A Retrospective Analysis of the Impact of EMD on Cardiac Arrest in North Carolina in 2017

Introduction—Emergency medical dispatch (EMD) is a critical part of the American Heart Association cardiac arrest “chain of survival.” EMD must quickly identify cardiac arrest, dispatch the proper response, and compel lay persons to initiate CPR through prearrival instructions. Frequent evaluations should be made to assess if EMD impacts patient disposition.

Objective—To determine if EMD prearrival instructions significantly impacted cardiac arrest patients’ prehospital disposition in North Carolina.

Methods—This retrospective observational study examined all 2017 9-1-1 EMS cardiac arrest patients in North Carolina. Study data were obtained from the North Carolina EMS Data System. During the study period protocols allowed termination of resuscitation efforts on scene for cardiac arrest patients who had no signs of reversal. If efforts were terminated, the patient was not transported. Transported patients were either successfully resuscitated or showed signs of reversal. Descriptive statistics and univariate odds ratios were calculated to determine if EMD prearrival instructions were associated with the decision to transport or not transport a cardiac arrest patient.

Results—There were 10,247 9-1-1 calls dispatched as cardiac arrests by EMD. Data were available for prearrival instructions delivery on 7,099 (69.3%) calls. Of these, prearrival instructions were provided on 5,570 (78.5%) and not provided on 1,529 (21.5%). Patient disposition was available on 4,184 calls. Of these, 728 (17.4%) patients were not transported, and 3,456 (82.6%) were. Of the 399 calls that were not transported, prearrival instructions were provided on 310 (77.7%), and no instructions for 89 (22.3%). Among 2,364 calls that were transported, 1,865 (78.9%) received prearrival instructions, and 499 (21.1%) did not. This difference was not statistically significant (OR 1.01; 95% CI, 0.97–1.06, p=0.589).

Conclusion—EMD is a critical part of the system of care and essential to the cardiac arrest chain of survival. However, this study did not identify an association between the delivery of EMD prearrival instructions and patient disposition for those in cardiac arrest. Further study should be conducted to determine the impact of EMD on patient outcomes.