Estimated Cost-Effectiveness of Dispatcher CPR Instruction via Telephone to Bystanders During Out-of-Hospital Ventricular Fibrillation

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Abstract

Hypothesis: Emergency cardiopulmonary resuscitation (CPR) instruction via telephone (ETCPR) is cost-effective compared to prehospital, emergency medical technicial (EMT)/paramedic treatment alone of witnessed, ventricular fibrillation (VE) in adult patients. Methods: A total of 118 patients, age >18 years, with prehospital, witnessed ventricular fibrillation were studied. Patient data were extracted from hospital records, monitor-defibrillator recordings, paramedic reports, dispatching records, and telephone interviews with bystanders. No ETCPR was available during this period. The costs of ETCPR implementation were estimated retrospectively. Marginal cost of the paramedic service attributable to treatment of VF was calculated from fire department records. Years-of-life saved were estimated from age, gender, and race matched norms. Results: Of the 53 patients receiving bystander CPR (BCPR), 14 (26%) survived to hospital discharge versus 4/65 patients (6%) lacking BCPR These groups did not differ significantly (p>.05) in age, EMS response times, or time from collapse to defibrillation. The mean time interval from collapse to CPR was significantly less for patients with BCPR (1.8 min) than for patients without BCPR (7.1 min). Had all patients received BCPR and survived at the rate of 0.26, 13 additional patients would have survived to hospital discharge. The cost per year-of-life saved by the EMS system with ETCPR would have been [US1$2,834 versus $4,881 without ETCPR The cost per additional year-of-life saved by ETCPR was estimated to be $560 in patients experiencing out-of-hospital ventricular fibrillation. Conclusion: The use of ETCPR instruction of callers by 9-1-1 dispatchers potentially is a cost-effective addition to a two-tier, EMS system for treatment of prehospital ventricular fibrillation.

Original languageEnglish (US)
Pages (from-to)229-233
Number of pages5
JournalPrehospital and Disaster Medicine
Volume7
Issue number3
DOIs
StatePublished - 1992

Fingerprint

Cardiopulmonary Resuscitation
Ventricular Fibrillation
Telephone
Cost-Benefit Analysis
Costs and Cost Analysis
Allied Health Personnel
Emergencies
Defibrillators
Hospital Records
Reaction Time
Therapeutics
Interviews

Keywords

  • bystander CPR
  • cardiac arrest
  • cardiopulmonary resuscitation (CPR)
  • cost-effectiveness
  • CPR telephone instruction
  • prehospital
  • response times
  • survival
  • ventricular fibrillation

ASJC Scopus subject areas

  • Emergency
  • Emergency Medicine

Cite this

@article{27ec5f62bdea4f99be6299ae31f64603,
title = "Estimated Cost-Effectiveness of Dispatcher CPR Instruction via Telephone to Bystanders During Out-of-Hospital Ventricular Fibrillation",
abstract = "Hypothesis: Emergency cardiopulmonary resuscitation (CPR) instruction via telephone (ETCPR) is cost-effective compared to prehospital, emergency medical technicial (EMT)/paramedic treatment alone of witnessed, ventricular fibrillation (VE) in adult patients. Methods: A total of 118 patients, age >18 years, with prehospital, witnessed ventricular fibrillation were studied. Patient data were extracted from hospital records, monitor-defibrillator recordings, paramedic reports, dispatching records, and telephone interviews with bystanders. No ETCPR was available during this period. The costs of ETCPR implementation were estimated retrospectively. Marginal cost of the paramedic service attributable to treatment of VF was calculated from fire department records. Years-of-life saved were estimated from age, gender, and race matched norms. Results: Of the 53 patients receiving bystander CPR (BCPR), 14 (26{\%}) survived to hospital discharge versus 4/65 patients (6{\%}) lacking BCPR These groups did not differ significantly (p>.05) in age, EMS response times, or time from collapse to defibrillation. The mean time interval from collapse to CPR was significantly less for patients with BCPR (1.8 min) than for patients without BCPR (7.1 min). Had all patients received BCPR and survived at the rate of 0.26, 13 additional patients would have survived to hospital discharge. The cost per year-of-life saved by the EMS system with ETCPR would have been [US1$2,834 versus $4,881 without ETCPR The cost per additional year-of-life saved by ETCPR was estimated to be $560 in patients experiencing out-of-hospital ventricular fibrillation. Conclusion: The use of ETCPR instruction of callers by 9-1-1 dispatchers potentially is a cost-effective addition to a two-tier, EMS system for treatment of prehospital ventricular fibrillation.",
keywords = "bystander CPR, cardiac arrest, cardiopulmonary resuscitation (CPR), cost-effectiveness, CPR telephone instruction, prehospital, response times, survival, ventricular fibrillation",
author = "Valenzuela, {Terence D} and Spaite, {Daniel W} and Clark, {Lani L.} and Meislin, {Harvey W}",
year = "1992",
doi = "10.1017/S1049023X00039558",
language = "English (US)",
volume = "7",
pages = "229--233",
journal = "Prehospital and Disaster Medicine",
issn = "1049-023X",
publisher = "World Association for Disaster and Emergency Medicine",
number = "3",

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TY - JOUR

T1 - Estimated Cost-Effectiveness of Dispatcher CPR Instruction via Telephone to Bystanders During Out-of-Hospital Ventricular Fibrillation

AU - Valenzuela, Terence D

AU - Spaite, Daniel W

AU - Clark, Lani L.

AU - Meislin, Harvey W

PY - 1992

Y1 - 1992

N2 - Hypothesis: Emergency cardiopulmonary resuscitation (CPR) instruction via telephone (ETCPR) is cost-effective compared to prehospital, emergency medical technicial (EMT)/paramedic treatment alone of witnessed, ventricular fibrillation (VE) in adult patients. Methods: A total of 118 patients, age >18 years, with prehospital, witnessed ventricular fibrillation were studied. Patient data were extracted from hospital records, monitor-defibrillator recordings, paramedic reports, dispatching records, and telephone interviews with bystanders. No ETCPR was available during this period. The costs of ETCPR implementation were estimated retrospectively. Marginal cost of the paramedic service attributable to treatment of VF was calculated from fire department records. Years-of-life saved were estimated from age, gender, and race matched norms. Results: Of the 53 patients receiving bystander CPR (BCPR), 14 (26%) survived to hospital discharge versus 4/65 patients (6%) lacking BCPR These groups did not differ significantly (p>.05) in age, EMS response times, or time from collapse to defibrillation. The mean time interval from collapse to CPR was significantly less for patients with BCPR (1.8 min) than for patients without BCPR (7.1 min). Had all patients received BCPR and survived at the rate of 0.26, 13 additional patients would have survived to hospital discharge. The cost per year-of-life saved by the EMS system with ETCPR would have been [US1$2,834 versus $4,881 without ETCPR The cost per additional year-of-life saved by ETCPR was estimated to be $560 in patients experiencing out-of-hospital ventricular fibrillation. Conclusion: The use of ETCPR instruction of callers by 9-1-1 dispatchers potentially is a cost-effective addition to a two-tier, EMS system for treatment of prehospital ventricular fibrillation.

AB - Hypothesis: Emergency cardiopulmonary resuscitation (CPR) instruction via telephone (ETCPR) is cost-effective compared to prehospital, emergency medical technicial (EMT)/paramedic treatment alone of witnessed, ventricular fibrillation (VE) in adult patients. Methods: A total of 118 patients, age >18 years, with prehospital, witnessed ventricular fibrillation were studied. Patient data were extracted from hospital records, monitor-defibrillator recordings, paramedic reports, dispatching records, and telephone interviews with bystanders. No ETCPR was available during this period. The costs of ETCPR implementation were estimated retrospectively. Marginal cost of the paramedic service attributable to treatment of VF was calculated from fire department records. Years-of-life saved were estimated from age, gender, and race matched norms. Results: Of the 53 patients receiving bystander CPR (BCPR), 14 (26%) survived to hospital discharge versus 4/65 patients (6%) lacking BCPR These groups did not differ significantly (p>.05) in age, EMS response times, or time from collapse to defibrillation. The mean time interval from collapse to CPR was significantly less for patients with BCPR (1.8 min) than for patients without BCPR (7.1 min). Had all patients received BCPR and survived at the rate of 0.26, 13 additional patients would have survived to hospital discharge. The cost per year-of-life saved by the EMS system with ETCPR would have been [US1$2,834 versus $4,881 without ETCPR The cost per additional year-of-life saved by ETCPR was estimated to be $560 in patients experiencing out-of-hospital ventricular fibrillation. Conclusion: The use of ETCPR instruction of callers by 9-1-1 dispatchers potentially is a cost-effective addition to a two-tier, EMS system for treatment of prehospital ventricular fibrillation.

KW - bystander CPR

KW - cardiac arrest

KW - cardiopulmonary resuscitation (CPR)

KW - cost-effectiveness

KW - CPR telephone instruction

KW - prehospital

KW - response times

KW - survival

KW - ventricular fibrillation

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