Fig. 1.
Discussion
Implementation of the new Los Angeles Tiered Dispatch System was associated with a significant increase in the prevalence of telecommunicator-assisted CPR; a greater proportion of OHCA patients being recognized within 1 min and having T-CPR started within 2 min; and significantly faster mean and median times to OHCA recognition, dispatch of resources, and initiation of T-CPR.
To our knowledge this is the first report comparing telecommunicator performance in OHCA management following
Conclusions
Dispatchers using the new Los Angeles Tiered Dispatch System significantly outperformed MPDS® in promoting telecommunicator-assisted CPR. Further studies are needed to identify the precise elements of this new dispatch system responsible for improved T-CPR as well as their effect on patient outcomes.
Conflicts of interest
None of the authors have financial conflicts of interest to declare.
Funding
The authors declare that they have no financial or personal relationships with other people or organizations that could inappropriately influence (bias) their work.
Authorship
All authors have made substantial contributions to all of the following: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted. There is no overlap between this publication and previous publications, and this manuscript, including related data, figures, and tables, has not been published previously. This
CRediT author statement
Stephen Sanko: Conceptualization, Investigation, Methodology, Supervision, Project administration, Validation, Writing – Original Draft.
Saman Kashani: Investigation, Writing – Review & Editing.
Christianne Lane: Data Curation, Formal analysis, Writing – Review & Editing.
Marc Eckstein: Conceptualization, Validation, Writing – Review & Editing.
Declaration of Competing Interest
The authors report no declarations of interest.
Acknowledgements
The authors wish to thank the research associates that participated in this study's call review process, including Jay Balagna, Luci Cassella, Abe Flinders, Pavan Reddy, and Sumeet Sidhu. We also wish to thank the members of the Los Angeles Fire Department Dispatch Workgroup for their tireless efforts to provide innovative care for their community. This publication was supported by NIH/NCRR SC CTSI Grant UL1TR001855. Its contents are solely the responsibility of the authors and do not
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