Simulation training to improve 911 dispatcher identification of cardiac arrest

描述（由申请人提供）：模拟培训，提高911调度员对心脏骤停的识别能力。每天，911调度员都会做出一线急症患者护理安全决策，从而产生生死结果。例如，在心脏骤停后关键的最初几分钟，911调度员接受过培训，可以通过电话向旁观者提供指导。电话辅助CPR （T-CPR）显著提高了心脏骤停患者的存活率。然而，调度员没有识别出大约30%的心脏骤停病例，因此，许多可能已经复苏的患者去世了。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很有挑战性。没有实际的病人，只有一个声音（通常是歇斯底里的声音）。没有医疗记录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。所有拨打9-1-1的人都要回答的主要心脏骤停筛查问题（“病人还有呼吸吗？”）通常被打电话的人肯定地回答，因为有痛苦的呼吸。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（并显着提高患者存活率）有关，但一般来说，调度员每年只遇到少数几个心脏骤停呼叫。我们建议在为期一年的研究期间，通过模拟911呼叫中心调度员的电话来增加这种至关重要的体验。尽管许多基于电话的紧急系统对患者的护理和健康结果有非常直接的影响，但使用基于电话的模拟来提高患者安全在文献中并没有得到很大的关注。我们建议进行一项随机对照试验，以测试使用模拟心脏骤停呼叫的过程和结果：次要目标是评估1)参与模拟频率对技能获得和绩效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T-CRP提供的影响。为了能够开展这项研究并在全国范围内传播研究结果，我们将与西雅图金县公共卫生紧急医疗服务部门以及太平洋西北地区的几个呼叫中心合作。

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.