Abstract Body (Do not enter title and authors here): Background: Bystander CPR (B-CPR) rates in Birmingham, Alabama are significantly below the national average, contributing to one of the lowest out-of-hospital cardiac arrest (OHCA) survival rates in the United States. Telecommunicator CPR (T-CPR), in which 9-1-1 call takers provide real-time CPR instruction to callers, is a cost-effective strategy to improve B-CPR rates. However, the current status of T-CPR practices in Birmingham remains unknown. We aimed to evaluate existing T-CPR performance, identify barriers to implementation, and compare local metrics to recently published American Heart Association (AHA) guidelines.

Methods: We retrospectively reviewed all 9-1-1 audio recordings for adult (≥18 years) non-traumatic Emergency Medical Services (EMS)-treated OHCA cases in Birmingham from January 1 to December 31, 2023. EMS-witnessed events or those occurring within healthcare or correctional facilities were excluded. T-CPR metrics were manually extracted and compared to the AHA T-CPR benchmarks using descriptive statistics.

Results: Among 236 included OHCA cases, 94 (39.8%) were correctly recognized by call takers (AHA goal: >75%). Of cases deemed recognizable by AHA definitions, 50.0% were identified correctly by the call taker (AHA goal: >95%), with a median recognition time of 60 seconds (AHA goal: <90 seconds). T-CPR instructions were provided to 72.7% of recognizable cases (AHA goal: >75%), with a median time to first chest compression of 172 seconds (AHA goal: <150s). When T-CPR instructions were offered to callers who were willing and able to perform CPR, chest compressions were initiated in 97.9% of cases. Performing CPR was refused by 6 callers. Common barriers to OHCA recognition included inaccurate assessment of breathing and reports of seizure activity.

Conclusion: Despite low rates of telecommunicator recognition of OHCA and T-CPR instruction in Birmingham, chest compressions were initiated by nearly all callers who received T-CPR guidance. Targeted improvements in T-CPR implementation represent a high-impact opportunity to increase bystander CPR rates in Birmingham and other communities with low B-CPR engagement.