Out-of-hospital cardiac arrest protocol comparison


cardiac arrest
emergency medical dispatcher
criteria based dispatch (CBD)
medical priority dispatch (MPD)

How to Cite

Perry O, Wacht O, Jaffe E, Sinuany-Stern Z, Bitan Y. Out-of-hospital cardiac arrest protocol comparison. Australasian Journal of Paramedicine [Internet]. 2019Sep.12 [cited 2021Dec.4];160. Available from: https://ajp.paramedics.org/index.php/ajp/article/view/685



Early identification of out-of-hospital cardiac arrest (OHCA) has been proven to increase survival rates. Toward this goal, emergency medical dispatchers commonly use one of two types of emergency medical dispatcher systems, each with a unique OHCA protocol. The criteria-based dispatch (CBD) protocol is a set of guidelines and prompts intended for dispatchers with clinical background and experience, while the medical priority dispatch (MPD) is a scripted caller interrogation protocol intended for non-healthcare dispatchers. The objective of this study was to compare CBD and MPD protocols in terms of accuracy and duration of the identification process.


To compare the two protocols we conducted an OHCA simulation of an emergency phone call by a bystander. Two groups participated in the simulation: 1) emergency medical technicians during paramedic vocational training, in the role of CBD dispatchers, and 2) non-healthcare personnel in the role of MPD dispatchers. Dispatchers were asked to identify whether a patient was having a cardiac arrest based on the information they received from the bystander.


Duration of the OHCA identification process was significantly shorter for participants using MPD (CBD 50 seconds vs. MPD 33 seconds, p=0.003). The OHCA accuracy was 86.49% for the CBD and 82.86% for MPD, but this difference was not statistically significant (p=0.60).


The advantages of each protocol suggest that some combination of the two protocols may optimise the OHCA identification process, leading to increased accuracy and shorter duration of the identification process.




Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics-2015 update : a report from the American Heart Association 2015;131. doi:10.1161/CIR.0000000000000152

Perkins GD, Handley AJ, Koster RW, et al. European Resuscitation Council Guidelines for Resuscitation 2015. Section 2. Adult basic life support and automated external defibrillation. Resuscitation 2015;95:81-99. doi:10.1016/j.resuscitation.2015.07.015

Larsen MP, Eisenberg MS, Cummins RO, Hallstrom AP. Predicting survival from out-of-hospital cardiac arrest: a graphic model. Ann Emerg Med 1993;22:1652-8. doi:10.1016/S0196-0644(05)81302-2

Holmberg M, Holmberg S, Herlitz J. Incidence, duration and survival of ventricular fibrillation in out-of-hospital cardiac arrest patients in Sweden. Resuscitation 2000;44:7-17. doi:10.1016/S0300-9572(99)00155-0

Gold LS, Fahrenbruch CE, Rea TD, Eisenberg MS. The relationship between time to arrival of emergency medical services (EMS) and survival from out-of-hospital ventricular fibrillation cardiac arrest. ibid. 2010;81:622-5. doi:10.1016/j.resuscitation.2010.02.004

Sasson C, Rogers MAM, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2010;3:63-81. doi:10.1161/CIRCOUTCOMES.109.889576

Wissenberg M, Lippert FK, Folke F, et al. Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest. JAMA 2013;310:1377-84. doi:10.1001/jama.2013.278483

Hasselqvist-Ax I, Riva G, Herlitz J, et al. Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest. N Engl J Med 2015;372:2307-15. doi:10.1056/NEJMoa1405796

Hazinski M, Shuster M, Donnino M, et al. Highlights of the 2015 American Heart Association - guidelines update for CPR and ECG. 2015:1-36. Available at: https://eccguidelines.heart.org/wp-content/uploads/2015/10/2015-AHA-Guidelines-Highlights-English.pdf

Clawson JJ, Cady GA, Martin RL, Sinclair R. Effect of a comprehensive quality management process on compliance with protocol in an emergency medical dispatch center. Ann Emerg Med 1998;32:578-84. doi:10.1016/S0196-0644(98)70036-8

Deakin CD, Sherwood DM, Smith A, Cassidy M. Does telephone triage of emergency (999) calls using advanced medical priority dispatch (AMPDS) with Department of Health (DH) call prioritisation effectively identify patients with an acute coronary syndrome? An audit of 42 657 emergency calls to Hampshi. Emerg Med J 2006;23:232-5. doi:10.1136/emj.2004.022962

Hardeland C, Olasveengen TM, Lawrence R, et al. Comparison of medical priority dispatch (MPD) and criteria based dispatch (CBD) relating to cardiac arrest calls. Resuscitation 2014;85:612-6. doi:10.1016/j.resuscitation.2014.01.029

Dami F, Heymann E, Pasquier M, et al. Time to identify cardiac arrest and provide dispatch-assisted cardio-pulmonary resuscitation in a criteria-based dispatch system. ibid. 2015;97:27-33. doi:10.1016/j.resuscitation.2015.09.390

Viereck S, Møller TP, Rothman JP, Folke F, Lippert FK. Recognition of out-of-hospital cardiac arrest during emergency calls - a systematic review of observational studies. Scand J Trauma Resusc Emerg Med 2017;25:1-12. doi:10.1186/s13049-017-0350-8

Bobrow BJ, Spaite DW, Vadeboncoeur TF, et al. Implementation of a regional telephone cardiopulmonary resuscitation program and outcomes after out-of-hospital cardiac arrest. JAMA Cardiol 2016;1:294-302. doi:10.1001/jamacardio.2016.0251

Cheng A, Kessler D, Mackinnon R, et al. Reporting guidelines for health care simulation research: extensions to the CONSORT and STROBE statements. Adv Simul 2016;1-13. doi:10.1186/s41077-016-0025-y

Maran NJ, Glavin RJ. Low- to high-fidelity simulation - a continuum of medical education? Med Educ 2003;37(S1):22-8. doi:10.1046/j.1365-2923.37.s1.9.x

Patrick J. Training: Research and Practice. San Diego, CA, US: Academic Press; 1992.

Feldman HA, McKinlay JB, Potter DA, et al. Nonmedical influences on medical decision making: an experimental technique using videotapes, factorial design, and survey sampling. Health Serv Res 1997;32:343-66.

Flynn J, Archer F, Morgans A, Hons B. Sensitivity and specificity of the medical priority dispatch system in detecting cardiac arrest emergency calls in Melbourne 2006;21(2).

Vaillancourt C, Charette M, Kasaboski A, et al. Cardiac arrest diagnostic accuracy of 9-1-1 dispatchers: a prospective multi-center study. Resuscitation 2015;90:116-20. doi:10.1016/j.resuscitation.2015.02.027

Emergency Services Telecommunications Authority. Application Information Kit. Available at: www.esta.vic.gov.au/file/761/download?token=zG2oqOXe

Berdowski J, Beekhuis F, Zwinderman AH, Tijssen JGP, 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. doi:10.1161/CIRCULATIONAHA.108.768325

Nurmi J, Pettilä V, Biber B, et al. Effect of protocol compliance to cardiac arrest identification by emergency medical dispatchers. Resuscitation 2006;70:463-9. doi:10.1016/j.resuscitation.2006.01.016

Bielecki JM, Wong J, Mitsakakis N, et al. Disparities in a provision of in-hospital post-arrest interventions for out-of-hospital cardiac arrest (OHCA) in the elderly population - protocol for a systematic review. Syst Rev 2016;1-9. doi:10.1186/s13643-016-0234-4

Clegg GR, Lyon RM, James S, et al. Dispatch-assisted CPR: Where are the hold-ups during calls to emergency dispatchers? A preliminary analysis of caller-dispatcher interactions during out-of-hospital cardiac arrest using a novel call transcription technique. Resuscitation 2014;85:49-52. doi:10.1016/j.resuscitation.2013.08.018

Lerner EB, Rea TD, Bobrow BJ, et al. Emergency medical service dispatch cardiopulmonary resuscitation prearrival instructions to improve survival from out-of-hospital cardiac arrest: a scientific statement from the American Heart Association. Circulation 2012;125:648-55. doi:10.1161/CIR.0b013e31823ee5fc

Cohen. Power tables for effect size d power pables for effect size r. 1988;0:55. Available at: http://psych.unl.edu/hoffman/Sheets/Workshops/Power_Tables.pdf

Schwarz G. Estimating the dimension of a model. Ann Stat 1978;6:461-4. doi:10.1214/aos/1176344136

Rea TD, Eisenberg MS, Sinibaldi G, White RD. Incidence of EMS-treated out-of-hospital cardiac arrest in the United States. Resuscitation 2004;63:17-24. doi:10.1016/j.resuscitation.2004.03.025

Atwood C, Eisenberg MS, Herlitz J, Rea TD. Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. ibid 2005;67:75-80. doi:10.1016/j.resuscitation.2005.03.021

Gräsner J, Lefering R, Koster RW, et al. EuReCa ONE-27 Nations, ONE Europe, ONE Registry. A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. ibid 2016;105:188-95. doi:10.1016/j.resuscitation.2016.06.004

Hauff SR, Rea TD, Culley LL, et al. Factors Impeding dispatcher-assisted telephone cardiopulmonary resuscitation. Ann Emerg Med 2003;42:731-7. doi:10.1016/mem.2003.294

Bang A, Herlitz J, Martinell S. Interaction between emergency medical dispatcher and caller in suspected out-of-hospital cardiac arrest calls with focus on agonal breathing . A review of 100 tape recordings of true cardiac arrest cases. Resuscitation 2003;56:25-34.