Language barriers in emergency ambulance calls for cardiac arrest: Cases of missing vital information.

In medical emergencies, phoning the ambulance service constitutes a high-stakes interaction. Call-takers rely on callers to provide information about the patient so they can promptly recognise the medical problem and take swift action to remedy it. When a language barrier exists between the call-taker and caller, this can add a further challenge, given that third-party interpreters are rarely engaged, especially for time-critical conditions such as cardiac arrest.

Breaking down barriers: Call-taker strategies to address caller perception of inappropriateness of cardiopulmonary resuscitation during the emergency ambulance call.

Background: Ambulance call-takers perform the critical role of prompting callers to initiate and continue cardiopulmonary resuscitation (CPR) for patients with suspected out-of-hospital cardiac arrest (OHCA). This study aimed to identify call-taker strategies to address callers' perceptions of CPR 'inappropriateness' (perceiving the patient as dead and beyond help, or as showing signs of life).

Methods: Using a linguistic approach, we analysed 31 calls previously identified as having an inappropriateness barrier to CPR initiation or continuation.

The association of out-of-hospital cardiac arrest barriers to cardiopulmonary resuscitation initiation and continuation during the emergency call: A retrospective cohort study.

Background: In a previous study, we identified eight types of potential barriers to bystander cardiopulmonary resuscitation (CPR) initiation and continuation until the arrival of emergency medical services (EMS) on scene, in the context of emergency calls for out-of-hospital cardiac arrest (OHCA). Many cases had multiple barriers. In this study, we aimed to estimate the independent effects of these barriers after adjusting for case characteristics.

Barriers to CPR initiation and continuation during the emergency call relating to out-of-hospital cardiac arrest: A descriptive cohort study.

Aim: To describe the barriers to cardiopulmonary resuscitation (CPR) initiation and continuation in emergency calls for out-of-hospital cardiac arrest (OHCA).

Methods: We analysed 295 consecutive emergency calls relating to OHCA over a four-month period (1 January - 30 April 2021). Calls included were paramedic-confirmed, non-traumatic, non-EMS-witnessed OHCA, where the caller was with the patient.

"If you miss that first step in the chain of survival, there is no second step"-Emergency ambulance call-takers' experiences in managing out-of-hospital cardiac arrest calls.

When a person has an out-of-hospital cardiac arrest (OHCA), calling the ambulance for help is the first link in the chain of survival. Ambulance call-takers guide the caller to perform life-saving interventions on the patient before the paramedics arrive at the scene, therefore, their actions, decisions and communication are integral to saving the patient's life. In 2021, we conducted open-ended interviews with 10 ambulance call-takers with the aim of understanding their experiences of managing these phone calls; and to explore their views on using a standardised call protocol and triage system for OHCA calls.

Association between initial presenting level of consciousness and patient acuity - A potential application for secondary triage in emergency ambulance calls.

Introduction: Conscious state assessment is important for the triage of emergency patients. In this study, we measured the association between ambulance patients' conscious state and high versus lower acuity, with a view to informing telephone triage assessment of conscious state.

Methods: Data were analysed from one year of emergency ambulance incidents in Perth, Western Australia.

Ambulance dispatch prioritisation for traffic crashes using machine learning: A natural language approach.

Introduction: Demand for emergency ambulances is increasing, therefore it is important that ambulance dispatch is prioritised appropriately. This means accurately identifying which incidents require a lights and sirens (L&S) response and those that do not. For traffic crashes, it can be difficult to identify the needs of patients based on bystander reports during the emergency phone call; as traffic crashes are complex events, often with multiple patients at the same crash with varying medical needs.

"I'm sorry, my English not very good": Tracking differences between Language-Barrier and Non-Language-Barrier emergency ambulance calls for Out-of-Hospital Cardiac Arrest.

Background: One-fifth of Australia's population do not speak English at home. International studies have found emergency calls with language barriers (LB) result in longer delays to out-of-hospital cardiac arrest (OHCA) recognition, and lower rates of bystander cardiopulmonary resuscitation (CPR) and survival. This study compared LB and non-LB OHCA call time intervals in an Australian emergency medical service (EMS).

'I think he's dead': A cohort study of the impact of caller declarations of death during the emergency call on bystander CPR.

Background: In emergency calls for out-of-hospital cardiac arrest (OHCA), dispatchers are instrumental in the provision of bystander cardiopulmonary resuscitation (CPR) through the recruitment of the caller. We explored the impact of caller perception of patient viability on initial recognition of OHCA by the dispatcher, rates of bystander CPR and early patient survival outcomes.

Methods: We conducted a retrospective cohort study of 422 emergency calls where OHCA was recognised by the dispatcher and resuscitation was attempted by paramedics.

"Sorry, what did you say?" Communicating defibrillator retrieval and use in OHCA emergency calls.

Background: The defibrillator prompt, which directs callers to retrieve a defibrillator during out-of-hospital cardiac arrest, is crucial to the emergency call because it can save lives. We evaluated communicative effectiveness of the prompt instated by the Medical Priority Dispatch System™ Version 13, namely: if there is a defibrillator (AED) available, send someone to get it now, and tell me when you have it.

Methods: Using Conversation Analysis and descriptive statistics, we examined linguistic features of the defibrillator sequences (call-taker prompt and caller response) in 208 emergency calls where non-traumatic out-of-hospital cardiac arrest was confirmed by the emergency medical services, and they attempted resuscitation, in the first six months of 2019.

Caller resistance to perform cardio-pulmonary resuscitation in emergency calls for cardiac arrest.

A key objective of an emergency call for cardiac arrest is to recruit a bystander to perform cardio-pulmonary resuscitation (CPR) until the ambulance arrives. Emergency medical services worldwide work towards increasing the rate of bystander-CPR, and existing research has identified a number of physical barriers to the provision of bystander-CPR. Yet, little is known about the specific ways in which emergency callers resist recruitment to perform basic first-aid, sometimes in the absence of any physical obstacle.

Motor Vehicle Crash Characteristics That Are Predictive of High Acuity Patients: An Analysis of Linked Ambulance and Crash Data.

Motor vehicle crashes (MVCs) comprise a significant component of emergency medical service workload. Due to the potential for life-threatening injuries, ambulances are often dispatched at the highest priority to MVCs. However, previous research has shown that only a small proportion of high-priority ambulance responses to MVCs encounter high acuity patients.

'We're going to do CPR': A linguistic study of the words used to initiate dispatcher-assisted CPR and their association with caller agreement.

Background: In emergency ambulance calls for out-of-hospital cardiac arrest (OHCA), dispatcher-assisted cardiopulmonary resuscitation (CPR) plays a crucial role in patient survival. We examined whether the language used by dispatchers to initiate CPR had an impact on callers' agreement to perform CPR.

Methods: We analysed 424 emergency calls relating to cases of paramedic-confirmed OHCA where OHCA was recognised by the dispatcher, the caller was with the patient, and resuscitation was attempted by paramedics.

'She's sort of breathing': What linguistic factors determine call-taker recognition of agonal breathing in emergency calls for cardiac arrest?

Background: In emergency ambulance calls, agonal breathing remains a barrier to the recognition of out-of-hospital cardiac arrest (OHCA), initiation of cardiopulmonary resuscitation, and rapid dispatch. We aimed to explore whether the language used by callers to describe breathing had an impact on call-taker recognition of agonal breathing and hence cardiac arrest.

Methods: We analysed 176 calls of paramedic-confirmed OHCA, stratified by recognition of OHCA (89 cases recognised, 87 cases not recognised).

The linguistic and interactional factors impacting recognition and dispatch in emergency calls for out-of-hospital cardiac arrest: a mixed-method linguistic analysis study protocol.

Introduction: Emergency telephone calls placed by bystanders are crucial to the recognition of out-of-hospital cardiac arrest (OHCA), fast ambulance dispatch and initiation of early basic life support. Clear and efficient communication between caller and call-taker is essential to this time-critical emergency, yet few studies have investigated the impact that linguistic factors may have on the nature of the interaction and the resulting trajectory of the call. This research aims to provide a better understanding of communication factors impacting on the accuracy and timeliness of ambulance dispatch.

'Tell me exactly what's happened': When linguistic choices affect the efficiency of emergency calls for cardiac arrest.

Background: Clear and efficient communication between emergency caller and call-taker is crucial to timely ambulance dispatch. We aimed to explore the impact of linguistic variation in the delivery of the prompt "okay, tell me exactly what happened" on the way callers describe the emergency in the Medical Priority Dispatch System.

Methods: We analysed 188 emergency calls for cases of paramedic-confirmed out-of-hospital cardiac arrest.

Association between ambulance dispatch priority and patient condition.

Objective: To compare chief complaints of the Medical Priority Dispatch System in terms of the match between dispatch priority and patient condition.

Methods: This was a retrospective whole-of-population study of emergency ambulance dispatch in Perth, Western Australia, 1 January 2014 to 30 June 2015. Dispatch priority was categorised as either Priority 1 (high priority), or Priority 2 or 3.