Case Report: Dispatcher-Directed CPR in the Prone Position

In June 2025, the York County 911 Center, York, PA, received a call from the wife of a 75-year-old male, described as not feeling well and having just fallen off the toilet. Upon initial Case Entry questioning by the Emergency Medical Dispatcher (EMD), the patient was described as “awake” and “breathing.”

Within a few seconds of these responses, the caller rechecked the patient and changed her response to “He was a minute ago” (regarding consciousness), then, after a brief pause said, “He’s unconscious at the moment.” Seconds later, when rechecking breathing at the EMD’s prompting, the caller stated, “I can’t tell, he’s on his stomach.”

Call Processing and Pre-Arrival Instructions

After coding the case an ECHO-level (highest priority emergency) and posting it for immediate dispatch, the EMD immediately began Pre-Arrival Instructions from Panel C-26 of the Medical Priority Dispatch System™ (MPDS®, version 14.0), which instructs the caller to roll the patient on their back, using a single-person roll technique, in order to provide CPR, including chest compressions on the sternum (front side of the chest).

After several unsuccessful attempts to roll the patient over, the EMD then moved to an alternate set of caller instructions that informs the caller to give CPR compressions on the patient’s back, right on the spine (Panel C-28 of the MPDS). CPR compressions were done for four full minutes in the prone position before a second person arrived to help roll the patient on his back. Paramedics arrived immediately thereafter.
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Significance of the Case

This case represents one of the few documented instances of Dispatcher-Directed CPR (DD-CPR) compressions (normally done by pressing down on the sternum, at the front of the chest, while the patient is lying on their back), completed, sustainably, with the patient in the prone position.

It demonstrates how a dispatch protocol—in this case, the MPDS—can be used to manage this difficult situation, where bystander CPR is necessary to improve the chance of survival from sudden cardiac arrest.

There have been several other case studies done on the effectiveness of prone-position CPR compressions, and the general consensus appears to be that this method is potentially a good alternative to the more conventional supine position in bystander CPR.¹²³

Protocol Development Background

The Pre-Arrival Instructions for rolling the prone patient and, if unsuccessful, providing CPR compressions on the patient’s back, were added to version 14.0 of the MPDS, released in April 2023.

Prior to this release, two cases where prone CPR compressions were delivered successfully by enhancing the existing MPDS Pre-Arrival Instructions of an older MPDS version (version 13.2, not containing Panel C-28), were documented in a 911 center.³

Patient Outcome

Upon arrival, the responding paramedic crew continued resuscitation efforts and was able to get a return of spontaneous circulation (ROSC) on the patient, but he did not survive his hospitalization—an outcome not uncommon for prehospital ROSC cases.⁴

Key Takeaways

This case not only demonstrates the effectiveness of a structured dispatch protocol—in this case, the MPDS—for managing difficult situations where DD-CPR is necessary, but it also demonstrates the dynamic nature of patients described by 911 (and other emergency line) callers as fallen for an unknown reason and deteriorating in real time, in front of the 911 caller.

By following the MPDS Protocol sequence—methodically obtaining a complete problem description from the 911 caller and confirming age, awake or not awake, and breathing or not breathing—the patient’s arrest was identified rapidly by the EMD, a correct emergency medical response was sent, and DD-CPR instructions were started promptly.