Association between the centralization of dispatch centers and dispatcher-assisted cardiopulmonary resuscitation programs: A natural experimental study.

Abstract

We aimed to evaluate the associations between the centralization of dispatch centers and dispatcher-assisted bystander cardiopulmonary resuscitation (DA-BCPR) for out-of-hospital cardiac arrest (OHCA) patients. All emergency medical services (EMS)-treated adults in Gyeonggi province (34 fire departments covering 43 counties, with a population of 12.6 million) with OHCAs of cardiac etiology were enrolled between 2013 and 2016, excluding cases witnessed by EMS providers. In Gyeonggi province, 34 agency-based dispatch centers were sequentially integrated into two province-based central dispatch centers (north and south) between November 2013 and May 2016. Exposure was the centralization of the dispatch centers. Endpoint variables were BCPR and dispatcher-provided CPR instructions. Generalized linear mixed models for multilevel regression analyses were performed. Overall, 11,616 patients (5060 before centralization and 6556 after centralization) were included in the final analysis. The OHCAs that occurred during the after-centralization period were more likely to receive BCPR (62.6%, 50.6% BCPR-with-DA and 12.0% BCPR-without-DA) than were those that occurred before-centralization period (44.6%, 16.6% BCPR-with-DA and 28.1% BCPR-without-DA) (p < 0.01, adjusted OR: 1.59 (1.38-1.83), adjusted rate difference: 9.1% (5.0-13.2)). For dispatcher-provided CPR instructions, OHCAs diagnosed at a higher rate during the after-centralization period than during the before-centralization period (67.4% vs. 23.1%, p < 0.01, adjusted OR: 4.57 (3.26-6.42), adjusted rate difference: 30.3% (26.4-34.2)). The EMS response time was not different between the groups (p=0.26). The centralization of dispatch centers was associated with an improved bystander CPR rate and dispatcher-provided CPR instructions for OHCA patients.