Barriers to cardiac arrest recognition: The impact of symptom interpretation on the effectiveness of dispatcher instructions

Abstract

Introduction: The outcome of out-of-hospital cardiac arrest (OHCA) critically depends on the early initiation of cardiopulmonary resuscitation (CPR). The emergency medical service (EMS) dispatcher plays a vital role as the "first responder," providing telephone instructions to bridge the time gap until the professional team arrives. Objective: To analyze the efficiency of OHCA recognition and the frequency of dispatcher-assisted telephone CPR (T-CPR) in EMS Subotica, while identifying key communication barriers. Methodology: This retrospective study analyzed 46 OHCA cases in the municipality of Subotica (population 141,554) over a six-month period. Data were collected from resuscitation protocols and by reviewing audio dispatch recordings for qualitative analysis of the dialogue between the dispatcher and the caller. Results: The incidence of OHCA was 32.5/100,000 (annual 65.0/100,000). Successful T-CPR was performed in only 4 cases (8.7%). In the remaining 42 cases (91,3%), T-CPR was not realized due to non-recognition of cardiac arrest in 20 calls (47.6% of n=42) and communication barriers in 14 calls (33.3% of n=42). In these patients, CPR was initiated only upon arrival of the EMS team. In all successful T-CPR cases (n=4), resuscitation was performed by family members at home. Conclusion: The low rate of telephone-assisted resuscitation highlights an urgent need for standardized dispatch protocols and targeted training in agonal breathing recognition. Enhancing dispatcher communication skills and continuous mass public education are essential for strengthening the chain of survival.