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Commencing one-handed chest compressions while activating emergency medical system using a handheld mobile device in lone-rescuer basic life support: a randomised cross-over simulation study
  1. Sang O Park1,
  2. Dong Hyuk Shin2,
  3. Changhoon Kim3,
  4. Young Hwan Lee4,5
  1. 1 Emergency Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
  2. 2 Emergency Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
  3. 3 Department of Preventive Medicine, Pusan National University School of Medicine, Busan, Republic of Korea
  4. 4 Emergency Medicine, Soonchunhyang University Hospital Bucheon, Bucheon, Republic of Korea
  5. 5 Emergency Medicine, Sacred Heart Hospital, Hallym University School of Medicine, Anyang, Republic of Korea
  1. Correspondence to Professor Young Hwan Lee, Emergency Medicine, Soonchunhyang University Hospital Bucheon, Bucheon, Gyeonggi 14584, Republic of Korea; zerohwani{at}


Introduction In conventional basic life support (c-BLS), a lone rescuer is recommended to start chest compressions (CCs) after activating the emergency medical system. To initiate earlier CCs in lone-rescuer BLS, we designed a modified BLS (m-BLS) sequence in which the lone rescuer commences one-handed CCs while calling for help using a handheld cellular phone with the other free hand. This study aimed to compare the quality of BLS between c-BLS and m-BLS.

Methods This was a simulation study performed with a randomised cross-over controlled trial design. A total of 108 university students were finally enrolled. After training for both c-BLS and m-BLS, participants performed a 3-minute c-BLS or m-BLS on a manikin with a SkillReporter at random cross-over order. The paired mean difference with SE between c-BLS and m-BLS was assessed using paired t-test.

Results The m-BLS had reduced lag time before the initiation of CCs (with a mean estimated paired difference (SE) of −35.0 (90.4) s) (p<0.001). For CC, a significant increase in compression fraction and a higher number of CCs with correct depth were observed in m-BLS (with a mean estimated paired difference (SE) of 16.2% (0.6) and 26.9% (3.3), respectively) (all p<0.001). However, no significant paired difference was observed in the hand position, compression rate and interruption time. For ventilation, the mean tidal volumes did not differ. However, the number of breaths with correct tidal volume was higher in m-BLS than in c-BLS.

Conclusion In simulated lone-rescuer BLS, the m-BLS could deliver significantly earlier CCs than the c-BLS while maintaining high-quality cardiopulmonary resuscitation.

  • cardiac arrest
  • effectiveness
  • chain of survival

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request via email.

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Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request via email.

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  • SOP and DHS contributed equally.

  • Contributors SOP, DHS and YHL established the main concept and designed this study. CK and YHL took part in simulation trials, analysis and interpretation of data. SOP and DHS drafted the manuscript. All authors reviewed, edited and approved the manuscript. YHL takes responsibility for the paper as a whole.

  • Funding This research was supported by Hallym University Research Fund 2016 (HURF-2016-08). We studied with the Resusci Anne SkillReporter (Laerdal Medical Corporation, Stavanger, Norway) and there is no conflict of interest regarding this simulator.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.