Rose’s niece, Jill, arrives to help her aunt tidy up after breakfast and notices that the curtains are still drawn. She lets herself in through the keysafe and finds her aunt collapsed on the kitchen floor. She immediately calls 999 on her mobile phone and, following the call handler’s guidance, commences CPR.
Examples of how a call-handler guides the CPR process can be heard in the two audio-recordings below:
- Save a Life for Scotland: Young Scott 99 (YouTube)
Although she is very distressed, Jill manages to follow the instructions given to her by the call-handler.
Jill continues to administer chest compressions to Rose until the first responders arrive.
Scottish Ambulance Service call handler
Call handler: Ambulance emergency what’s the number you’re calling from?
Caller: It’s zero double seven double five double six double seven double eight
Call handler: Ok, can you just confirm that number for me please
Caller: Zero double seven double five double six double seven double eight
Call handler: And the address of the emergency
Caller: We’re at the public toilets behind the Forth Road Bridge control room off the A90 in South Queensferry
Call handler: Ok, can you just confirm that address for me please
Caller: Yeah, its the public toilets behind the Forth Road Bridge control room in South Queensferry
Call handler: Ok, is the patient breathing?
Caller: No
Call handler: Ok, tell me exactly what happened
Caller: Its my husband, he just collapsed and stopped breathing
Call handler: Right ok, now there is a defibrillator available ok, I’m going to tell you where to get it ok?
Caller: Ok
Call handler: Its in the reception of the Forth Road Bridge control ok?
Caller: Ok
Call handler: And there’s an access code, ok its six seven eight one zero five
Caller: Ok, somebody go and get the defib from the bridge control room please, you need this code its six seven eight one zero five, go and get it. Ok, they’re away
Call handler: So they’ve sent someone to get that now, yeah?
Caller: Yeah
Call handler: Ok, just tell me when you have it ok?
Caller: Ok we will
Call handler: Ok I’m organising help for you now stay on the line I’ll tell you exactly what to do next, ok?
Caller: Ok
Call handler: Are you right by him now?
Caller: I’m right beside him
Call handler: Right, listen carefully, lay him flat on his back and remove any pillows
Caller: Ok, he’s on his back, that’s how he is
Call handler: Ok, is the defibrillator there now?
Caller: No its not here yet
Call handler: No, right. Ok, tell me as soon as the defibrillator is there, right there with you ok?
Caller: Yeah
Call handler: Now listen carefully and I’ll tell you how to do chest compressions
Caller: Ok
Call handler: Make sure they’re flat on their back on the floor
Caller: Yeah
Call handler: Put the heel of your hand on the breast bone in the centre of the chest right between the nipples, put your other hand on top of that hand, ok?
Caller: Yeah
Call handler: Pump the chest hard and fast at least at least twice per second and two inches deep, let the chest come all the way up between pumps. We’re going to do this until help can take over. Count out loud so I can count with you, ok? And we’ll go at the rate of one, two, three, four
Caller: I’m going to put you on speaker phone
Call handler: Yeah, loudspeaker, yeah do that now
Caller: I’m going, ok
Both: One, two, three, four. One, two, three, four. One, two, three, four
Call handler: That’s it, keep that going
Caller: One, two, three, four. They’re back with the defib. That’s the defib here
Call handler: Right, ok, ok. Is the defibrillator there right now?
Caller: Yeah, its right with me now
Call handler: Put the defibrillator on the floor next to their head…
Caller: Oh, the ambulance is here now too
Call handler: Is that the ambulance there with you?
Caller: Yeah, they’re here
Call handler: That’s great I’ll let you go and speak to the ambulance crew. You did really well
Caller: Ok, thank you, thanks bye
Call handler: Bye bye
Pulse point
When a call-handler gives CPR instructions over the phone, this is known as Dispatcher-Assisted CPR. Dispatcher-Assisted CPR appears to improve cardiac arrest outcomes. Increased availability and use of mobile phones has made it easier for the rescuer to stay with the person who has had the arrest, whilst receiving instructions.
Ro et al (2017) carried out an interesting research study (Effect of dispatcher-assisted cardiopulmonary resuscitation program and location of out-of-hospital cardiac arrest on survival and neurological outcome) which appeared to show that dispatcher-assisted CPR was more effective than bystander CPR alone when the cardiac arrest occurred in a private setting.
The Resuscitation Council UK Guidelines 2015 point out that, in the UK, call-handlers who answer 999 calls generally have no medical training background. It is essential that they are fully trained in recognising and managing OHCA calls, particularly as they may be dealing with very distressed callers. Following an OHCA call, the call-handler will normally be offered a hot debrief or time out with a supervisor.
