Emergency calls analysis reveals opportunities to save more lives

New analysis of emergency calls to the Scottish Ambulance Service has identified key barriers that delay bystanders from starting cardiopulmonary resuscitation (CPR) during out-of-hospital cardiac arrests.

Prompt bystander CPR is the single most important factor in survival, increasing the chance of survival by up to four times. For every minute without CPR, survival chances fall by around 10%.

The study, led by researchers at the University of Stirling in partnership with the Scottish Ambulance Service, reviewed 200 emergency calls and found that communication difficulties, emotional distress and physical challenges were the most common reasons CPR was delayed.

Communication issues such as poor phone signal or background noise were present in 48% of calls. High emotional distress affected 45.5% of callers, while 38.5% faced physical challenges, including moving the patient or positioning them correctly.

Dr Barbara Farquharson, associate professor at the University of Stirling, said delays often occur because CPR is most frequently needed on a loved one.

“When someone collapses because their heart has stopped, they will die unless CPR starts immediately, but it often doesn’t. Many callers were dealing with intense distress, worried about doing harm, or felt it might already be too late. Those who said they didn’t know how to do CPR also took longer to begin.”

The calls analysed were drawn from more than 11,000 potentially eligible cases between January 2019 and December 2020. Patients ranged from infants to people over 90, with most aged between their 40s and 80s. Sixty-one per cent were male.

Researchers found it took a median of 40 seconds to position a patient flat, followed by a further 50 seconds to begin CPR. Different barriers influenced each step, highlighting opportunities for more targeted support during emergency calls.

The research team now plans to work closely with call handlers to explore ways of addressing these barriers in real time.

“Call handlers are experts in managing these highly distressing situations. By working alongside them, we can trial techniques that respond to individual callers’ concerns and help CPR start sooner.”

Dr Barbara Farquharson.

Dispatcher-assisted CPR (DA-CPR), where call handlers provide live instructions over the phone, is known to improve CPR rates and survival. However, studies show that even with guidance, up to a third of bystanders still do not begin CPR.

Dr Gareth Clegg, associate medical director at the Scottish Ambulance Service and senior lecturer at the University of Edinburgh, said the findings provide a strong foundation for improving support to hesitant callers.

“Out-of-hospital cardiac arrest can happen to anyone, anywhere, and most occur at home. Knowing CPR and feeling confident to act could save the life of someone you love.”

The study was published in the Emergency Medicine Journal and was funded by the British Heart Foundation and the Laerdal Foundation.

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