A new statement published by the American Heart Association (AHA) in their journal Circulation on Monday suggests that more people survive sudden cardiac arrest when 9-1-1 dispatchers coach bystanders to assess victims and then begin CPR straight away.

Cardiac arrest occurs when electrical impulses in the heart go awry and cause it to stop beating normally (note this is not the same as a heart attack).

Dr E Brooke Lerner, an associate professor of emergency medicine at the Medical College of Wisconsin in Milwaukee, and lead author of the AHA statement describes it as a “call to arms”.

“It isn’t as common as you think, that you call 9-1-1 and they tell you what to do,” said Lerner.

The AHA had already issued new guidelines in 2010 advising 9-1-1 dispatchers to do this: this latest statement goes more specifically into how they should give the help, and also points out the importance of following this up with assessment of how well the dispatcher gave the help, and also how to implement other measures of performance.

The statement is part of an overall plan to strengthen what is referred to as the “Chain of Survival”.

When a bystander calls 9-1-1 to summon emergency assistance to a person who may have collapsed because of sudden cardiac arrest, they potentially form the first link in the Chain of Survival. The chain starts with immediate recognition of cardiac arrest and activation of emergency response. The rest of the chain then ensues with early cardiopulmonary resuscitation (CPR), rapid defibrillation, advanced life support, and ends with post-cardiac arrest care.

Each link in the chain involves various participants each with his or her own motivations, skills and responsibilities, such as bystanders, family members, 9-1-1 dispatchers, pre-hospital care providers, hospital staff, and post-hospital carers.

Unfortunately, as Lerner and colleagues explain in their paper, only 5% to 10% of all patients who experience sudden cardiac arrest outside of hospital, and in whom resuscitation is attempted, survive to discharge from the hospital.

Yet, in communities where there is good awareness and the Chain of Survival is strong, the survival rates can approach 20%, they add.

And given that more than 380,000 Americans each year are assessed by EMS for sudden cardiac arrest, strengthening any weak links in the Chain of Survival means potentially thousands more lives saved.

The AHA statement recommends that emergency medical services (EMS) systems and 9-1-1 dispatchers implement four specific measures:

  1. When a potential cardiac arrest call comes through to 9-1-1, dispatchers should assess whether the victim has had a cardiac arrest, and if this is the case, then give the caller instructions on how to give immediate CPR.
  2. If the victim is an adult, and the cardiac arrest was not caused by asphyxia (as in drowning), dispatchers should “confidently give Hands-Only CPR instructions” to the caller.
  3. Communities should assess the performance of their 9-1-1 dispatchers and EMS providers, such as measuring how long it takes until CPR is started.
  4. Such performance measures should be “part of a quality assurance program involving the entire emergency response system including EMS and hospitals”.

The authors developed the statement on behalf of the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative, and Resuscitation (3-CPR).

Lerner said the entire community needs to be behind this, so dispatchers get the training they need and the statement is fully implemented.

“It takes a lot of people believing in it to make it happen,” she urged.

People who are not trained in CPR and come across someone who needs it are often afraid to act incase they do something wrong.

But Lerner said even if the victim hasn’t had a cardiac arrest, “the chances that you’re going to hurt somebody are very, very small”.

Besides, not acting at all means they don’t get any of the help that could save their life.

Since 2008 the AHA has urged bystanders faced with an adult victim who is uresponsive and not breathing or only gasping, to start giving them Hands-Only CPR straight away.

They say that research shows skipping mouth-to-mouth with conventional CPR doesn’t lessen the chances of survival in the first few minutes of CPR, and means chest compressions often start about a minute sooner this way.

The key factor is starting chest compressions as early as possible. Lerner said:

“We know that early chest compressions can improve outcomes.”

But if the victim is a baby or a child, or an adult who has suffered asphyxia (such as from drowning), then you should give mouth to mouth as well as chest compressions.

Written by Catharine Paddock PhD