IMAGINE THAT YOU are with a family member or friend and they suddenly gasp, grab their chest, and collapse. You try to arouse them but they will not respond. You notice they are gasping. You grab your cell phone and dial 911. In many communities, you get the Massachusetts State Police and they ask you five questions. Then you are transferred to the local police fire dispatcher, who asks the same questions again. Finally you are transferred to an emergency medical dispatcher, who after asking the same questions, begins questioning that leads to CPR instructions. Your loved one or friend has been without a heartbeat now for several minutes.
Sudden cardiac arrest is one of the most common causes of death outside the hospital, claiming approximately 4,000 lives in Massachusetts each year. That number may be at risk of going up during this COVID era as more people delay care.
Two-thirds of sudden cardiac arrests occur at home, often witnessed by family or friends. Nationally, the survival rate is estimated to average 10 percent. Massachusetts has limited data compared to other states, but what is available indicates the Massachusetts survival rate is far below the national average. For example, Worcester data shows a survival rate of 3 percent, one-third the national average.
The survival rate can be markedly improved, in some cases up to 60 percent, with immediate bystander CPR and early defibrillation. The Massachusetts Legislature has a unique opportunity to begin bringing Massachusetts to the forefront of helping residents improve citizens’ survival if it chooses to pass the sudden cardiac arrest legislation presently before it (House 1,938 and Senate 1,313).
Key to the best chance of a good outcome is early bystander CPR. Every minute without CPR decreases survival by 10 percent. With an EMS response time of 8 minutes as an example, the chance of survival is almost zero without CPR. Obviously every second counts and systematic delays must be reduced in order to save lives. Currently less than 30 percent of sudden cardiac arrest victims receive bystander CPR before EMS arrives and only 3 percent survive.
911 telecommunciators have been shown to be able to successfully guide novices over the phone to provide life-saving bystander CPR. New recommendations that support hands-only CPR make bystander CPR easier to accomplish and double survival chances.
Telephone-assisted CPR has been demonstrated to be effective but must be initiated as quickly as possible. Current Massachusetts 911 protocol and practice can unintentionally delay the initiation of telephone-assisted CPR due to standard questioning and dispatch handoffs. CPR instructions are initiated often several minutes later, too late to save many lives.
The current best practice recommendation for 911 is: 1. is the victim awake and arousable? 2. If not awake, is the victim breathing normally? 3. If not arousable or breathing normally, then start CPR. This is called the No, No, Go protocol, and has been shown to expedite CPR and save lives in many other places. Answering ancillary supportive questions can follow the start of CPR, while CPR is being performed.
The two bills before the Legislature would require Massachusetts 911 operators to have state-of-the-art training in telephone assisted CPR. The bills also add an emergency physician and regional EMS representative to the 911 oversight commission, providing valuable input into state policy and procedure for 911 communications. The legislation also makes out-of-hospital sudden cardiac arrest a reportable disease so the state may collect data to help identify best practices and further opportunities to save lives.
Instituting the best practice and training for 911 answering staff so that they can effectively communicate with emergency callers who have witnessed a cardiac arrest can save as many as 500 Massachusetts residents each year. We need to let our legislators know that passage of these companion bills can save lives
Dr. Joseph Sabato Jr. is an associate professor at the University of Massachusetts Medical School and the medical director of 911 telecommunications for the city of Worcester.