Description of call handling in emergency medical dispatch centres in Scandinavia: recognition of out-of-hospital cardiac arrests and dispatcher-assisted CPR

Background The European resuscitation council have highlighted emergency medical dispatch centres as an important key player for early recognition of Out-of-Hospital Cardiac Arrest (OHCA) and in providing dispatcher assisted cardiopulmonary resuscitation (CPR) before arrival of emergency medical services. Early recognition is associated with increased bystander CPR and improved survival rates. The aim of this study is to describe OHCA call handling in emergency medical dispatch centres in Copenhagen (Denmark), Stockholm (Sweden) and Oslo (Norway) with focus on sensitivity of recognition of OHCA, provision of dispatcher-assisted CPR and time intervals when CPR is initiated during the emergency call (NO-CPRprior), and to describe OHCA call handling when CPR is initiated prior to the emergency call (CPRprior). Methods Baseline data of consecutive OHCA eligible for inclusion starting January 1st 2016 were collected from respective cardiac arrest registries. A template based on the Cardiac Arrest Registry to Enhance Survival definition catalogue was used to extract data from respective cardiac arrest registries and from corresponding audio files from emergency medical dispatch centres. Cases were divided in two groups: NO-CPRprior and CPRprior and data collection continued until 200 cases were collected in the NO-CPRprior-group. Results NO-CPRprior OHCA was recognised in 71% of the calls in Copenhagen, 83% in Stockholm, and 96% in Oslo. Abnormal breathing was addressed in 34, 7 and 98% of cases and CPR instructions were started in 50, 60, and 80%, respectively. Median time (mm:ss) to first chest compression was 02:35 (Copenhagen), 03:50 (Stockholm) and 02:58 (Oslo). Assessment of CPR quality was performed in 80, 74, and 74% of the cases. CPRprior comprised 71 cases in Copenhagen, 9 in Stockholm, and 38 in Oslo. Dispatchers still started CPR instructions in 41, 22, and 40% of the calls, respectively and provided quality assessment in 71, 100, and 80% in these respective instances. Conclusions We observed variations in OHCA recognition in 71–96% and dispatcher assisted-CPR were provided in 50–80% in NO-CPRprior calls. In cases where CPR was initiated prior to emergency calls, dispatchers were less likely to start CPR instructions but provided quality assessments during instructions.publishedVersio

Bystander CPR : New aspects of CPR training among students and the importance of bystander education level on survival

Background: It has been proved that bystander cardiopulmonary resuscitation (CPR) saves lives; however, which training method in CPR is most instructive and whether survival is affected by the training level of the bystander have not yet been fully described. Aim: To identify the factors that may affect 7th grade students’ acquisition of CPR skills during CPR training and their willingness to act, and to describe 30-day survival from outof- hospital cardiac arrest (OHCA) after bystander CPR and the actions performed by laymen versus off-duty medically educated personnel. Methods: Studies I–III investigate a CPR training intervention given to students in 7th grade during 2013–2014. The classes were randomized to the main intervention: the mobile phone application (app) or DVD-based training. Some of the classes were randomized to one or several additional interventions: a practical test with feedback, reflection, a web course, a visit from elite athletes and automated external defibrillator (AED) training. The students’ practical skills, willingness to act and knowledge of stroke symptoms, symptoms of acute myocardial infarction (AMI) and lifestyle factors were assessed directly after training and at 6 months using the Laerdal PC SkillReporting system (and entered into a modified version of the Cardiff test scoring sheet) and a questionnaire. The Cardiff test resulted in a total score of 12–48 points, and the questionnaire resulted in a total score of 0–7 points for stroke symptoms, 0–9 points for symptoms of AMI and 0– 6 points on lifestyle factors. Study IV is based on retrospective data from the national quality register, the Swedish registry of cardiopulmonary resuscitation, 2010-2014. Results: A total of 1339 students were included in the CPR training intervention. The DVD-based group was superior to the app-based group in CPR skills, with a total score of 35 (SD 4.o) vs 33 (SD 4.2) points directly after training (p<0.001) and 33 (SD 4.0) vs 31 (SD 4.2) points at six months (p<0.001). Of the additional interventions, the practical test with feedback had the greatest influence regarding practical skills: at six months the intervention group scored 32 (SD 3.9) points and the control group (CPR only) scored 30 (SD 4.0) points (p<0.001). Reflection, the web course, visits from elite athletes and AED training did not further increase the students’ acquisition of practical CPR skills. The students who completed the web course Help-Brain-Heart received a higher total score for theoretical knowledge in comparison with the control group, directly after training: stroke 3.8 (SD 1.8) vs 2.7 (SD 2.0) points (p<0.001); AMI 4.0 (SD 2.0) vs 2.5 (SD 2.0) points (p<0.001); lifestyle factors 5.4 (SD 1.2) vs 4.5 (SD 2.0) points p<0.001. Most of the students (77% at 6 months), regardless of the intervention applied, expressed that they would perform both chest compressions and ventilations in a cardiac arrest (CA) situation involving a relative. If a stranger had CA, a significantly lower proportion of students (32%; p<0.001) would perform both compressions and ventilations. In this case, however, many would perform compressions only. In most cases of bystander-witnessed OHCA, CPR was performed by laymen. Off-duty health care personnel bystanders initiated CPR within 1 minute vs 2 minutes for laymen (p<0.0001). Thirty-day survival was 14.7% among patients who received CPR from laymen and 17.2% (p=0.02) among patients who received bystander CPR from off-duty health care personnel. Conclusions: The DVD-based method was superior to the app-based method in terms of teaching practical CPR skills to 7th grade students. Of the additional interventions, a practical test with feedback was the most efficient intervention to increase learning outcome. The additional interventions, reflection, web course, visit from elite athletes and AED did not increase CPR skills further. However, the web course Help-Brain-Heart improved the students’ acquisition of theoretical knowledge regarding stroke, AMI and lifestyle factors. For OHCA, off-duty health care personnel bystanders initiated CPR earlier and 30-day survival was higher compared with laymen bystanders

CPR training in 7th grade. Instructor-led or DVD-based, which teaching method is most effective?

Syfte: var att undersöka vilken pedagogisk metod, instruktörsledd eller filmbaserad med facilitator som ger bäst kunskap såväl kortsiktigt som långsiktigt vid hjärt-lungräddningsutbildning (HLR) i årskurs sju. Syftet var även att undersöka elevers motivation till att ingripa i en akut hjärtstoppssituation. Teori Då lärande enligt läroplanen ska ske i social miljö, genom samspel har jag i studien valt att utgå från det sociokulturella perspektivet där kontexten är viktig i ett sammanhang, i kombination med praktikorienterad teori för att beskriva lärandet. Metod Datainsamling har skett genom en kombination av kvantitativ och kvalitativ metod. Åttio elever utförde treminuters praktiskt test direkt efter utbildningstillfället i HLR samt efter tre månader. Bedömning av medvetandekontroll och andningskontroll utfördes genom direktobservation. Kvalitet på utförd HLR registrerades via en övningsdocka kopplad till ett datorbaserat program, Leaerdal PC skill reporter. Insamlad data registrerades i en modifierad version av mätinstrumentet Cardiff Test. I testet bedömdes 13 variabler med total poängsumma 12-48 poäng. Primärt effektmått var den totala poängen med enskilda variabler som sekundär endpoints. En hypotes är att det inte är någon skillnad mellan utbildningsmetoderna gällande elevernas totalpoäng, vilket medför att den filmbaserade metoden är effektivare då den utförts i helklass. Semistrukturerade intervjuer genomfördes direkt efter utbildningstillfället för att undersöka elevers motivation till att göra en livräddande insats. Resultat: Ingen signifikant skillnad ses mellan utbildningsgrupperna beträffande kvalitetstestets totalpoäng, vare sig vid mätning direkt efter utbildningstillfället; instruktörsledd 33 poäng, DVD-baserad 34 poäng, eller vid tre månaders uppföljning; instruktörsledd 31 poäng, DVD-baserad 30 poäng. Vid tremånaders test utförde majoriteten av eleverna bröstkompressioner med handplacering för långt ned mot bröstbensspetsen, DVD-baserad 20 %, instruktörsledd 48 %. I den instruktörsledda gruppen sågs vid tre månaders uppföljning en signifikant ökning av andelen elever som utförde kompressioner med korrekt kompressionsdjup (5-6 cm), 7,5 % vs 32,5 %, DVD-baserad 10 % vs 25 %. Flertalet elever ansåg spontant att de hade tillräckliga kunskaper för att göra en livräddande insats. Vid följdfrågor framkom dock att flertalet av de intervjuade kände oro och rädsla för bristande kunskaper, dels för att skada den drabbade, dels för att göra fel vid en livräddande insats i verkligheten. Några elever beskrev att bekräftelse och återkoppling bidrog till att stärka elevens självkänsla till att våga ingripa i en verklig situation, vilket kan vara svårt att hinna med vid utbildning i stora grupper. En möjlig slutsats är att den filmbaserade metoden är effektivare sätt till antal utbildade deltagare, men med stöd av sociokulturell teori bör det i framtida utbildningar avsättas mer tid för gemensamt lärande, tillvaratagande av frågeställningar samt avsättning av tid för individuell och gemensam reflektion.Aim: To compare students’ practical CPR skills and attitude to perform bystander CPR after instructor-led versus DVD-based training. Method:  Data was collected through a combination of quantitative and qualitative methods. CPR skills were assessed of 80 seventh grade students during a three minutes practical test, directly after training and at three months follow up by using a PC Skill Reporting System. For CPR skills a total score, 12-48 points, was calculated.  A hypothesis is that there is no difference between training methods regarding students' total score, which means that the DVD-based method is more efficient when performed with the whole class. Nine semi-structured interviews were conducted immediately after the training to investigate students' motivation to make a life-saving effort. Result: There were no significant differences between the instructor-led or the DVD-based group regarding CPR skills, a total score of 33 points versus 34 points directly after training and 31 points versus 30 points at three months, respectively.Most students felt spontaneously that they had enough knowledge to make a life-saving effort, but the follow-up questions showed that the majority of the responders, felt worry and fear of lack of sufficient knowledge, to harm the victim or to make mistakes in a life-saving situation. Some students described that feedback after the practical test, helped to strengthen the student's self-esteem, which can be difficult to find time for when training in large groups.One possible conclusion is that the DVD-based method is more efficient in number of participants trained, but with support of the socio-cultural theory, it should in future trainings aside more time for joint learning, valorization of issues and deposition of time for individual and collective reflection

Lived experiences of ageing and later life in older people with intellectual disabilities

The aim of this article is to explore how older people with intellectual disability (ID), who live in group accommodation, describe their lived experience in relation to ageing and later life. The study adopted a phenomenological approach, based on the concept of life-world. Individual, qualitative interviews were conducted with twelve people with ID (five men, seven women), between the ages of 48 and 71 (m=64), who lived in four different group accommodation units in southern Sweden. A descriptive phenomenological analysis method was used, which disclosed a structure consisting of themes and subthemes. The findings of the study reveal the informants’ lived experience of ageing and later life as a multifaceted phenomenon, expressed through the two themes, “age as a process of change” and “existential aspects of ageing”, each with three sub themes. along with six substantialising[SK1]  subthemes. The body is an essential element in their experience of ageing and growing old, and in how this experience is expressed. The study also finds social, cultural and historical dimensions of the life-world to be important in the informants’ experience of ageing and later life. This supports understanding of  the existence of a collective life-world for older people with ID, the unique experiences the informants share because of their disability and its consequences for their life course.

OPTICAL AND PHOTOPHYSICAL PROPERTIES OF THE OXAZOLE YELLOW DNA PROBES YO AND YOYO

The photophysical properties of the optical DNA probe YOYO (homodimeric derivative of oxazole yellow) have been characterized in terms of the monomeric part, the YO chromophore. In aqueous solutions YO is virtually nonfluorescent but upon binding to DNA its fluorescence quantum yield is strongly increased. A similar enhancement of the fluorescence is observed for YO in the viscous solvent glycerol. The high fluorescence quantum yield of YO, when bound to DNA or in a viscous solution, is proposed to be a result of decreased rotational mobility around the internuclear bridge between the two aromatic ring systems. This hypothesis is based on similar values of the activation energies for the temperature-dependent nonradiative decay processes (E(A) = 53 kJ/mol) and viscous flow (E(A) = 63 kJ/mol), suggesting related rate-limiting mechanisms. A single electronic transition is found to be responsible for the intense visible absorption band. This conclusion is based on the observation of an essentially wavelength-independent reduced linear dichroism and similarly wavelength independent fluorescence anisotropy, and the fact that the emission spectrum is very nearly a mirror image of the absorption spectrum. The conclusion is further supported by quantum mechanical calculations (CNDO/S). By combination of measurements of fluorescence anisotropy of YO in glycerol and linear dichroism of YO in a stretched poly(vinyl alcohol) film, the transition moment of the strong visible absorption band was found to be nearly long axis polarized, in agreement with the CNDO/S calculations. The low-energy electronic transition and its polarization direction in the YO chromophore remain essentially unperturbed in the YOYO dye, suggesting that the results obtained for the excited state of the YO chromophore are applicable also to YOYO. One difference, though, is that in aqueous solutions the two YO chromophores of YOYO interact with each other, forming an internal dimer, resulting in a distorted absorption spectrum

Effect of mobile application-based versus DVD-based CPR training on students practical CPR skills and willingness to act: a cluster randomised study

Objectives: The aim was to compare students practical cardiopulmonary resuscitation (CPR) skills and willingness to perform bystander CPR, after a 30 min mobile application (app)-based versus a 50 min DVD-based training. Settings: Seventh grade students in two Swedish municipalities. Design: A cluster randomised trial. The classes were randomised to receive app-based or DVD-based training. Willingness to act and practical CPR skills were assessed, directly after training and at 6 months, by using a questionnaire and a PC Skill Reporting System. Data on CPR skills were registered in a modified version of the Cardiff test, where scores were given in 12 different categories, adding up to a total score of 12-48 points. Training and measurements were performed from December 2013 to October 2014. Participants: 63 classes or 1232 seventh grade students (13-year-old) were included in the study. Primary and secondary outcome measures: Primary end point was the total score of the modified Cardiff test. The individual variables of the test and self-reported willingness to make a life-saving intervention were secondary end points. Results: The DVD-based group was superior to the app-based group in CPR skills; a total score of 36 (3338) vs 33 (30-36) directly after training (pamp;lt;0.001) and 33 (30-36) and 31 (28-34) at 6 months (pamp;lt;0.001), respectively. At 6 months, the DVD group performed significantly better in 8 out of 12 CPR skill components. Both groups improved compression depth from baseline to follow-up. If a friend suffered cardiac arrest, 78% (DVD) versus 75% (app) would do compressions and ventilations, whereas only 31% (DVD) versus 32% (app) would perform standard CPR if the victim was a stranger. Conclusions: At 6 months follow-up, the 50 min DVD-based group showed superior CPR skills compared with the 30 min app-based group. The groups did not differ in regard to willingness to make a life-saving effort.Funding Agencies|Foundation for cardiopulmonary resuscitation in Sweden; Swedish Resuscitation Council; Swedish Heart-Lung Foundation [20130629]; County Council of Ostergotland</p

Increased survival from out-of-hospital cardiac arrest when off duty medically educated personnel perform CPR compared with laymen.

BACKGROUND: Bystander cardiopulmonary resuscitation (CPR) has been proved to save lives; however, whether survival is affected by the training level of the bystander is not fully described. AIM: To describe if the training level of laymen and medically educated bystanders affect 30-day survival in out-of-hospital cardiac arrests (OHCA). METHODS: This observational study included all witnessed and treated cases of bystander CPR reported to the Swedish Registry of Cardiopulmonary Resuscitation between 2010 and 2014. Bystander CPR was divided into two categories: (a) lay-byCPR (non-medically educated) and (b) med-byCPR (off duty medically educated personnel). RESULTS: During 2010-2014, 24,643 patients were reported to the OHCA registry, of which 6850 received lay-byCPR and 1444 med-byCPR; 16,349 crew-witnessed and non-witnessed cases and those with missing information were excluded from the analysis. The median interval from collapse to call for emergency medical services was 2min in both groups (p=0.97) and 2min from collapse to start of CPR for lay-byCPR versus 1min for med-byCPR (p&lt;0.0001). There were no significant differences in CPR methods used; 64.3% (lay-byCPR) and 65.7% (med-byCPR) applied compressions and ventilation, respectively (p=0.33). The 30-day survival was 14.7% for lay-byCPR and 17.2% for the med-byCPR group (p=0.02). The odds ratio adjusted for potential confounders regarding survival (med-byCPR versus lay-byCPR) was 1.34 (95% confidence interval, 1.11-1.62; p=0.002). CONCLUSIONS: In cases of OHCA, medically educated bystanders initiated CPR earlier and an increased 30-day survival was found compared with laymen bystanders. These results support the need to improve the education programme for laypeople.Funding agencies: Foundation for Cardiopulmonary Resuscitation in Sweden; Swedish Resuscitation Council; Swedish Heart-Lung Foundation [20130629]; County Council of Ostergotland</p

Effect of two additional interventions, test and reflection, added to standard cardiopulmonary resuscitation training on seventh grade students practical skills and willingness to act : a cluster randomised trial

Objectives The aim of this research is to investigate if two additional interventions, test and reflection, after standard cardiopulmonary resuscitation (CPR) training facilitate learning by comparing 13-year-old students practical skills and willingness to act. Settings Seventh grade students in council schools of two municipalities in south-east Sweden. Design School classes were randomised to CPR training only (O), CPR training with a practical test including feedback (T) or CPR training with reflection and a practical test including feedback (RT). Measures of practical skills and willingness to act in a potential life-threatening situation were studied directly after training and at 6 months using a digital reporting system and a survey. A modified Cardiff test was used to register the practical skills, where scores in each of 12 items resulted in a total score of 12-48 points. The study was conducted in accordance with current European Resuscitation Council guidelines during December 2013 to October 2014. Participants 29 classes for a total of 587 seventh grade students were included in the study. Primary and secondary outcome measures The total score of the modified Cardiff test at 6 months was the primary outcome. Secondary outcomes were the total score directly after training, the 12 individual items of the modified Cardiff test and willingness to act. Results At 6 months, the T and O groups scored 32 (3.9) and 30 (4.0) points, respectively (pamp;lt;0.001), while the RT group scored 32 (4.2) points (not significant when compared with T). There were no significant differences in willingness to act between the groups after 6 months. Conclusions A practical test including feedback directly after training improved the students acquisition of practical CPR skills. Reflection did not increase further CPR skills. At 6-month follow-up, no intervention effect was found regarding willingness to make a life-saving effort.Funding Agencies|Foundation for Cardiopulmonary Resuscitation in Sweden; Swedish Resuscitation Council; Swedish Heart-Lung Foundation [20130629]; County Council of Ostergotland</p

The effect of a national web course "Help-Brain-Heart" as a supplemental learning tool before CPR training: a cluster randomised trial

Background: The effectiveness of cardiopulmonary resuscitation (CPR) learning methods is unclear. Our aim was to evaluate whether a web course before CPR training, teaching the importance of recognition of symptoms of stroke and acute myocardial infarction (AMI) and a healthy lifestyle, could influence not only theoretical knowledge but also practical CPR skills or willingness to act in a cardiac arrest situation. Methods: Classes with 13-year-old students were randomised to CPR training only (control) or a web course plus CPR training (intervention). Data were collected (practical test and a questionnaire) directly after training and at 6 months. CPR skills were evaluated using a modified Cardiff test (12-48 points). Knowledge on stroke symptoms (0-7 points), AMI symptoms (0-9 points) and lifestyle factors (0-6 points), and willingness to act were assessed by the questionnaire. The primary endpoint was CPR skills at 6 months. CPR skills directly after training, willingness to act and theoretical knowledge were secondary endpoints. Training and measurements were performed from December 2013 to October 2014. Results: Four hundred and thirty-two students were included in the analysis of practical skills and self-reported confidence. The mean score for CPR skills was 34 points after training (control, standard deviation [SD] 4.4; intervention, SD 4.0; not significant [NS]); and 32 points at 6 months for controls (SD 3.9) and 33 points for intervention (SD 4.2; NS). At 6 months, 73% (control) versus 80% (intervention; P = 0.05) stated they would do compressions and ventilation if a friend had a cardiac arrest, whereas 31% versus 34% (NS) would perform both if the victim was a stranger. One thousand, two hundred and thirty-two students were included in the analysis of theoretical knowledge; the mean scores at 6 months for the control and intervention groups were 2.8 (SD 1.6) and 3.2 (SD 1.4) points (P amp;lt; 0.001) for stroke symptoms, 2.6 (SD 2.0) and 2.9 (SD 1.9) points (P = 0.008) for AMI symptoms and 3.2 (SD 1.2) and 3.4 (SD 1.0) points (P amp;lt; 0.001) for lifestyle factors, respectively. Discussion: Use of online learning platforms is a fast growing technology that increases the flexibility of learning in terms of location, time and is available before and after practical training. Conclusions: A web course before CPR training did not influence practical CPR skills or willingness to act, but improved the students theoretical knowledge of AMI, stroke and lifestyle factors.Funding Agencies|Foundation for Cardiopulmonary Resuscitation in Sweden; Swedish Resuscitation Council; Swedish Heart-Lung Foundation [20130629]; County Council of Ostergotland</p