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Background Early identification of warning symptoms among out-of-hospital cardiac arrest (OHCA) patients remains challenging. Thus, we examined the registered prodromal symptoms of patients who called medical helpline services within 30-days before OHCA. Methods Patients unwitnessed by emergency medical services (EMS) aged ≥18 years during their OHCA were identified from the Danish Cardiac Arrest Registry (2014-2018) and linked to phone records from the 24-h emergency helpline (1-1-2) and out-of-hours medical helpline (1813-Medical Helpline) in Copenhagen before the arrest. The registered symptoms were categorized into chest pain; breathing problems; central nervous system (CNS)-related/unconsciousness; abdominal/back/urinary; psychiatric/addiction; infection/fever; trauma/exposure; and unspecified (diverse from the beforementioned categories). Analyses were divided by the time-period of calls (0-7 days/8-30 days preceding OHCA) and call type (1-1-2/1813-Medical Helpline). Results Of all OHCA patients, 18% (974/5442) called helpline services (males 56%, median age 76 years[Q1-Q3:65-84]). Among these, 816 had 1145 calls with registered symptoms. The most common symptom categories (except for unspecified, 33%) were breathing problems (17%), trauma/exposure (17%), CNS/unconsciousness (15%), abdominal/back/urinary (12%), and chest pain (9%). Most patients (61%) called 1813-Medical Helpline, especially for abdominal/back/urinary (17%). Patients calling 1-1-2 had breathing problems (24%) and CNS/unconsciousness (23%). Nearly half of the patients called within 7 days before their OHCA, and CNS/unconsciousness (19%) was the most registered. The unspecified category remained the most common during both time periods (32%;33%) and call type (24%;39%). Conclusions Among patients who called medical helplines services up to 30-days before their OHCA, besides symptoms being highly varied (unspecified (33%)), breathing problems (17%) were the most registered symptom-specific category.

ObjectivesCallers with myocardial infarction presenting atypical symptoms in telephone consultations when calling out-of-hours medical services risk misrecognition. We investigated characteristics in callers’ interpretation of experienced conditions through communication with call-takers.MethodsRecording of calls resulting in not having an ambulance dispatched for 21 callers who contacted a non-emergency medical helpline, Copenhagen (Denmark), up to one week before they were diagnosed with myocardial infarction. Qualitative content analysis was applied.ResultsAwareness of illness, remedial actions and previous experiences contributed to callers’ interpretation of the experienced condition. Unclear symptoms resulted in callers reacting to their interpretation by being unsure and worried. Negotiation of the interpretation was seen when callers tested the call-taker’s interpretation of the condition and when either caller or call-taker suggested: “wait and see”.ConclusionCallers sought to interpret the experienced conditions but faced challenges when the conditions appeared unclear and did not correspond to the health system’s understanding of symptoms associated with myocardial infarction. It affected the communicative interaction with the call-taker and influenced the call-taker’s choice of response. OBJECTIVES: Callers with myocardial infarction presenting atypical symptoms in telephone consultations when calling out-of-hours medical services risk misrecognition. We investigated characteristics in callers' interpretation of experienced conditions through communication with call-takers. METHODS: Recording of calls resulting in not having an ambulance dispatched for 21 callers who contacted a non-emergency medical helpline, Copenhagen (Denmark), up to one week before they were diagnosed with myocardial infarction. Qualitative content analysis was applied. RESULTS: Awareness of illness, remedial actions and previous experiences contributed to callers' interpretation of the experienced condition. Unclear symptoms resulted in callers reacting to their interpretation by being unsure and worried. Negotiation of the interpretation was seen when callers tested the call-taker's interpretation of the condition and when either caller or call-taker suggested: "wait and see". CONCLUSION: Callers sought to interpret the experienced conditions but faced challenges when the conditions appeared unclear and did not correspond to the health system's understanding of symptoms associated with myocardial infarction. It affected the communicative interaction with the call-taker and influenced the call-taker's choice of response. PRACTICE IMPLICATIONS: Call-takers, as part of the decision-making process, could ask further questions about the caller's insecurity and worry. It might facilitate faster recognition of conditions warranting hospital referral.

AIM: There is limited evidence regarding prodromal symptoms of out-of-hospital cardiac arrest (OHCA). We aimed to describe patient characteristics, prodromal symptoms, and prognosis of patients contacting emergency medical services (EMS) within 24 hours before OHCA.METHODS: We identified all OHCA treated by Copenhagen EMS from 2016 through 2018 using the Danish Cardiac Arrest Registry and linked them to emergency calls. We included all pre-arrest calls by patients or bystanders if they were performed 1) within 24 hours before the OHCA call or 2) during the OHCA event for EMS-witnessed OHCA. Calls were reviewed by healthcare professionals using a survey guide.RESULTS: Among 4,071 patients, 481 patients (12%) had 539 calls within 24 hours prior to OHCA (60% male, median age 74 years of age). The patient spoke on the phone in 25% of calls. The most common symptoms were breathing problems (59%), confusion (23%), unconsciousness (20%), chest pain (20%), and paleness (19%). Patients with breathing problems compared to chest pain were more likely to be ≤75 years of age (55% versus 35%), less likely to be male (52% versus 73%), have shockable rhythm (10% versus 38%), receive bystander defibrillation (6% versus 19%) or EMS defibrillation (15% versus 65%), achieve return of spontaneous circulation (37% versus 68%) and survive 30 days following OHCA (10% versus 50%).CONCLUSION: More than 10% of patients with OHCA had a call to EMS within 24 hours before OHCA. The most common symptom was breathing problems which compared to chest pain had lower 30-day survival.

INTRODUCTION: Cardiac arrest patients presenting with back pain are at risk of not receiving the appropriate help when calling emergency medical services. In telephone consultations regarding patients with back pain preceding an out-of-hospital cardiac arrest, we investigated how communication between caller and call-taker influenced the call-taker's interpretation of back pain descriptions and decision-making about choice of response.METHOD: The study was conducted using 20 recorded phone calls from 17 patients who contacted the Copenhagen Emergency Medical Services (Denmark) reporting back pain up to 24 hours before an out-of-hospital cardiac arrest. Qualitative content analysis was applied.RESULTS: Two main categories emerged: (1) reasons, including subcategories: reported conditions, descriptions of conditions, patient's interpretation of condition and patient's own remedial actions; and (2) considerations, including subcategories: assessment of the severity, call-taker's interpretation of the condition, arguments for chosen response and conditions not facilitating further communication by the call-taker.CONCLUSION: In telephone consultations regarding patients with back pain preceding an out-of-hospital cardiac arrest the communication was influenced by the communicative preconditions of the call-taker. Communication in consultations where ambulances were not dispatched was characterized by complex descriptions of symptoms not easily fitting into the health system's interpretations of conditions warranting an urgent response.

Aim As proxy for initiation of the first link in the Chain of Survival by the dispatcher, we aimed to investigate the effect of time to first dispatch on 30-day survival among patients with OHCA ultimately receiving the highest-level emergency medical response. Methods We linked data on all OHCA unwitnessed by emergency medical services (EMS) treated by Copenhagen EMS from 2016 through 2018 to corresponding emergency call records. Among patients receiving highest priority emergency response, we calculated time to dispatch as time from start of call to time of first dispatch. Results We included 3548 patients with OHCA. Of these, 94.1% received the highest priority response (median time to dispatch 0.84 min, 25th–75th percentile 0.58–1.24 min). Patients with time to dispatch within one minute compared to three or more minutes were more likely to receive bystander cardiopulmonary resuscitation (77.3 vs 54.2%), bystander defibrillation (11.5 vs 6.5%) and defibrillation by emergency medical services (24.1 vs 7.5%) and were 2.6-fold more likely to survive 30 days after the OHCA (P = 0.004). Results from multivariate logistic regression were similar: odds ratio (OR) of survival 0.83 per minute increase (95% confidence interval 0.70–1.00, P = 0.04). However, survival was similar between those who received highest priority response and those who did not: OR of survival 0.88 (95% confidence interval 0.53–1.46, P = 0.61). Conclusion Rapid time to dispatch among patients with highest priority response was significantly associated with a higher probability of 30-day survival following OHCA.