Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jan 29, 2023
Date Accepted: Jun 26, 2023
Tele-Instruction Tool for Multiple Lay Responders Providing Cardiopulmonary Resuscitation in Telehealth Emergency Dispatch Services: A Mixed-Methods Study
ABSTRACT
Background:
Telephone-assisted cardiopulmonary resuscitation (T-CPR) is one of the most critical measures for increasing lay responders CPR in telehealth emergency services. Proposing team-based tele-instruction plan for telecommunicators might be a low-cost but high-benefit strategy to maximize the effectiveness of multiple lay responders' team cooperation and guarantee the implementation of high-quality CPR for out-of-hospital cardiac arrest (OHCA) patients.
Objective:
T-CPR is one of the most critical measures for increasing lay responders CPR in telehealth emergency services. We developed an innovative team-based tele-instruction tool to well-organized and instruct the CPR process for multiple lay responders to improve resuscitation quality.
Methods:
A mixed-methods design was applied to evaluate the effectiveness and feasibility of this team-based tele-instruction tool. In quantitative analysis, we conducted a randomized controlled simulation trial with 132 participants (44 teams) aged 18-60 years to operate resuscitation procedure before (phase Ⅰ test) and after (phase Ⅱ test) the team-based CPR training in a simulated scenario. In qualitative analysis, we randomly select 1 person in each team and 4 experts in emergency medical services to conduct semi-structured interviews.
Results:
The team-based tele-instruction tool significantly improved the quality of chest compression by maintaining more appropriate average compression rates in both phase Ⅰ and phase Ⅱ tests [median 104.5 (IQR 98.8-111.8) vs. 112 (106-120.8) min-1, P=0.04 and 117.5 (112.3-125) vs. 111 (105.3-119) min-1, P=0.03, respectively]. The emergency response time was delayed in the intervention group [time to first chest compression: 20 (15-24.8) vs. 25 (20.5-40.3) s, P=0.03; time to open the airway: 48 (36.3-62) vs. 73.5 (54.5-227.8) s, P=0.01], but it could be mitigated to some extent after the phase Ⅱ test. The qualitative results approved the compatibility and generalization of the team-based tele-instruction tool. The tool could instruct multiple lay responders with effective teamwork and good communication with telecommunicators.
Conclusions:
The effectiveness and promotional value of the team-based tele-instruction tool for improving resuscitation quality for multiple lay responders in prearrival care have been verified. We suggest a wide application of the team-based tele-instruction tool in the telehealth emergency services system for better resuscitation performance in multiple lay responders situations.
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