What should the emergency medical dispatcher do after sending an ambulance to a patient's location?

Emergency Medical Dispatcher Actions After Ambulance Dispatch

The emergency medical dispatcher must remain on the line with the caller to assess the patient's condition, determine if cardiac arrest or another life-threatening emergency exists, and provide pre-arrival instructions—particularly CPR guidance if the patient is unresponsive with absent or abnormal breathing. 1

Immediate Post-Dispatch Protocol

Stay on the Line and Continue Assessment

• The dispatcher should never hang up after sending the ambulance but must continue active engagement with the caller to assess the evolving clinical situation 1
• The dispatcher should only hang up when instructed to do so by the dispatcher themselves, after completing all necessary assessments and instructions 1
• Continuing the call allows for real-time updates to responding crews and enables life-saving pre-arrival instructions 1

Rapid Identification of Life-Threatening Conditions

The dispatcher must use a systematic, streamlined approach to identify cardiac arrest as early as possible, as delays of even minutes significantly reduce survival 1

The critical two-question approach includes:

• Is the patient responsive? (Can be assessed by instructing caller to tap shoulder and shout) 1
• Is the patient breathing normally? (Distinguish normal breathing from agonal gasps or absent breathing) 1

If the patient is unresponsive AND not breathing or not breathing normally, the presumptive diagnosis is cardiac arrest and CPR pre-arrival instructions must be provided immediately 1

Common Pitfalls in Recognition

• Agonal gasps occur in up to half of cardiac arrest patients and are often misinterpreted as normal breathing—dispatchers must recognize gasping, deep snoring, or slow breathing in an unresponsive patient as signs of cardiac arrest 1
• Brief seizure-like activity (shaking) immediately after collapse can mask cardiac arrest recognition 1
• Inconsistent information from callers (e.g., stating patient is conscious but not breathing) should raise suspicion for cardiac arrest 1

Providing Pre-Arrival CPR Instructions

When to Initiate CPR Instructions

CPR pre-arrival instructions should be provided with minimal delay whenever a patient is determined to be unresponsive with absent or abnormal breathing 1

• The benefit-to-risk ratio strongly favors an assertive approach—serious injury from bystander CPR in non-arrest patients is uncommon (1-2%), but failure to provide CPR in true cardiac arrest is lethal 1
• Even if uncertain about cardiac arrest, dispatchers should err on the side of providing instructions 1

Specific CPR Instruction Protocol

The dispatcher should use directive, confident language to engage hesitant bystanders, stating "We need to start CPR. I will help you" rather than asking if they would like to try 1

The American Heart Association recommends this specific sequence 1:

1. "Bring the phone and get NEXT to the person if you can"
2. "Listen carefully. I'll tell you what to do"
3. "Place the person FLAT on his back on the floor"
4. "KNEEL by the person's side"
5. "Put the HEEL of your HAND on the CENTER of the person's CHEST"
6. "Put your OTHER HAND ON TOP of THAT hand"
7. "PUSH DOWN FIRMLY, ONLY on the HEELS of your hands, at least 2 inches"
8. "Do this 50 times, just like you're PUMPING the chest. Count OUT LOUD: 1-2-3...50"
9. "KEEP DOING IT: KEEP PUMPING the CHEST UNTIL HELP TAKES OVER. I'll stay on the line"

Hands-Only CPR Priority

For adults who suddenly collapse, dispatchers should provide Hands-Only CPR instructions (compressions only, no ventilations) as the primary benefit is generating blood flow to the brain and heart 1

• Ventilation instructions (30 compressions followed by 2 breaths) should only be added when cardiac arrest is suspected secondary to respiratory arrest 1

Condition-Specific Guidance

For Chest Pain Presentations

If the patient is conscious with chest pain, the dispatcher should 1:

• Confirm severe discomfort lasting >15 minutes and still present
• Ask about associated symptoms (sweating, nausea, difficulty breathing)
• Provide reassurance and advise the caller to keep the patient calm
• Instruct not to transport by private vehicle as EMS can provide life-saving interventions en route 2

Avoiding Premature Diagnostic Questions

Dispatchers should NOT ask extensive questions about medical history or attempt diagnosis before identifying potential cardiac arrest, as this delays critical bystander actions 1

• The focus must be on identifying cardiac arrest through responsiveness and breathing assessment first 1
• Detailed history gathering can occur after life-threatening conditions are ruled out or addressed 1

Key Operational Principles

• The dispatcher's role extends beyond resource allocation to active medical guidance that directly impacts survival 1
• Dispatchers should convey leadership, confidence, and teamwork to overcome bystander hesitation and emotional distress 1
• All emergency medical dispatchers should receive formal training in CPR pre-arrival instructions with regular recertification 1