Elsevier

Resuscitation

Volume 155, October 2020, Pages 74-81
Resuscitation

Clinical paper
Implementation of the Los Angeles Tiered Dispatch System is associated with an increase in telecommunicator-assisted CPR

Presented, in part, at the American College of Emergency Physicians Annual Conference, Boston, MA, October 2015.
https://doi.org/10.1016/j.resuscitation.2020.06.039Get rights and content

Abstract

Background

In 2015, the Los Angeles Fire Department (LAFD) replaced the Medical Priority Dispatch System® (MPDS) with a new, homegrown Los Angeles Tiered Dispatch System (LA-TDS). The objective of this study was to assess the impact of this new dispatch system on telecommunicator-assisted CPR (T-CPR).

Methods

This was an interrupted time series study of out-of-hospital cardiac arrest (OHCA) cases where resuscitation was attempted with LAFD 9-1-1 telecommunicators using either MPDS® (January 1, 2014 to March 31, 2014) or LA-TDS (January 1, 2015 to March 31, 2015). Trained non-LAFD abstractors listened to all 9-1-1 calls and recorded if T-CPR was initiated, and the elapsed time from the start of the call until key events. The primary outcome was prevalence of T-CPR.

Results

Of 1027 calls during the study period, 597 9-1-1 calls met study inclusion/exclusion criteria (including 289 in MPDS cohort, 308 in LA-TDS cohort). The prevalence of T-CPR was significantly greater using LA-TDS (57%) vs. MPDS (43%) (OR 1.86, 95% CI 1.3–2.6). The LA-TDS cohort demonstrated a significant decrease (p < 0.001) in time to recognition of cardiac arrest, time to dispatch, and time to first T-CPR chest compression while there was no significant difference in the elapsed time to first description of agonal breathing. For cases where the telecommunicator had the opportunity to assess consciousness and breathing, there was a significant improvement in cardiac arrest recognition in < 1 min, prevalence of T-CPR (p < 0.001), and T-CPR started in <2 min (p < 0.001).

Conclusion

Implementation of the new Los Angeles Tiered Dispatch System was associated with decreased time to recognition of cardiac arrest and an increased rate of T-CPR compared to the previously used Medical Priority Dispatch System®.

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

References (17)

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