- Email: [email protected]
Emergency medical dispatch. With increasing research it is important to unify the reporting
Resuscitation 85 (2014) 3–4
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Editorial
Emergency medical dispatch. With increasing research it is important to unify the reporting
The survival rate of out-of-hospital cardiac arrest (OHCA) is assumed to increase if certain crucial treatment interventions are optimized and coordinated. This has been coined “the chain of survival” concept and is well known. The two first links in the chain of survival are immediate recognition of cardiac arrest (CA) and activation of the emergency medical system (EMS) and early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions. The emergency medical dispatchers have a key role in the first link of the chain since they are expected to recognize the symptoms of CA1,2 and dispatch an ambulance accordingly. Telephone instructions for CPR (T-CPR) can be provided by dispatchers to bystanders, without risking the health of patients not in CA.3 T-CPR increases the proportion of patients receiving CPR before the arrival of the ambulance4 and seems to increase survival,5 when compared to patients not receiving CPR before the arrival of the first ambulance.6 Nevertheless, one in five OHCA patients does not receive CPR prior to ambulance arrival.7 In this issue of Resuscitation there are five papers that address some of the important topics surrounding emergency medical dispatch. Song et al. performed a before–after study in which they implemented a T-CPR protocol at the emergency medical communication center (EMCC) of the capital city of the Republic of Korea.8 Bystander CPR rates and survival to hospital discharge with good neurological outcome after OCHA correlated and both increased significantly after the implementation of the protocol. The ability to identify reliably CA at the point of dispatch is a presumption for appropriate allocations of EMS resources as well as the opportunity to give pre-arrival instructions to the bystander. We know that about 30–40%4,9 of CA patients do not stop breathing entirely when the arrest occurs, but continue breathing in an abnormal way, called agonal breathing or gasping. Agonal breathing is related to higher survival rates from OHCA9 but is a symptom that leads to failed identification in the EMCC in about half of the cases.4 We need to continue the implementation of this knowledge at EMCCs over the world. The intervention by Song et al. is an example of this, implementing a protocol including questions to the caller about abnormal breathing. However, they did not give the dispatchers any training during the implementation. Training and re-training has been shown successful in an implementation process.10 Nehme et al. showed in a registry study the likelihood of receiving EMS treatment and survival to hospital discharge if the emergency call initially was directed to the EMCC or to others like a relative, friend or neighbor.11 The frequency of inappropriate bystander calls was low, but associated with a reduced probability 0300-9572/$ – see front matter © 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.resuscitation.2013.10.003
of treatment by EMS and poorer survival outcomes. Bystander delay has been shown earlier by others12 and may be due to as many as 80% of bystanders without first aid training failing to recognize signs of CA.13 This highlights the need of first aid training for lay people and illuminates the important role of the dispatcher. Two simulation studies, one from Austria by van Tulder et al.14 and one from United States by Rodriguez et al.15 did evaluate chest compression depth after testing different instructions regarding chest compression instructions by dispatchers. In the former they concluded that an intensified wording and/or repetitive target depth instruction did not improve compression depth compared to the standard instruction. In the latter, regarding pediatric (six year old) victims, a simplified dispatcher instruction “Push as hard as you can” was associated with deeper and faster compressions, but the percentage of providers leaning between compressions increased. It can be speculated why the recommended compression depth of 5–6 cm rarely is achieved at T-CPR.16–19 It has been observed that there is a fear among laypeople to harm the victim when compressions are performed.20 Maybe the instruction “push as hard as you can” leads to a more adequate compression depth as shown by Rodrigues et al.15 because the layman will be less worried about causing harm. Others have also shown similar results when using the “push as hard as you can”-instruction21,22 as well as when a less detailed instructions were evaluated.23 However, the proportion of compressions performed in these studies with sufficient relief was 100%21–23 in contrary to the study by Rodrigues et al.15 Differences in compression rhythm and other aspects of the T-CPR most likely depend on these differences in instructions and needs further investigation. Some other recent published simulation studies have shown instructions to be more successful if continuous communication is enhanced24,25 and if cellular-phone video during the T-CPR instructions is possible.26 As the last, a study by Glegg et al. presents a new call description technique in which the time progress in each stage through the CPR-protocol as well as the caller–dispatcher interactions from the audio call recordings were analyzed.27 To study the communication between the caller and the dispatcher is indeed an interesting way to improve the dispatcher’s part in the chain of care. Clegg et al. have shown an example of a feasible way to do this.27 Thus the dispatcher shall be an expert on communication. As shown in this study, CPR-instructions are complicated and it is a challenge both for the dispatcher and for the bystander to manage this with the aim to perform CPR with quality. Correct identification of CA by the dispatcher saves lives.1,28 It also opens the possibility for T-CPR, saving even more lives.
4
Editorial / Resuscitation 85 (2014) 3–4
However when reading all above mentioned literature an overwhelming amount of expressions for processes and functions appear (e.g. telephone-assisted CPR, dispatcher (or dispatch)assisted CPR, telephone-CPR, dispatcher, emergency medical dispatcher, call-taker, dispatch center etcetera). There have been suggestions to uniform the reporting in research on emergency medical dispatch.29,30 It is satisfying that research in the field of emergency dispatch seems to be increasing. What happens during the process often affects the rest of the continuum of care and has great significance for the individual patient. It is crucial that research of emergency medical dispatch is finally given the resources and focus it deserves. We use, however different methods and expressions in our reports and this makes successful comparisons of studies difficult. There is a great need to define both concepts and practices for the continued successful growth of knowledge in the field of emergency dispatch.
13.
14.
15.
16.
17.
18. 19.
20.
Conflicts of interest statement 21.
Katarina Bohm has an unrestricted grant from SOS Alarm Sweden AB. Maaret Castrén does not have any conflicts of interest to declare. References
22.
23. 24.
1. Berdowski J, Beekhuis F, Zwinderman AH, Tijssen JG, Koster RW. Importance of the first link: description and recognition of an out-of-hospital cardiac arrest in an emergency call. Circulation 2009;119:2096–102. 2. Vaillancourt C, Charette ML, Bohm K, Dunford J, Castren M. In out-of-hospital cardiac arrest patients, does the description of any specific symptoms to the emergency medical dispatcher improve the accuracy of the diagnosis of cardiac arrest: a systematic review of the literature. Resuscitation 2011;82: 1483–9. 3. White L, Rogers J, Bloomingdale M, et al. Dispatcher assisted cardiopulmonary resuscitation: risks for patients not in cardiac arrest. Circulation 2010;121:91–7. 4. Vaillancourt C, Verma A, Trickett J, et al. Evaluating the effectiveness of dispatch-assisted cardiopulmonary resuscitation instructions. Acad Emerg Med 2007;14:877–83. 5. Vaillancourt C, Kasaboski A, Charette M, Morrow S, Wells GA, Stiell IG. Impact of dispatch-assisted CPR instructions on bystander CPR and survival rates: a before-after multicenter study. Resuscitation 2001;82:S6. 6. Bohm K, Vaillancourt C, Charette ML, Dunford J, Castren M. In patients with out-of-hospital cardiac arrest, does the provision of dispatch cardiopulmonary resuscitation instructions as opposed to no instructions improve outcome: a systematic review of the literature. Resuscitation 2011;82:1490–5. 7. Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-ofhospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2010;3:63–81. 8. Song KJ, Shin SD, Park CB, et al. Dispatcher-assisted bystander cardiopulmonary resuscitation in a metropolitan city: a before-after population-based study. Resuscitation 2014;85:34–41. 9. Bobrow BJ, Zuercher M, Ewy GA, et al. Gasping during cardiac arrest in humans is frequent and associated with improved survival. Circulation 2008;118:2550–4. 10. Bohm K, Stålhandske B, Rosenqvist M, Ulfvarson J, Hollenberg J, Svensson L. Tuition of emergency medical dispatchers in the recognition of agonal respiration increases the use of telephone assisted CPR. Resuscitation 2009;80:1025. 11. Nehme Z, Andrew E, Cameron P, et al. Direction of first bystander call for help is associated with outcome from out-of-hospital cardiac arrest. Resuscitation 2014;85:42–8. 12. Takei Y, Inaba H, Yachida T, Enami M, Goto Y, Ohta K. Analysis of reasons for emergency call delays in Japan in relation to location: high incidence of
25.
26.
27.
28.
29.
30.
correctable causes and the impact of delays on patient outcomes. Resuscitation 2010;81:1492–8. Breckwoldt J, Schloesser S, Arntz HR. Perceptions of collaps and assessment of cardiac arrest by bystanders of out-of-hospital cardiac arrest (OOHCA). Resuscitation 2009;80:1108–13. van Tulder R, Roth D, Krammel M, et al. Effects of repetitive or intensified instruction in telephone assisted, bystander cardiopulmonary resuscitation: an investigator-bilnded 4-armed, randomized, factorial, simulation trial. Resuscitation 2014;85:112–8. Rodriguez SA, Sutton RM, Berg MD, et al. Simplified dispatcher instructions improve bystander chest compression quality during simulated pediatric resuscitation. Resuscitation 2014;85:119–23. Woollard M, Smith A, Whitfield R, et al. To blow or not to blow: a randomised controlled trial of compression-only and standard telephone CPR instructions in simulated cardiac arrest. Resuscitation 2003;59:123–31. Cheung S, Deakin CD, Hsu R, Petley GW, Clewlow F. A prospective manikin-based observational study of telephone-directed cardiopulmonary resuscitation. Resuscitation 2007;72:425–35. Dorph E, Wik L, Steen PA. Dispatcher-assisted cardiopulmonary resuscitation. An evaluation of efficacy amongst elderly. Resuscitation 2003;56:265–73. Neset A, Birkenes TS, Furunes T, et al. A randomized trial on elderly laypersons’ CPR performance in a realistic cardiac arrest simulation. Acta Anaesthesiol Scand 2012;56:124–31. Coons SJ, Guy MC. Performing bystander CPR for sudden cardiac arrest: behavioral intentions among the general adult population in Arizona. Resuscitation 2009;80:334–40. Mirza M, Brown TB, Saini D, et al. Instructions to push as hard as you can improve average chest compression depth in dispatcher-assisted cardiopulmonary resuscitation. Resuscitation 2008;79:97–102. Brown TB, Saini D, Pepper T, et al. Instructions to put the phone down do not improve the quality of bystander initiated dispatcher-assisted cardiopulmonary resuscitation. Resuscitation 2008;76:249–55. Dias JA, Brown TB, Saini D, et al. Simplified dispatch assisted CPR instructions outperform standard protocol. Resuscitation 2007;72:108–14. Birkenes TS, Myklebust H, Neset A, Olasveengen TM, Kramer-Johansen J. Video analysis of dispatcher-rescuer teamwork – effects on CPR technique and performance. Resuscitation 2012;83:494–9. Birkenes TS, Myklebust H, Neset A, Kramer-Johansen J. Quality of CPR performed by trained bystanders with optimized pre-arrival instructions. Resuscitation 2014;85:124–30. Lee JS, Jeon WC, Ahn JH, Cho YJ, Jung YS, Kim GW. The effect of a cellularphone video demonstration to improve the quality of dispatcher-assisted chest compression-only cardiopulmonary resuscitation as compared with audio coaching. Resuscitation 2011;82:64–8. Clegg GR, Lyon RM, James S, Branigan HP, Bard EG, Egan GJ. Dispatchassisted CPR: where are the hold-ups during calls to emergency dispatchers? A preliminary analysis of caller–dispatcher interactions during after out-ofhospital cardiac arrest using a novel call transcription technique. Resuscitation 2014;85:49–52. Kuisma M, Boyd J, Väyrynen T, Repo J, Nousila-Wiik M, Holmström P. Emergency call processing and survival from out-of-hospital ventricular fibrillation. Resuscitation 2005;67:89–93. Castrén M, Karlsten R, Lippert F, et al. Recommended guidelines for reporting on emergency medical dispatch when conducting research in emergency medicine: the Utstein style. Resuscitation 2008;79:193–7. Castrén M, Bohm K, Kvam AM, et al. Reporting of data from out-of-hospital cardiac arrest has to involve emergency medical dispatching – taking the recommendations on reporting OHCA the Utstein style a step further. Resuscitation 2011;82:1496–500.
Katarina Bohm ∗ Maaret Castrén Karolinska Institutet, Sweden ∗ Corresponding author. E-mail address: [email protected] (K. Bohm)
11 October 2013
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Editorial
Emergency medical dispatch. With increasing research it is important to unify the reporting
The survival rate of out-of-hospital cardiac arrest (OHCA) is assumed to increase if certain crucial treatment interventions are optimized and coordinated. This has been coined “the chain of survival” concept and is well known. The two first links in the chain of survival are immediate recognition of cardiac arrest (CA) and activation of the emergency medical system (EMS) and early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions. The emergency medical dispatchers have a key role in the first link of the chain since they are expected to recognize the symptoms of CA1,2 and dispatch an ambulance accordingly. Telephone instructions for CPR (T-CPR) can be provided by dispatchers to bystanders, without risking the health of patients not in CA.3 T-CPR increases the proportion of patients receiving CPR before the arrival of the ambulance4 and seems to increase survival,5 when compared to patients not receiving CPR before the arrival of the first ambulance.6 Nevertheless, one in five OHCA patients does not receive CPR prior to ambulance arrival.7 In this issue of Resuscitation there are five papers that address some of the important topics surrounding emergency medical dispatch. Song et al. performed a before–after study in which they implemented a T-CPR protocol at the emergency medical communication center (EMCC) of the capital city of the Republic of Korea.8 Bystander CPR rates and survival to hospital discharge with good neurological outcome after OCHA correlated and both increased significantly after the implementation of the protocol. The ability to identify reliably CA at the point of dispatch is a presumption for appropriate allocations of EMS resources as well as the opportunity to give pre-arrival instructions to the bystander. We know that about 30–40%4,9 of CA patients do not stop breathing entirely when the arrest occurs, but continue breathing in an abnormal way, called agonal breathing or gasping. Agonal breathing is related to higher survival rates from OHCA9 but is a symptom that leads to failed identification in the EMCC in about half of the cases.4 We need to continue the implementation of this knowledge at EMCCs over the world. The intervention by Song et al. is an example of this, implementing a protocol including questions to the caller about abnormal breathing. However, they did not give the dispatchers any training during the implementation. Training and re-training has been shown successful in an implementation process.10 Nehme et al. showed in a registry study the likelihood of receiving EMS treatment and survival to hospital discharge if the emergency call initially was directed to the EMCC or to others like a relative, friend or neighbor.11 The frequency of inappropriate bystander calls was low, but associated with a reduced probability 0300-9572/$ – see front matter © 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.resuscitation.2013.10.003
of treatment by EMS and poorer survival outcomes. Bystander delay has been shown earlier by others12 and may be due to as many as 80% of bystanders without first aid training failing to recognize signs of CA.13 This highlights the need of first aid training for lay people and illuminates the important role of the dispatcher. Two simulation studies, one from Austria by van Tulder et al.14 and one from United States by Rodriguez et al.15 did evaluate chest compression depth after testing different instructions regarding chest compression instructions by dispatchers. In the former they concluded that an intensified wording and/or repetitive target depth instruction did not improve compression depth compared to the standard instruction. In the latter, regarding pediatric (six year old) victims, a simplified dispatcher instruction “Push as hard as you can” was associated with deeper and faster compressions, but the percentage of providers leaning between compressions increased. It can be speculated why the recommended compression depth of 5–6 cm rarely is achieved at T-CPR.16–19 It has been observed that there is a fear among laypeople to harm the victim when compressions are performed.20 Maybe the instruction “push as hard as you can” leads to a more adequate compression depth as shown by Rodrigues et al.15 because the layman will be less worried about causing harm. Others have also shown similar results when using the “push as hard as you can”-instruction21,22 as well as when a less detailed instructions were evaluated.23 However, the proportion of compressions performed in these studies with sufficient relief was 100%21–23 in contrary to the study by Rodrigues et al.15 Differences in compression rhythm and other aspects of the T-CPR most likely depend on these differences in instructions and needs further investigation. Some other recent published simulation studies have shown instructions to be more successful if continuous communication is enhanced24,25 and if cellular-phone video during the T-CPR instructions is possible.26 As the last, a study by Glegg et al. presents a new call description technique in which the time progress in each stage through the CPR-protocol as well as the caller–dispatcher interactions from the audio call recordings were analyzed.27 To study the communication between the caller and the dispatcher is indeed an interesting way to improve the dispatcher’s part in the chain of care. Clegg et al. have shown an example of a feasible way to do this.27 Thus the dispatcher shall be an expert on communication. As shown in this study, CPR-instructions are complicated and it is a challenge both for the dispatcher and for the bystander to manage this with the aim to perform CPR with quality. Correct identification of CA by the dispatcher saves lives.1,28 It also opens the possibility for T-CPR, saving even more lives.
4
Editorial / Resuscitation 85 (2014) 3–4
However when reading all above mentioned literature an overwhelming amount of expressions for processes and functions appear (e.g. telephone-assisted CPR, dispatcher (or dispatch)assisted CPR, telephone-CPR, dispatcher, emergency medical dispatcher, call-taker, dispatch center etcetera). There have been suggestions to uniform the reporting in research on emergency medical dispatch.29,30 It is satisfying that research in the field of emergency dispatch seems to be increasing. What happens during the process often affects the rest of the continuum of care and has great significance for the individual patient. It is crucial that research of emergency medical dispatch is finally given the resources and focus it deserves. We use, however different methods and expressions in our reports and this makes successful comparisons of studies difficult. There is a great need to define both concepts and practices for the continued successful growth of knowledge in the field of emergency dispatch.
13.
14.
15.
16.
17.
18. 19.
20.
Conflicts of interest statement 21.
Katarina Bohm has an unrestricted grant from SOS Alarm Sweden AB. Maaret Castrén does not have any conflicts of interest to declare. References
22.
23. 24.
1. Berdowski J, Beekhuis F, Zwinderman AH, Tijssen JG, Koster RW. Importance of the first link: description and recognition of an out-of-hospital cardiac arrest in an emergency call. Circulation 2009;119:2096–102. 2. Vaillancourt C, Charette ML, Bohm K, Dunford J, Castren M. In out-of-hospital cardiac arrest patients, does the description of any specific symptoms to the emergency medical dispatcher improve the accuracy of the diagnosis of cardiac arrest: a systematic review of the literature. Resuscitation 2011;82: 1483–9. 3. White L, Rogers J, Bloomingdale M, et al. Dispatcher assisted cardiopulmonary resuscitation: risks for patients not in cardiac arrest. Circulation 2010;121:91–7. 4. Vaillancourt C, Verma A, Trickett J, et al. Evaluating the effectiveness of dispatch-assisted cardiopulmonary resuscitation instructions. Acad Emerg Med 2007;14:877–83. 5. Vaillancourt C, Kasaboski A, Charette M, Morrow S, Wells GA, Stiell IG. Impact of dispatch-assisted CPR instructions on bystander CPR and survival rates: a before-after multicenter study. Resuscitation 2001;82:S6. 6. Bohm K, Vaillancourt C, Charette ML, Dunford J, Castren M. In patients with out-of-hospital cardiac arrest, does the provision of dispatch cardiopulmonary resuscitation instructions as opposed to no instructions improve outcome: a systematic review of the literature. Resuscitation 2011;82:1490–5. 7. Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-ofhospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2010;3:63–81. 8. Song KJ, Shin SD, Park CB, et al. Dispatcher-assisted bystander cardiopulmonary resuscitation in a metropolitan city: a before-after population-based study. Resuscitation 2014;85:34–41. 9. Bobrow BJ, Zuercher M, Ewy GA, et al. Gasping during cardiac arrest in humans is frequent and associated with improved survival. Circulation 2008;118:2550–4. 10. Bohm K, Stålhandske B, Rosenqvist M, Ulfvarson J, Hollenberg J, Svensson L. Tuition of emergency medical dispatchers in the recognition of agonal respiration increases the use of telephone assisted CPR. Resuscitation 2009;80:1025. 11. Nehme Z, Andrew E, Cameron P, et al. Direction of first bystander call for help is associated with outcome from out-of-hospital cardiac arrest. Resuscitation 2014;85:42–8. 12. Takei Y, Inaba H, Yachida T, Enami M, Goto Y, Ohta K. Analysis of reasons for emergency call delays in Japan in relation to location: high incidence of
25.
26.
27.
28.
29.
30.
correctable causes and the impact of delays on patient outcomes. Resuscitation 2010;81:1492–8. Breckwoldt J, Schloesser S, Arntz HR. Perceptions of collaps and assessment of cardiac arrest by bystanders of out-of-hospital cardiac arrest (OOHCA). Resuscitation 2009;80:1108–13. van Tulder R, Roth D, Krammel M, et al. Effects of repetitive or intensified instruction in telephone assisted, bystander cardiopulmonary resuscitation: an investigator-bilnded 4-armed, randomized, factorial, simulation trial. Resuscitation 2014;85:112–8. Rodriguez SA, Sutton RM, Berg MD, et al. Simplified dispatcher instructions improve bystander chest compression quality during simulated pediatric resuscitation. Resuscitation 2014;85:119–23. Woollard M, Smith A, Whitfield R, et al. To blow or not to blow: a randomised controlled trial of compression-only and standard telephone CPR instructions in simulated cardiac arrest. Resuscitation 2003;59:123–31. Cheung S, Deakin CD, Hsu R, Petley GW, Clewlow F. A prospective manikin-based observational study of telephone-directed cardiopulmonary resuscitation. Resuscitation 2007;72:425–35. Dorph E, Wik L, Steen PA. Dispatcher-assisted cardiopulmonary resuscitation. An evaluation of efficacy amongst elderly. Resuscitation 2003;56:265–73. Neset A, Birkenes TS, Furunes T, et al. A randomized trial on elderly laypersons’ CPR performance in a realistic cardiac arrest simulation. Acta Anaesthesiol Scand 2012;56:124–31. Coons SJ, Guy MC. Performing bystander CPR for sudden cardiac arrest: behavioral intentions among the general adult population in Arizona. Resuscitation 2009;80:334–40. Mirza M, Brown TB, Saini D, et al. Instructions to push as hard as you can improve average chest compression depth in dispatcher-assisted cardiopulmonary resuscitation. Resuscitation 2008;79:97–102. Brown TB, Saini D, Pepper T, et al. Instructions to put the phone down do not improve the quality of bystander initiated dispatcher-assisted cardiopulmonary resuscitation. Resuscitation 2008;76:249–55. Dias JA, Brown TB, Saini D, et al. Simplified dispatch assisted CPR instructions outperform standard protocol. Resuscitation 2007;72:108–14. Birkenes TS, Myklebust H, Neset A, Olasveengen TM, Kramer-Johansen J. Video analysis of dispatcher-rescuer teamwork – effects on CPR technique and performance. Resuscitation 2012;83:494–9. Birkenes TS, Myklebust H, Neset A, Kramer-Johansen J. Quality of CPR performed by trained bystanders with optimized pre-arrival instructions. Resuscitation 2014;85:124–30. Lee JS, Jeon WC, Ahn JH, Cho YJ, Jung YS, Kim GW. The effect of a cellularphone video demonstration to improve the quality of dispatcher-assisted chest compression-only cardiopulmonary resuscitation as compared with audio coaching. Resuscitation 2011;82:64–8. Clegg GR, Lyon RM, James S, Branigan HP, Bard EG, Egan GJ. Dispatchassisted CPR: where are the hold-ups during calls to emergency dispatchers? A preliminary analysis of caller–dispatcher interactions during after out-ofhospital cardiac arrest using a novel call transcription technique. Resuscitation 2014;85:49–52. Kuisma M, Boyd J, Väyrynen T, Repo J, Nousila-Wiik M, Holmström P. Emergency call processing and survival from out-of-hospital ventricular fibrillation. Resuscitation 2005;67:89–93. Castrén M, Karlsten R, Lippert F, et al. Recommended guidelines for reporting on emergency medical dispatch when conducting research in emergency medicine: the Utstein style. Resuscitation 2008;79:193–7. Castrén M, Bohm K, Kvam AM, et al. Reporting of data from out-of-hospital cardiac arrest has to involve emergency medical dispatching – taking the recommendations on reporting OHCA the Utstein style a step further. Resuscitation 2011;82:1496–500.
Katarina Bohm ∗ Maaret Castrén Karolinska Institutet, Sweden ∗ Corresponding author. E-mail address: [email protected] (K. Bohm)
11 October 2013