Can Telephone CPR Instructions Help Save More Lives?

For passersby who’ve never attended CPR training, the best you can do if a person collapses near you is call 911.

Word is going around that there’s a way a passerby can save a victim’s life by applying over-the-phone the instructions from a remote dispatcher. But what is the accuracy of telephone CPR instructions (T-CPR)? Is it as helpful in saving lives as proposers say?

Well, its effectiveness is a concern because human lives are at risk, put aside the fact that the bystander might be you, and the victim your loved one.

Why T-CPR is Important

According to a Journal by the University of Arizona’s Emergency Medicine Department, Telephone CPR instructions could lead to more survival rates and desirable results for victims who suffer cardiac arrests away from health facilities.

“Though cardiac arrest cases that occur outside health facilities are a public concern in the US, Americans can rely on CPR to save lives at risk. Regrettably, most of these victims, do not get enough help before expert medics turn up,” says Bentley J. Bobrow, co-executive at Phoenix-based Arizona Emergency Medicine Research Center.

Several studies have credited Bystander CPR – administered by a passerby—to double or triple the rates of surviving an outside-the-hospital cardiac arrest.

But the public has not been proactive to attend CPR classes. In fact, less than 50 % of people with cardiac arrest hardly ever get passerby CPR, one of the major contributors to low survival rates.

No wonder the American Heart Association has been stressing on the significance of telephone CPR instructions and telecommunicators in saving lives.

These are the 911 call receivers and medical assistants who help passersby identify cardiac arrest victims and help them administer CPR to increase the victim’s chances.

Bobrow and his team conducted regional research on the effectiveness of T-CPR on outside-the-hospital cardiac arrest victims. The study scrutinized over 2000 cases of outside-the-hospital cardiac arrests by going through the phone call recordings from 911 conversations and tying them to emergency health services and outcome data from hospitals.

What surfaced was that; administering a complete package of care services which include – proper step-by-step guidelines, T-CPR expertise, and focus on quality improvement – led to desirable results in many areas.

Apart from cutting down the time for the first passerby chest compression attempt from 256 to 212 seconds, T-CPR also boosted the chance of survival to hospice discharge to 12 % from 9% and in desirable on-the-spot results to 8% from 5%.

But despite these encouraging findings, Bobrow still agrees that not enough continuous quality control is being done to ensure that telephone CPR instructions remain effective and gets better with time.

“We must look at the outcomes because it shows that the 911 system is capable of rescuing cardiac arrest patients.

But Telephone CPR instructions must be adopted with care and constantly monitored if we are going to get more desirable results,” the doctor said.

Adopting T-CPR is not a costly move because the United States already has multiple 911 assistance points that work round-the-clock, all week long.

The Shortcomings of T-CPR

But a successful implementation goes beyond cost-effectiveness and the availability of 911 support agents to help 24/7. Because human lives are at risk, we must question the competence of these agents in identifying cardiac arrest cases.

How fast are they at identifying a passerby in need of bystander cardiac arrest help and referring them to the right dispatcher?

The 911 agents are our watchdogs, the patient’s situation deteriorates every second they waste trying to figure out the caller’s emergency, and the appropriate response.

Bobrow agrees that in the future, TCPR dispatchers and 911 agents must train to recognize cardiac arrest cases over the phone straight away.

If possible, dispatchers and 911 agents should receive T-CPR training, and responsible bodies should measure success and ensure quality improvement from time to time.

According to the expert, the public should recognize that anyone who collapses near them is in danger. And the best thing is to start administering chest compressions as an emergency caller reaches a dispatcher for accurate CPR.

States Proposing and Passing Laws to Improve Effectiveness of T-CPR

Based on the idea that training 911 support agents and dispatchers on T-CPR will help increase the effectiveness of Bystander CPR, states are making moves to ensure the approach saves more lives.


Representative Julie Sandstede of DFL-Hibbing is one of them, according to Minnesota Legislature. The Rep is sponsoring HF1520 which would—by 2021— offer training for 911 dispatchers to either offer CPR instructions or refer the emergency phone call to a public safety response point with staff who are experts at issuing such instructions.

Sanstede told the House of Judiciary Finance and Civil law division that passerby CPR can better a victim’s chance of survival by 3. The division approved the bill.

The Minnesota Legislature also mentioned a comparable proposal SF1638, backed by Sen. Dan Hall of R-Burnsville is awaiting the Senate Judiciary and Public Safety Committee’s approval.

According to Sanstede, most, but not all 911 centers have dispatchers qualified enough to give CPR instructions to an emergency caller. Her bill awaits an amount that is yet to be announced. Finances will come from the General Fund that will be disbursed in the 2020-2021financial year. This money will enable counties to train 911 dispatchers so that all state members can enjoy over-the-phone CPR guidance.


Soon, all 911 operators in Indiana State will need to undergo T-CPR training. This is after State Representative Ron Bacon proposed the law to the American Heart Association when the national CPR controlling body requested his opinion on what to add to their training procedures.

State Rep. Ron Bacon, a staunch Republican, is also a certified Respiratory Therapist with years of experience who admits to having seen Bystander CPR rescue lives throughout his career.

Act 1342 does not only mandate the training of newbie and existing dispatchers but also requires that they update their skill set every two years.

On April 18, Gov. Eric Holcomb signed the law after the House approved it. All current 911 agents in Indiana must make an effort to take and complete T-CPR training by July 1, 2020.  Newbie staff will attend T-CPR training within the first few weeks of service.

Passerby CPR: 4 Ways to Improve Cardiac arrest Survival with T-CPR.

So what can then authorities do to better the public’s chances of saving a cardiac arrest victim?

Well, we already know that survival rates are low for people who are unlucky to suffer an attack outside a health facility. But emergency experts recommend three response strategies to help save more victims in the event of sudden attacks.

After looking into the effectiveness of T-CPR, Dr. Bobrow and his team have a few suggestions they believe can help the US survive outside-the-hospital cardiac arrest attacks.

Most of these proposals may take time to implement and may require approval by state authorities and federal bodies. Luckily, it’s a sweet coincidence US states are making almost similar moves; common among them is the move to insist on trained 911 dispatchers.

Here are the four ways to make telephone CPR instructions more helpful, according to Dr. Bobrow and his team.

  1. Establishment of a federal registry that will record all cases of outside-the-hospital cardiac arrest and tie the health intervention measures administered to a victim as well as the outcomes in a uniform manner;
  2. Advocating for passerby cardiopulmonary resuscitation by educating the public, along with coaching 911 agents, to give passersby clear CPR instructions will help keep a patient alive as the public waits for an emergency medical response crew to arrive.
  3. Promoting high-quality CPR by health experts by assessing the performance of CPR during the procedure and improving it from time to time.
  4. Advertise Womanikin CPR training tools to reduce the public fear of administering CPR to female cardiac arrest victims. Studies have repeatedly shown that bystanders hesitate to administer CPR to women because of two reasons (1) Lack of knowledge on how to perform CPR on women because the manikins used in CPR classes feature male characteristics, and (2) the fear of facing sexual assault charges.

Hopefully, the responsible bodies will push for these changes predicted to lead to better Telephone CPR instructions and outcomes.

Final Words

Telephone Cardiopulmonary resuscitation is not a new way to save lives. But improvements must be made if we are going to rescue more citizens.

T-CPR is an over-the-phone rescue technique; this characteristic makes it a tricky life-saving method because a passerby has to take instructions and apply them in real-time.

Having someone to answer on the other end is not enough. We need competent and well-trained 911 dispatchers and agents who can identify cardiac arrest situations over the phone, and guide the caller to administer CPR accurately.