Time Delays on the Identification of the Need for CPR for Limited English Proficient 9-1-1 Callers
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Background: A substantial percentage of the U.S. population does not speak English well (Limited English proficient [LEP]). When a LEP reporting person (RP) calls 9-1-1 for a cardiac arrest and receives Telephone-Assisted Cardiopulmonary Resuscitation (T-CPR) from the dispatch call receiver (CR), communication barriers may cause delays to initiating bystander T-CPR. This study investigates the causes of delays in CR recognition of the need for CPR and delivery of T-CPR to LEP and non-LEP reporting persons in cardiac arrest emergencies. Methods: The cohort consisted of 76 LEP and 76 non-LEP confirmed out-of-hospital cardiac arrest calls in King County, WA in 2010-2012. CPR determination times and CPR introduction-to-instruction time intervals were analyzed for causes of delays using independent sample t-tests. Results: The CPR determination time was 53% longer for LEP calls than non-LEP calls (p < 0.001). Three delay causes significantly lengthened determination time in LEP calls: due to RP language difficulties (48% longer, p = 0.010), RP not knowing answers to CR questions (54% longer, p = 0.006), and CR not initially recognizing CPR need (56% longer, p = 0.015). Three delay causes significantly lengthened determination time in non-LEP calls: delays due to RP leaving phone (69% longer, p = 0.009), due to unclear RP responses (77% longer, p = 0.001), and RP not knowing answers to CR questions (60% longer, p < 0.001). The CPR introduction-instruction time gap was 70% shorter for LEP calls than non-LEP calls (p = 0.111). Within the LEP group, the only significant delay was that due to the CR asking if the RP wanted to do CPR (81% longer, p = 0.003). Within the non-LEP group, the only significant delay was that due to the RP being confused about whether or not the patient was breathing (86% longer, p = 0.002). Conclusion: Many of the significant causes of delays found in this study involved communication barriers between the RP and CR. Improvements to training dispatchers and the population served may address communication insufficiencies as well as the level of familiarity with emergency situations among the general population.
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