Abstract Body: Background: Bystander cardiopulmonary resuscitation (CPR) plays a critical role in cardiac arrest outcomes. Accurate reporting of bystander CPR is essential for measuring the effectiveness of public health and 911 dispatch interventions. While cardiac arrest registries often rely on prehospital provider documentation of bystander CPR, the accuracy of such reporting is unknown.
Hypothesis: We hypothesize that there is discordance in 911 telecommunicator and paramedic documentation of the provision of bystander CPR.
Aim: The objective of this study was to determine the agreement of bystander CPR reporting among emergency medical services provider documentation and that obtained via audio review of public safety access point (PSAP) emergency dispatch calls.
Methods: This is a retrospective cohort study analyzing cardiac arrests from the Salt Lake City Cardiac Arrest Registry between August 2016 and February 2025. In August 2016, we began a process of dispatch audio review and directed feedback to dispatchers. Three investigators independently reviewed 1,017 paired paramedic electronic patient care reports and dispatch audio files to determine the provision of bystander CPR by each method of review. Cases with incomplete data were excluded. The primary analysis included 889 cases. We compared the rates of bystander CPR documented by each method, calculated inter-rater agreement, and identified potential cardiac arrest characteristics that may play a role in bystander CPR reporting.
Results: Among 889 included cases, we found moderate inter-rater agreement in the reporting of bystander CPR between EMS provider documentation and dispatch audio review (kappa = 0.514, SE = 0.031, 95% confidence interval 0.453–0.574). The overall concurrence in reporting was 75.8%. Review of dispatch audio files revealed an 11.1% higher rate of bystander CPR performance when compared to EMS provider documentation (69.3% vs. 58.2%).
Conclusion: In this single-center EMS agency, we found moderate agreement in the documentation of bystander CPR between emergency call dispatch audio review and EMS provider documentation. A higher incidence of bystander CPR was measured when using dispatch audio files as the criterion standard. These findings highlight potential inconsistencies in how bystander CPR is identified and documented across the emergency response system and underscore the importance of standardized reporting practices to ensure accurate data for quality improvement and research.