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Impact of the caller’s emotional state and cooperation on out-of-hospital cardiac arrest recognition and dispatcher-assisted cardiopulmonary resuscitation
  1. Cheng-Yu Chien1,2,
  2. Wei-Che Chien1,3,
  3. Li-Heng Tsai1,
  4. Shang-Li Tsai1,
  5. Chen-Bin Chen1,
  6. Chen-June Seak1,
  7. Yu-Shao Chou1,4,
  8. Matthew Ma5,
  9. Yi-Ming Weng1,6,
  10. Chip-Jin Ng1,
  11. Cheng-Yu Lin2,
  12. I-Shiang Tzeng7,8,
  13. Chi-Chun Lin1,2,
  14. Chien Hsiung Huang1,6
  1. 1 Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, TaoYuan, Taiwan
  2. 2 Department of Emergency Medicine, Ton-Yen General Hospital, Hsinchu, Taiwan
  3. 3 Department of Emergency Medicine, Chang Gung Memorial Hospital Keelungi Branch, Keelung, Taiwan
  4. 4 Department of Emergency Medicine, En Chu Kong Hospital, New Taipei, Taiwan
  5. 5 Department of Emergency Medicine, National Taiwan University Hospital YunLin Branch, Douliou, Taiwan
  6. 6 Department of Emergency Medicine, Taoyuan General Hospital, Taoyuan, Taiwan
  7. 7 Department of Research, Taipei Tzu Chi Hospital, New Taipei, Taiwan
  8. 8 Department of Statistics, National Taipei University, Taipei, Taiwan
  1. Correspondence to Prof. Chi-Chun Lin, Department of Emergency Medicine Ton-Yen General Hospital Hsinchu Taiwan ; phenoca{at} and Dr Chien Hsiung Huang, Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan; innoto86{at}


Objective This study determined the impact of the caller’s emotional state and cooperation on out-of-hospital cardiac arrest (OHCA) recognition and dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) performance metrics.

Methods This was a retrospective study using data from November 2015 to October 2016 from the emergency medical service dispatching centre in northern Taiwan. Audio recordings of callers contacting the centre regarding adult patients with non-traumatic OHCA were reviewed. The reviewers assigned an emotional content and cooperation score (ECCS) to the callers. ECCS 1–3 callers were graded as cooperative and ECCS 4–5 callers as uncooperative and highly emotional. The relation between ECCS and OHCA recognition, time to key events and DA-CPR delivery were investigated.

Results Of the 367 cases, 336 (91.6%) callers were assigned ECCS 1–3 with a good inter-rater reliability (k=0.63). Dispatchers recognised OHCA in 251 (68.4%) cases. Compared with callers with ECCS 1, callers with ECCS 2 and 3 were more likely to give unambiguous responses about the patient’s breathing status (adjusted OR (AOR)=2.6, 95% CI 1.1 to 6.4), leading to a significantly higher rate of OHCA recognition (AOR=2.3, 95% CI 1.1 to 5.0). Thirty-one callers were rated uncooperative (ECCS 4–5) but had shorter median times to OHCA recognition and chest compression (29 and 122 s, respectively) compared with the cooperative caller group (38 and 170 s, respectively). Nevertheless, those with ECCS 4–5 had a significantly lower DA-CPR delivery rate (54.2% vs 85.9%) due to ‘caller refused’ or ‘overly distraught’ factors.

Conclusions The caller’s high emotional state is not a barrier to OHCA recognition by dispatchers but may prevent delivery of DA-CPR instruction. However, DA-CPR instruction followed by first chest compression is possible despite the caller’s emotional state if dispatchers are able to skilfully reassure the emotional callers.

  • out-of-hospital cardiac arrest
  • dispatcher-assisted cardiopulmonary resuscitation
  • emotional content
  • cooperation score

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  • C-YC and W-CC contributed equally.

  • Contributors S-LT, L-HT, C-BC and C-JS conceived and designed the study. Y-SC, C-CL, W-CC and Y-MW supervised the data collection. C-JN and C-YL managed the data, including quality control. I-ST and C-YC analysed the data. C-YC, W-CC, MM and CHH drafted the manuscript, and all authors contributed substantially to its revision. CHH takes responsibility for the paper as a whole.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval This study was approved by the Chang Gung Medical Foundation’s Hospital Ethics Committee on Human Research (104-2875B) with a waiver of informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.