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Introduction: Rapid identification of sudden out-of-hospital cardiac arrest (OHCA) and delivery of bystander chest compressions in patients with ventricular fibrillation are key elements in the chain of survival. However, time to bystander compressions can be greatly affected by a wide variety of barriers, some beyond an EMD’s control.

Objectives: The aim of this study is to identify and quantify the impact that barriers have on the time taken to achieve bystander compressions for suspected OHCAs. Methods: This retrospective, quantitative cohort study was conducted by auditing audio recordings of 911 emergency calls, spanning November 25, 2014 – August 29, 2018, in which EMDs initiated bystander CPR.

Results: A total 496 audio recordings were reviewed, and 311 were excluded for various reasons. Therefore, 185 audio recordings were included in the study. Of these, in a majority (73.0%, n=135) of the calls, a bystander experienced at least one barrier to performing CPR. Overall, the elapsed median time to bystander compressions was significantly different for barrier versus non-barrier calls (272 seconds and 200.5 seconds, respectively). Time to bystander compressions for a baseline call was 171 seconds. Not surprisingly, as the number of barriers encountered during a call increased, the time to bystander compressions also increased significantly.

Conclusion: New instructions and modified scripting of protocols should be investigated to guide trained and certified EMDs in managing a wide variety of barrier types. Future studies should specifically investigate whether modified or new instructions reduce time to bystander compressions and/or increase survival from OHCA.