CPR instructions delivered by 9-1-1 call takers have been shown to significantly improve community bystander CPR rates [11-14], and received a Class IIa recommendation from the American Heart Association and the Heart and Stroke Foundation of Canada [15]. In Ontario, 9-1-1 call takers began offering CPR instructions to callers reporting suspected cardiac arrests on April 1, 2004. However, the success of this intervention in increasing bystander CPR rates and ultimately survival to hospital discharge is check details directly linked to the ability

of the call taker to accurately identify cardiac Inhibitors,research,lifescience,medical arrest over the telephone [14]. Call taker identification of OOHCA In previous studies, the ability of 9-1-1 call takers to accurately identify cardiac arrest has been reported to range from 47% to as high as 90% [16-19]. A

recently published study conducted in Ottawa reported similar results: call takers correctly identified 56.3% of cardiac arrests Inhibitors,research,lifescience,medical during the first nine-month period following the implementation of assisted CPR instructions [14]. Agonal breathing, often present early in cardiac arrest victims, can wrongly be interpreted as a sign of life by 9-1-1 call takers, and is believed to be a key factor explaining why cardiac arrest is not identified [14]. Agonal breathing Inhibitors,research,lifescience,medical is defined as ineffective, gasping respiration occurring early in cardiac arrest [20]. Agonal breathing has been variably described by 9-1-1 callers. Some of the more common descriptions include: barely or occasionally Inhibitors,research,lifescience,medical breathing, irregular breathing, laboured breathing, sighing, gurgling, moaning, groaning or snorting [16,21]. Previous observational studies have reported

agonal breathing in as many as 55% of witnessed cardiac arrests, however the true incidence is likely higher since establishing the presence or absence of agonal breathing Inhibitors,research,lifescience,medical was determined retrospectively and relied solely on the callers’ descriptions of breathing during review of 9-1-1 call recordings [14,16,19,21]. Previous research has reported increased survival in patients with agonal respirations when compared with patients without agonal respirations (27% vs. 9%; p < 0.001) [21]. However, agonal breathing is frequently mistaken as a sign of life by 9-1-1 call takers, and represents a significant proportion of missed diagnoses of cardiac arrest – up to 50% in some studies [14,19]. If more cardiac arrest cases STK38 can be correctly identified by 9-1-1 call takers, there is the potential to increase the proportion of victims receiving early bystander CPR, and ultimately improve survival for out-of-hospital cardiac arrest. The Theory of Planned Behaviour The Theory of Planned Behaviour (TPB) can be a useful, systematic approach to identify barriers to and facilitators of change, and aid in the design of appropriate forms of intervention. [22-29].