Chest Compressions Only CPR Instructions Suggested for 9 1 1 Dispatchers



July 2005, MERGINET—Emergency medical dispatchers—the early link to emergency interventions—provide instructions to laypersons that can alter the course of the emergency. Dispatcher-CPR instructions traditionally included the standard ventilation and chest compression techniques taught in CPR classes, but researchers in the May issue of Resuscitation noted “expeditious compliance with these multiple directives can be extremely difficult, especially when (undemonstrated) instructions are provided, for the first time, over the telephone, to a frightened person in a stressful situation.”

To address this problem, the National Academies of Emergency Dispatch (NAED) Council of Standards developed a modified telephone CPR protocol to support the use of chest-compressions-only CPR instructions (CCOIs) by emergency medical dispatchers. The NAED is the only organization setting standards for emergency medical dispatchers, noted Jeff J. Clawson, MD, of Medical Priority Consultants, Salt Lake City, Utah, and NAED member.

After testing draft protocols in numerous cities in the U.S., the NAED Council of Standards developed the current set of CPR protocol pre-arrival instructions which, Clawson said, were distributed to 1,500 emergency dispatch centers in the U.S. in February 2005.

The new protocols include:

Instructing trained lay rescuers to continue performing CPR per their training.

In adult cases of sudden cardiac arrest, instructing rescuers untrained in, unsure of, or unwilling to give mouth-to-mouth ventilation to perform consecutive chest compressions for approximately four minutes (400 compressions), followed by ventilations between each subsequent 100 chest compressions, until EMS arrives.

Providing current rescue breathing/CPR instructions for children and for adult cases involving probable respiratory or traumatic causes, such as choking, drowning, inhalation of noxious fumes, strangulation, or other trauma.

The NAED Council of Standards noted these recommendations are “based on the best available information and reasonable inferences from physiological and experimental data.” They cite much of the same research that prompted Austin/Travis County EMS and Tucson Fire Department to adopt chest-compressions-only protocols. Similar CPR protocol pre-arrival instructions are already actively used in London, U.K., and throughout Canada, Clawson told Merginet.

Noting the need to allow time for retraining in the use of the new protocol, the NAED supports the previous standard CPR protocol for one year; therefore no adequate oversight data is currently available. But the Council believes that medical direction


and quality assurance are key components of protocol implementation and use, and supports ongoing oversight.


Roppolo LP. Pepe PE. Cimon N. Gay M et al: “Modified cardiopulmonary resuscitation (CPR) instruction protocols for emergency medical dispatchers: rationale and recommendations.” Resuscitation 65(2005) 203-