Simulation training to improve 911 dispatcher identification of cardiac arrest

描述（由申请人提供）：模拟培训，以提高9- 1 - 1调度员识别心脏骤停每天，9-1-1调度员作出一线急性病人护理安全的决定，导致生命或死亡的结果。例如，在心脏骤停后的关键最初几分钟内，9-1-1调度员接受了通过电话向旁观者提供指示的培训。电话辅助CPR（T-CPR）显著提高了心脏骤停的存活率。然而，调度员无法识别大约30%的心脏骤停病例，因此，许多可能已经复苏的患者死亡。鉴于目前大多数社区心脏骤停的存活率很低，增加T-CPR可能会在全国范围内产生巨大影响。通过电话识别心脏骤停是一项挑战。没有病人的身体，只有一个声音（通常是歇斯底里的声音）。没有病历。打电话的人可能是在传递二手信息。打电话的人可能英语说得不好。主要的心脏骤停筛查问题要求所有呼叫9-1-1的人（“病人有呼吸吗？“），由于濒死呼吸的存在，呼叫者往往会给予肯定的回答。尽管研究发现调度员处理心脏骤停呼叫的频率与更快地识别心脏骤停（并显着提高患者生存率）有关，但一般来说，调度员每年只会遇到少数心脏骤停呼叫。我们建议通过在9-1-1呼叫中心为调度员模拟电话呼叫来增加这种重要的体验，为期一年。使用基于电话的模拟，以提高病人的安全性，并没有得到很大的关注，在文献中，即使许多基于电话的紧急系统有一个非常直接的影响病人的护理和健康结果。我们提出了一项随机对照试验，以测试使用模拟心脏骤停呼叫的过程和结果：9-1-1调度员在模拟期间和实际呼叫中识别心脏骤停的能力次要目的是评估1）参与模拟的频率对技能获得和表现水平的剂量反应效应，2）存在或不存在即时反馈对绩效水平的影响，以及3）参与模拟对提供T-CRP的影响。为了能够在全国范围内进行这项研究并传播研究结果，我们将与西雅图国王县公共卫生紧急医疗服务部门以及太平洋西北部的几个呼叫中心合作。 公共卫生相关性：尽管由911调度员提供的电话辅助CPR（T-CPR）显著提高了心脏骤停的存活率，但是提高存活率的潜力受到调度员不能识别大约30%的心脏骤停病例的事实的阻碍，并因此放弃T-CPR。我们提出了一个随机对照试验，以测试过程和结果的使用模拟心脏骤停呼叫，使用“标准化呼叫者”对9-1-1调度员的能力，以确定心脏骤停在模拟和真实的谎言。使用基于电话的模拟来提高患者安全性在文献中没有得到大量关注，尽管许多基于电话的紧急系统对患者护理和健康结果具有非常直接的影响。

DESCRIPTION (provided by applicant): Simulation training to improve 911 dispatcher identification of cardiac arrest Every day, 9-1-1 dispatchers make front-line acute patient care safety decisions, resulting in life or death outcomes. For example, in the critical first few minuts following a cardiac arrest 9-1-1 dispatchers have been trained to provide instructions to bystanders over the phone. Telephone- assisted CPR (T-CPR) has significantly increased survival from cardiac arrest. However, dispatchers do not recognize approximately 30% of cardiac arrest cases, and as a result, many patients pass away who might have been resuscitated. Given the current low survival rates for cardiac arrest in most communities, increasing T-CPR could have an enormous impact nationwide. Identifying cardiac arrest over the phone is challenging. There is no physical patient, only a voice (often a hysterical one at that). There is no medical record. Callers may be relaying information second-hand. Callers may not speak English well. The primary cardiac arrest screening question asked of all callers to 9-1-1 ("Is the patient breathing?") is often answered affirmatively by callers because of the presence of agonal respirations. Although research has found that the frequency with which dispatchers handle cardiac arrests calls is associated with quicker recognition of cardiac arrest (and significantly improved patient survival rates), in general dispatchers encounter only a handful of cardiac arrest calls a year. We propose to increase this vital experience through simulated phone calls for dispatchers at 9-1-1 call centers for a study period of one year. The use of phone-based simulations to improve patient safety has not received a great deal of attention in the literature even though many phone-based emergency systems have a very direct impact on patient care and health outcomes. .We propose a randomized controlled trial to test processes and outcomes of the use of simulated cardiac arrest calls on: 9-1-1 dispatchers' ability to identify cardiac arrests during simulations and in actual calls Secondary aims are to evaluate 1) a dose-response effect of frequency of participation in the simulations for skill acquisition and performance levels , 2) the impact of presence or absence of immediate feedback on performance levels, and 3) the impact of participation in the simulations on provision of T-CRP. To be able to conduct this study as well as disseminate the findings nationwide, we will partner with Emergency Medical Services division of Public Health Seattle-King County, and several call centers in the Pacific Northwest. PUBLIC HEALTH RELEVANCE: Simulation training to improve 911 dispatcher identification of cardiac arrest Although telephone-assisted CPR (T-CPR) provided by 911 dispatchers has significantly increased survival from cardiac arrest, the potential for improved survival is hampered by the fact that dispatchers do not recognize approximately 30% of cardiac arrest cases, and as a result, forgo T- CPR. We propose a randomized controlled trial to test processes and outcomes of the use of simulated cardiac arrest calls, using a "standardized caller" on 9-1-1 dispatchers' ability to identify cardiac arrests during simulations and in real lie. The use of phone-based simulations to improve patient safety has not received a great deal of attention in the literature even though many phone- based emergency systems have a very direct impact on patient care and health outcomes.