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The main goal of this project is to help 9-1-1 emergency medical dispatchers save the lives of more cardiac arrest victims. The investigators will develop teaching tools to help the dispatchers recognize abnormal breathing that may indicate a victim as having a cardiac arrest. After training sessions, the investigators will see if dispatchers can get better at recognizing abnormal breathing, how often they give CPR instructions, and if use of the teaching tool will increase bystander CPR and the number of victims leaving the hospital alive.
Cardiac arrest is a leading cause of death in Canada; it is defined as the sudden cessation of cardiac mechanical activity. It is uniformly fatal if not treated within minutes. More than 85% of out-of-hospital cardiac arrest (OOHCA) occur in residential locations so public access to automatic external defibrillators, to restart the heart, are not helpful. The overall rate of survival for OOHCA rarely exceeds 8%.
Bystander cardiopulmonary resuscitation (CPR) is chest compression and ventilations provided by someone not on the emergency response team. A victim or cardiac arrest is almost 4 times more likely to survive when receiving bystander CPR. However, despite various attempts to improve bystander rates they have remained low, not exceeding 15% in Ontario. It has been shown that since the ambulance dispatch centres in Ontario implemented dispatch-assisted CPR instructions (given to callers while emergency vehicles were on the way), there was a significant increase in use.
Emergency medical dispatchers can identify about 70% of OOHCA cases over the phone. Agonal breathing (laboured breathing preceding death) may be misinterpreted as a sign of life, and is responsible for as much as 50% of missed diagnoses. There is no specific training on the significance of this sign, and minimal information about recognizing cardiac arrest. An educational intervention designed to better understand the significance of agonal breathing and to clarify the existing CPR instruction protocol will most likely increase the frequency of CPR instructions, bystander CPR rates, and potentially survival of victims of cardiac arrest.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Training site | All emergency medical dispatchers at a central ambulance communication centre in Ontario will participate in an educational program designed to improve cardiac arrest diagnostic accuracy. |
| |
| Control site | All emergency medical dispatchers at a central ambulance communications centre geographically remote from the Training Site and has a similar rate to the Training Site for cardiac arrests, bystander CPR rate, and survival |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Education | Behavioral | An education program will be developed using behaviour change techniques specifically mapped to address modifiable factors identified in a previous study. These techniques will include: information about the significance of agonal breathing, modeling/demonstration of desired behavioural skills, rehearsal of desired skills, and monitoring/reinforcement and feedback. |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Participants With Agonal Breathing | By reviewing recordings of all cardiac arrest calls, including missed cases retrieved from a registry, document presence or absence of agonal breathing. | At the time of the cardiac arrest event |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Cases Where Cardiac Arrest Was Recognized by the Ambulance Dispatcher | By reviewing recordings of all cardiac arrest calls, collect information on dispatcher recognition of cardiac arrest to bystander implementation of chest compressions | At the time of the cardiac arrest event |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Participants Who Received Bystander CPR | The first member of the emergency response team to arrive at scene will document whether or not chest compressions have been initiated by someone prior to the arrival of emergency team | At the time of the cardiac arrest event |
| Number of Participants Surviving to Hospital Discharge |
Inclusion Criteria:
Exclusion Criteria:
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All patients with out-of-hospital cardiac arrest
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| Name | Affiliation | Role |
|---|---|---|
| Christian Vaillancourt, MD,MSc,FRCPC | The Ottawa Hospital Research Institute and University of Ottawa | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ottawa Hospital Research Institute | Ottawa | Ontario | K1Y 4E9 | Canada |
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| ID | Title | Description |
|---|---|---|
| FG000 | Training Site | All emergency medical dispatchers at a central ambulance communication centre in Ontario will participate in an educational program designed to improve cardiac arrest diagnostic accuracy. Education: An education program will be developed using behaviour change techniques specifically mapped to address modifiable factors identified in a previous study. These techniques will include: information about the significance of agonal breathing, modeling/demonstration of desired behavioural skills, rehearsal of desired skills, and monitoring/reinforcement and feedback. |
| FG001 | Control Site | All emergency medical dispatchers at a central ambulance communications centre geographically remote from the Training Site and has a similar rate to the Training Site for cardiac arrests, bystander CPR rate, and survival |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Training Site | All emergency medical dispatchers at a central ambulance communication centre in Ontario will participate in an educational program designed to improve cardiac arrest diagnostic accuracy. Education: An education program will be developed using behaviour change techniques specifically mapped to address modifiable factors identified in a previous study. These techniques will include: information about the significance of agonal breathing, modeling/demonstration of desired behavioural skills, rehearsal of desired skills, and monitoring/reinforcement and feedback. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Number of Participants With Agonal Breathing | By reviewing recordings of all cardiac arrest calls, including missed cases retrieved from a registry, document presence or absence of agonal breathing. | Posted | Count of Participants | Participants | At the time of the cardiac arrest event |
|
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Training Site | All emergency medical dispatchers at a central ambulance communication centre in Ontario will participate in an educational program designed to improve cardiac arrest diagnostic accuracy. Education: An education program will be developed using behaviour change techniques specifically mapped to address modifiable factors identified in a previous study. These techniques will include: information about the significance of agonal breathing, modeling/demonstration of desired behavioural skills, rehearsal of desired skills, and monitoring/reinforcement and feedback. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Christian Vaillancourt | Ottawa Hospital Research Institute | 613-798-5555 | 17012 | cvaillancourt@ohri.ca |
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| ID | Term |
|---|---|
| D006323 | Heart Arrest |
| ID | Term |
|---|---|
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
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| ID | Term |
|---|---|
| D004522 | Educational Status |
| ID | Term |
|---|---|
| D012959 | Socioeconomic Factors |
| D011154 | Population Characteristics |
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|
Accessing hospital medical records or coroner's reports, assess survival of cardiac arrest victim as being discharged alive from hospital |
| At the time of the cardiac arrest event to discharge alive from hospital (varies, depending on length of hospital stay) |
| BG001 | Control Site | All emergency medical dispatchers at a central ambulance communications centre geographically remote from the Training Site and has a similar rate to the Training Site for cardiac arrests, bystander CPR rate, and survival |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race and Ethnicity Not Collected | Race and Ethnicity were not collected from any participant. | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| Witnessed Status | A witnessed cardiac arrest is seen or heard by someone other than Emergency Medical Services (lay person, a healthcare provider, a police officer or an off-duty fire/Emergency Medical Services provider who is not part of the organized response). | Count of Participants | Participants |
|
| Initial Cardiac Rhythm Ventricular Fibrillation/Ventricular Tachycardia | Count of Participants | Participants |
|
| OG001 | Control Site | All emergency medical dispatchers at a central ambulance communications centre geographically remote from the Training Site and has a similar rate to the Training Site for cardiac arrests, bystander CPR rate, and survival |
|
|
| Secondary | Number of Cases Where Cardiac Arrest Was Recognized by the Ambulance Dispatcher | By reviewing recordings of all cardiac arrest calls, collect information on dispatcher recognition of cardiac arrest to bystander implementation of chest compressions | Posted | Count of Participants | Participants | At the time of the cardiac arrest event |
|
|
|
| Other Pre-specified | Number of Participants Who Received Bystander CPR | The first member of the emergency response team to arrive at scene will document whether or not chest compressions have been initiated by someone prior to the arrival of emergency team | Posted | Count of Participants | Participants | At the time of the cardiac arrest event |
|
|
|
| Other Pre-specified | Number of Participants Surviving to Hospital Discharge | Accessing hospital medical records or coroner's reports, assess survival of cardiac arrest victim as being discharged alive from hospital | Posted | Count of Participants | Participants | At the time of the cardiac arrest event to discharge alive from hospital (varies, depending on length of hospital stay) |
|
|
|
| 0 |
| 689 |
| 0 |
| 689 |
| EG001 | Control Site | All emergency medical dispatchers at a central ambulance communications centre geographically remote from the Training Site and has a similar rate to the Training Site for cardiac arrests, bystander CPR rate, and survival | 0 | 387 | 0 | 387 |
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