Using Behavioural Science To Improve The Effectiveness Of Telephone-Assisted CPR

THE PROBLEM Out of hospital cardiac arrest (OHCA) is a common and serious problem: only 1 in 12 of the 60,000 people who experience OHCA every year in UK survive (UK Government, 2019). The most important modifiable factor determining survival is whether a member of the public (or bystander) performs chest compressions (CPR) on the victim (Hasselqvist-Ax et al., 2015). Promoting bystander CPR is a key element of Scotland’s OHCA strategy and thousands of people have been trained in CPR skills. However, members of the public frequently don’t perform CPR when faced with a real emergency. Not everyone is trained, and even amongst those who are trained, only 35%-45% attempt CPR when required (Swor et al., 2006). Telephone-assisted CPR (T-CPR), whereby trained dispatchers provide real-time instructions to bystanders who have called the emergency services on how to perform CPR, increases the initiation of CPR but more than a quarter of bystanders still refuse to deliver CPR despite receiving dispatcher instructions to do so (Oman et al., 2016). Thus many people are missing out on life-saving CPR because bystanders do not follow dispatcher instructions. If the proportion of people who follow dispatcher instructions could be increased, lives would be saved THE PROPOSAL We have previously been successful in obtaining a previous Catalytic Grant and subsequent MRC funding for projects which apply behavioural science to the problem of lay CPR. During our systematic review we have identified another link in the chain of survival that we believe would benefit from a behavioural approach: dispatcher instructions. We propose to apply to funding for a parallel stream of work which would incorporate behavioural science into dispatcher instructions. We would propose to first seek funding from MRC PHIND or BHF to develop the intervention in collaboration with dispatchers and members of the public. We would then apply to NIHR for funding to trial the effect of the instructions on CPR initiation rates. The Catalytic grant will allow us to do a comprehensive and systematic review of the literature to identify the psychological factors which are barriers to T-CPR instructions being followed and thus to identify the cognitions that are amenable to change and which can subsequently be targeted by intervention. This preparatory work will strengthen the subsequent funding bids to BHF/MRC/NIHR.