• Philip Weng Kee Leong, Benjamin Sieu-Hon Leong, Shalini Arulanandam, NgMarie Xin RuMXREmergency Medical Services Department, Singapore Civil Defence Force, Singapore., Yih Yng Ng, OngMarcus Eng HockMEHDepartment of Emergency Medicine, Singapore General Hospital, Singapore.Health Service and Systems Research, Duke-NUS Medical School, Singapore., and MaoDesmond Ren HaoDRHDepartment of Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore..
• Department of Emergency Medicine, Singapore General Hospital, Singapore.
• Singap Med J. 2021 Dec 1; 62 (12): 647-652.

IntroductionIn our national emergency dispatch centre, the standard protocol for dispatcher-assisted cardiopulmonary resuscitation (DACPR) in out-of-hospital cardiac arrests (OHCAs) involves the instruction 'push 100 times a minute 5 cm deep'. As part of quality improvement, the instruction was simplified to 'push hard and fast'.MethodsWe analysed all dispatcher-diagnosed OHCAs over four months in 2018: January to February ('push 100 times a minute 5 cm deep') and August to September ('push hard and fast'). We also performed secondary per-protocol analysis based on the protocol used: (a) standard (n = 48); (b) simplified (n = 227); and (c) own words (n = 231).ResultsA total of 506 cases were included: 282 in the 'before' group and 224 in the 'after' group. Adherence to the protocol was 15.2% in the 'before' phase and 72.8% in the 'after' phase (p < 0.001). The mean time between instruction and first compression for the 'before' and 'after' groups was 34.36 seconds and 26.83 seconds, respectively (p < 0.001). Time to first compression was 238.62 seconds and 218.83 seconds in the 'before' and 'after' groups, respectively (p = 0.016). In the per-protocol analysis, the interval between instruction and compression was 37.19 seconds, 28.31 seconds and 32.40 seconds in the standard protocol, simplified protocol and 'own words' groups, respectively (p = 0.005). The need for paraphrasing was 60.4% in the standard protocol group and 81.5% in the simplified group (p < 0.001).ConclusionSimplified instructions were associated with a shorter interval between instruction and first compression. Efforts should be directed at simplifying DACPR instructions.Copyright: © Singapore Medical Association.

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