Study On Status Quo And Influencing Factors Of Sudden Cardiac Arrest Telephone-assistanted Cardiopulmonary Resuscitation In China

This study is supported by Innovation Program of Shanghai Municipal EducationCommission (The research on the instruction program of telephone-assistedcardiopulmonary resuscitation to patients with cardiac arrest）and the program number is12ZS080.AimsSince the fact that there is an upward trend in incidence of cardiac arrest and lowersurvival rate, we conducted this study on the status quo of the cardiac arrest victims usingdispatch telephone, also on emergency dispatchers and laypersons’ needs and attitude tothe telephone-assisted cardiopulmonary resuscitation (T-CPR) in Shanghai, Wuxi, andLanzhou by qualitative interviews and questionnaire survey, using the framework of theknowledge-attitude-belief-practice Model (KABP Model). We also analyzed theinfluencing factors of the adoption of telephone-assisted CPR, and proposed thesuggestions to promote telephone-assisted CPR in our country. This study provided a basisfor the introduction of telephone-assisted CPR to Emergency Medical Service System andthe research on the subsequent instruction program of telephone-assisted CPR, so as toimprove the successful rate of cardiopulmonary resuscitation.MethodologiesThis research consisted of three parts.1.The qualitative research on the status quo of patients with cardiac arrest usingdispatch telephone and the cognition of telephone-assisted CPR: we interviewed10emergency dispatchers and12laypersons by phenomenological research methods andsemi-structured interview outlines to understand the status quo of patients with cardiacarrest using dispatch telephone, the demands for CPR and the attitude of dispatchers andlaymen to telephone-assisted CPR. The software of QSR Nvivo7was used to analyze thedata of the interviews.2.Questionnaire development of influencing factors on telephone-assisted CPR withthe versions of dispatchers and laypersons: The first draft in accordance with literatures athome and abroad, qualitative interview and discussion of team conference was formed.Then the questionnaires of influencing factors on telephone-assisted CPR with the versions of dispatchers and laypersons were developed through expert consultation.3.The research on the influencing factors of telephone-assisted CPR:We sampled132emergency dispatchers in Shanghai,Wuxi and Lanzhou with purposive sampling andconvenience sampling and361persons without medical background in6districts ofShanghai, Nanchang district of Wuxi and Xigu district of Lanzhou by conveniencesampling. Using the questionnaires developed by our research group, we collected the dataand analyzed them with SAS9.2to understand the status quo of the dispatch of thosecardiac arrest victims in Shanghai,Wuxi and Lanzhou, and also studied the influencingfactors of T-CPR and finally proposed the suggestions to promote T-CPR in China.Results1. Qualitative research(1)Eight themes for the dispatchers emerged, those were dispatchers’ attitude towardshuman resource, equipment and dispatch procedure; Emergency knowledge and skills ofdispatchers; Dispatchers’ view of their roles; Psychological knowledge of dispatchers;Dispatchers’ view on telephone callers’ emergency knowledge; Dispatchers’ attitudetowards T-CPR; Personal factors of telephone callers; Attitude towards medical laws andregulations of emergency dispatching.(2)Six themes for the laypersons emerged; those were layperson’s knowledge tocardiac arrest; layperson’s emergency knowledge and skills; layperson’s awareness of firstaids; layperson’s view on dispatchers’ role; layperson’s demands for T-CPR; influencingfactors of layperson’s acceptance of T-CPR.2. Questionnaire developmentThrough this research, we developed two versions questionnaires that were thedispatchers’ version and layperson version. The items of these questionnaires were34and36respectively. Both of them had a good content validity, SCVI is0.98and0.96respectively.3. Questionnaire survey(1)The places investigated had not used T-CPR systematically, and the telephonedispatch of the patients with cardiac arrest was based on the traditional way, not providingthe instructions of first-aids.(2)There was a positive correlation between reference standard and T-CPR selection （P＝0.0448）. There was also a positive correlation between the recognition of thenecessity to master the knowledge and skills of CPR and the necessity to adopt T-CPR(P＝0.0352）.At the same time, there was a positive correlation between the self-assessment ofdispatch related psychological knowledge and the recognition of the necessity to useT-CPR（P＝0.0192）.In addition, there was a positive correlation between the fact thatwhether dispatchers had heard of T-CPR and the recognition of the necessity to use T-CPR（P＝0.0001).(3)Through the investigation to the laypersons, we found the following results. Firstly,there was a positive correlation between the idea that “if one people collapsed suddenlyand emergency measures were done in time, people has more chance of survive” and theacceptance of T-CPR（P＝0.0162）. Secondly, there was a positive correlation betweensimple emergency methods provided by dispatchers and start of first-aids following thedispatchers’ instructions（P＝0.0003). Thirdly, there was a positive correlation between thefact that the laypersons would be more confident if some peers are available and theinitiation of T-CPR（P＝0.0295）.Lastly, there was a positive correlation between theknowledge of CRP and the acceptance of T-CPR（P＝0.0090).Conclusions1.Qualities research. Eight themes emerged through the interviews with dispatchers,i.e. Dispatchers’ attitude towards human resource, equipment and dispatching procedure,Emergency knowledge and skills of dispatchers, Dispatchers’ view of their role,Psychological knowledge of dispatchers, Dispatchers’ view on telephone callers’emergency knowledge, Dispatchers’ attitude towards T-CPR, Personal factors of telephonecallers and Attitude towards medical laws and regulations of emergency dispatching. Sixthemes emerged after the interviews with laypersons, were: Laypersons’ knowledge tocardiac arrest, Laypersons’ emergency knowledge and skills, Laypersons’ awareness offirst aids, Laypersons’ view on dispatchers’ role, Laypersons’ demands for T-CPR andInfluencing factors of laypersons’ acceptance of T-CPR.2.Questionnaire development. Both of the dispatcher version questionnaires andlayperson version one had good content validity and they were used to investigate thestatus quo of patients with cardiac arrest using dispatching telephone and some relatedfactors to its adoption.3.Questionnaire survey (1)Our current dispatch system and modes are traditional ones with “no instructionand no assistance”, only answering the telephone and dispatching vehicles. However,according to the survey to the dispatchers and laypersons in Shanghai, Wuxi and Lanzhou,there showed a demand for T-CPR.(2)In terms of instructors (dispatchers), the following factors may influence theadoption of T-CPR, i.e.: There is no normative, authoritative and simple operation flowchart in dispatch center so far; The dispatchers don’t have a good command of emergencyknowledge; The self-assessment of psychological knowledge and whether they have heardof T-CPR before.(3)In terms of mentees(laypersons), the factors influencing the respondents to acceptdispatchers’ instructions were: Laypersons views of dispatchers’ instructional role andmeaning psychologically makes them more willing to accept the dispatcher’s guidance;The dispatcher’s guidance would give them much more confidence to give CPR;Whetherthe laypersons have the knowledge and skills of CPR would influence their start CPR atonce after the simple emergency guidance from the dispatchers. Our government andmedical departments still have to make more efforts to introduce T-CPR into China, topromote the rate of resuscitation to patients with cardiac arrest and reach the goal thatanybody can take part in T-CPR anytime.