Introduction: Public Safety Answering Point (PSAP) quality can have life-or-death implications. The quality of service provided by PSAPs is inconsistent due to the lack of mandatory standards of care at the national, state, and local levels. Public demands and duties placed on PSAPs have grown due to technological changes, civil cases alleging negligence, and the emergence of national recommended standards of care, yet governments at all levels have been slow to create governance structures to reinforce adherence to standards.

Methods: This article focuses on the question: How do PSAP leaders measure performance based on their definition of quality? The method used is directed content analysis, including analysis of interview and focus group data.

Results: As a result of this study, a new six-dimensional model for quality emerged. Participants defined PSAP quality as achieving balance across a continuum of nuanced variables because a single 911 call may have “99 tasks that need to be done.” Telecommunicators must: (a) Be fast AND accurate, (b) Use their judgement AND follow the protocol, and (c) Utilize all available technology AND prepare for that same technology to fail.

Conclusion: PSAP leaders should consider instructing new employees with the sixdimensional model to set expectations of performance while avoiding the perception of false dichotomies. This model should also be considered when implementing new quality improvement programs or procedures. By considering the totality and complexity of quality definitions, PSAP leaders can allow for reasonable variation and thus curb anxiety and frustration among their employees.

Introduction: Rapid identification of sudden out-of-hospital cardiac arrest (OHCA) and delivery of bystander chest compressions in patients with ventricular fibrillation are key elements in the chain of survival. However, time to bystander compressions can be greatly affected by a wide variety of barriers, some beyond an EMD’s control.

Objectives: The aim of this study is to identify and quantify the impact that barriers have on the time taken to achieve bystander compressions for suspected OHCAs. Methods: This retrospective, quantitative cohort study was conducted by auditing audio recordings of 911 emergency calls, spanning November 25, 2014 – August 29, 2018, in which EMDs initiated bystander CPR.

Results: A total 496 audio recordings were reviewed, and 311 were excluded for various reasons. Therefore, 185 audio recordings were included in the study. Of these, in a majority (73.0%, n=135) of the calls, a bystander experienced at least one barrier to performing CPR. Overall, the elapsed median time to bystander compressions was significantly different for barrier versus non-barrier calls (272 seconds and 200.5 seconds, respectively). Time to bystander compressions for a baseline call was 171 seconds. Not surprisingly, as the number of barriers encountered during a call increased, the time to bystander compressions also increased significantly.

Conclusion: New instructions and modified scripting of protocols should be investigated to guide trained and certified EMDs in managing a wide variety of barrier types. Future studies should specifically investigate whether modified or new instructions reduce time to bystander compressions and/or increase survival from OHCA.