Reasons for delays in the implementation of telephone-assisted bystander CPR for limited English proficient callers

Abstract

Study Objective: Early recognition of CPR is crucial given the large burden of out-of –hospital cardiac arrest events in the US and bystander CPR increases patient survival. Limited English proficiency can delay and prevent timely emergency response. This study examines and compares the possible barriers of communication between limited English proficient callers and non-limited English proficient callers and 9-1-1 call receivers (CR) resulting in delays in telephone-assisted CPR (T-CPR) during cardiac arrest calls. Methods: The cohort of this study consisted of 112 out –of-hospital confirmed cardiac arrest calls, where the call receiver (CR) identified the need for T-CPR, in King County, Washington between 2010 and 2012. The CPR delays related the CRs recognition of need for CPR and the start of T-CPR were examined in limited English and non-limited English proficient callers. In addition, the reasons why CPR was delayed or not performed were also examined. Results: Fifty-eight out of 60 (97%) limited English proficiency calls and 34 out of 52 calls (69.4%) of non-LEP calls included delays in performing CPR. Limited English proficient calls had more delays associated with the reporting party (RP) (85% (51/60) LEP vs 51.9% (27/52) non-LEP, p<0.01). The RP-related delays in the recognition of need of CRP were due to ambiguous responses to call receiver’s questions (20% (12/60) LEP vs 1.92% (1/52) non LEP, p<0.01). Three reasons were associated with overall CPR being delayed or not initiated: RP language barrier (p<0.01), RP not at scene (p=0.01) and RP confusion about patient consciousness state (p<0.01). Reporting party delays in the start of T-CPR were observed for more non-LEP calls (40% (12/30) vs 25% (9/36) than LEP calls. Conclusion: Limited English callers experienced more delays than non-LEP callers related to communication barriers between the RP and 9-1-1 call receiver Identifying the delays associated with the implementation of bystander T-CPR may provide training opportunities for telecommunicators and help tailor CPR training and 9-1-1 education in limited English proficient communities.