The Emergency 911 System Where Callers Still Don't Always Get Proper CPR Instructions

It's taken two years and $1.2 million to get Rhode Island's 911 system ready to provide CPR and other medical instructions to callers.

This article was published on Tuesday, April 6, 2021 in ProPublica.

By Lynn Arditi, The Public's Radio  

It's been nearly two years since Rhode Island lawmakers approved funding to train all 911 call takers to provide CPR instructions over the phone, but new data shows no improvement in people's chances of receiving CPR in the critical minutes prior to the arrival of first responders.

Only about one in five people who went into cardiac arrest in their homes or someplace other than a hospital or healthcare setting in Rhode Island last year received CPR before police, fire or emergency medical providers showed up, according to data provided to The Public's Radio by the state Department of Health. The state's bystander CPR rate has remained between 19% and 21% since 2018.

"The needle hasn't really moved," said Jason Rhodes, the health department's chief of emergency medical services.

For people who go into cardiac arrest, getting CPR during the first few minutes can mean the difference between life and death. Every minute of delay in performing CPR on people in cardiac arrest decreases their chances of survival by as much as 10%, according to the American Heart Association.

Rhode Island's bystander CPR rate is less than half the national average, according to the nonprofit Cardiac Arrest Registry to Enhance Survival, which collects data on regions that encompass about 40% of the nation's population. (Rhode Island does not participate in CARES but models its data collection on it.) Rhode Island's survival rate for out-of-hospital cardiac arrests also remains well below the national average.

Rhode Island's 911 system was the subject of a 2019 investigation by The Public's Radio and ProPublica that raised questions about whether the lack of training for the state's 911 call takers was costing lives. Among the findings: a 6-month-old baby in Warwick died in 2018 after a 911 call taker gave incorrect CPR instructions to the family.

But Rhode Island's lack of progress is not for lack of trying. The state had to replace its aging computer-aided dispatch system before the 911 center could install the software that would guide its call takers to deliver the appropriate medical instructions.

"I'm becoming a little bit despondent at this point," said Dr. Joseph Lauro, an emergency room physician and member of the Rhode Island chapter of the American College of Emergency Physicians, which helped lead the push to improve training. "All those efforts and nothing has happened."

In June 2019, Rhode Island lawmakers earmarked $220,000 in the state's budget for the 2020 fiscal year, for training and software that would enable 911 call takers to deliver CPR instructions and other medical assistance by phone.

It was expected to be up and running more than a year ago. But Rhode Island's EMD training began just last month.

Emergency medical calls in every other New England state are handled by people certified in emergency medical dispatch, or EMD.

"We're frustrated, too," about the delays, said J. David Smith, director of the 911 center. But he said the extra time was needed to buy and install a new $1.2 million computer-aided dispatch system so the new software can operate properly. "So that when we finally do this," he said, "it's going to be the best it can be."

The training includes following carefully scripted instructions to talk a caller or bystander through performing CPR. The system is used in Washington state's King County, home to Seattle, a national model for prehospital cardiac care. More than 75% of people in King County who experienced out-of-hospital cardiac arrests in 2020 received bystander CPR.

The new software program also will enable the Rhode Island State Police, which oversees the 911 center, to collect data and track its performance in handling 911 calls. Priority Dispatch, a company based in Salt Lake City, Utah, is providing the software and training under a state contract signed in August 2019 for about $150,000, Smith said.

The center is currently completing training for all 911 call takers and supervisors on the new computer-aided dispatch system, Smith said, and vetting the EMD protocols with state health officials. He said the new system is expected to launch in June. Legislation has been introduced in the General Assembly to mandate that all 911 call takers be certified in EMD, which includes being trained to provide CPR instructions over the phone. A bill (H 5629) introduced by Rep. Mia Ackerman, D-Cumberland, the House deputy majority whip, would require that at least one 911 call taker trained in what's known as telephone CPR be on duty at all times. A companion Senate bill (S 0385) has been introduced by Sen. Maryellen Goodwin, D-Providence.

At a March 30 committee hearing on the House bill, Lauro, the emergency medicine physician, said that as medical director for several EMS departments he reviews cases of cardiac arrest patients treated by emergency medical personnel. "One of the most common things that I find in out-of-hospital cardiac arrest is lack of bystander CPR," he said.

Dr. Catherine Cummings, president of the Rhode Island Medical Society, said most Rhode Islanders assume that 911 callers routinely receive CPR instructions over the phone, and "are surprised to find out that it doesn't" happen.

Ackerman said the legislation would ensure that 911 call takers continue to receive the training required for them to maintain their EMD certifications. "The law is the only way to assure that it will happen," she said. "It's that simple."

A similar bill she introduced in March 2019 did not make it out of committee.

Health reporter Lynn Arditi can be reached at larditi@thepublicsradio.org.