Background Telephone-assisted CPR (t-CPR), where ambulance-service call-handlers provide instructions to callers on how to perform CPR, increases rates of CPR and survival. However, up to 1/3 of bystanders do not deliver CPR even when provided instructions. If the proportion of people who initiate CPR could be increased, lives would be saved. As a part of a larger project aimed at increasing rates of CPR, we conducted a qualitative study to identify call-handlers’ perceptions of the main barriers to CPR and what they think helps people to initiate CPR.

Methods Semi-structured qualitative interviews were conducted with 30 call-handlers from seven UK ambulance services, purposively selected to ensure diversity in terms of age, gender, years of experience, geographical location, population served (size/rurality), dispatch software used (MPDS and Pathways), published outcomes for ROSC and Care Quality Commission Rating.

Results Thirty call-handlers (19F, 10M, 1 non-binary; aged 22-59) participated. Participants had between 6mths and 25yrs experience and rated their confidence in providing CPR instructions between 3 and 10/10 (mean: 9). The barriers to CPR identified most commonly were the physical challenges of getting people flat on ground; the extreme emotional state of the caller and agonal breathing leading callers to believe that CPR was not required. Call-handlers described various techniques (some suggested by protocol and some not) used to encourage people to initiate/continue CPR. Data relating to the impact of pandemic-related pressures on call-handlers’ experiences of the role also emerged.

Conclusions Providing t-CPR instructions is a challenging but rewarding and valued aspect of call-handlers role. By synthesising the collective experience of a representative sample of call-handlers we have identified techniques used to overcome barriers to CPR initiation, many of which are consistent with behavioural theory. Additional opportunities to use behavioural techniques have been identified and will be developed in partnership with call-handlers.