Abstract Background Telehealth has become increasingly essential in healthcare provision, also in the Prehospital Emergency Medical Services (EMS), where live video is implemented as a supplemental tool to assess and triage medical emergency calls. So far, using video for emergency calls seems beneficial for patient assessment and dispatcher-assisted first aid. However, the EMS dispatchers’ experiences with and perceptions of using video during emergency calls are largely unexplored. Methods In 2023, a nationwide survey study was conducted in Denmark, which is covered by five Emergency Medical Dispatch Centers. All Danish EMS dispatchers were invited to participate in the study. The survey explored the dispatchers’ experience with using video during emergency calls, the perception of their own video use, and the process of implementing video as a new tool in their working procedure. Main questions were answered on a scale from 1 to 7, where higher scores indicate more agreement. Results Of the 183 EMS dispatchers employed during the study period, 78% completed the survey. They found video easy to use (median = 7) and found video supportive in guidance and dispatch when the patient’s problem was unclear (median = 7), but did not find video suitable for all emergency calls and expressed that complications with the technology was a barrier for using video. The EMS dispatchers were least likely to agree that they choose not to use video due to the risk of being emotionally affected by what they might see (median = 1). When dividing the sample based on EMS dispatcher’s gender, age, seniority, and educational background, generally few differences between groups were found. Conclusions Live video during emergency calls is generally experienced as a useful supplemental tool by EMS dispatchers in Denmark, and the greatest self-perceived barriers for using video were not finding video suitable for all situations and the technology.

Aim The study aimed to investigate whether a bystander’s emotional stress state affects dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) in out-of-hospital cardiac arrest (OHCA). The primary outcome was initiation of chest compressions (Yes/No). Secondarily we analysed time until chest compressions were initiated and assessed how dispatchers instructed CPR. Method The study was a retrospective, observational study of OHCA emergency calls from the Capital Region of Denmark. Recorded calls were evaluated by five observers using a pre-defined code catalogue regarding the variables wished investigated. Results Included were 655 OHCA emergency calls, of which 211 callers were defined as emotionally stressed. When cardiac arrest was recognized, chest compressions were initiated in, respectively, 76.8% of cases with an emotionally stressed caller and 73.9% in cases with a not emotionally stressed caller (2.18 (0.80–7.64)). Cases with an emotionally stressed caller had a longer time until chest compressions were initiated compared to cases with a not emotionally stressed caller, however non-significant (164 s. vs. 146 s.; P = 0.145). The dispatchers were significantly more likely to be encouraging and motivating, and to instruct on speed and depth of chest compressions in cases with an emotionally stressed caller compared to cases with a not emotionally stressed caller (1.64 (1.07–2.56); 1.78 (1.13–2.88)). Barriers to CPR were significantly more often reported in cases with an emotionally stressed caller compared to cases with a not emotionally stressed caller (1.83 (1.32–2.56)). Conclusion There was no significant difference in initiation of chest compressions or in time until initiation of chest compressions in the two groups. However, the dispatchers were overall more encouraging and motivating, and likely to instruct on speed and depth of chest compressions when the caller was emotionally stressed. Furthermore, barriers to CPR were more often reported in cases with an emotionally stressed caller compared to cases with a not emotionally stressed caller. Trial registration We applied for ethical approval from The Danish National Committee on Health Research Ethics, but formal approval was waived. We received permission for storage of data and to use these for research of OHCAs in the Capital Region of Denmark by Danish Data Protection Agency (P-2021-670) and Danish Health Authorities (R-2,005,114). The study is registered at ClinicalTrials (NTC05113706).

Background Young children are among the most frequent patients at medical call centers, even though they are rarely severely ill. Respiratory tract symptoms are among the most prevalent reasons for contact in pediatric calls. Triage of children without visual cues and through second-hand information is perceived as difficult, with risks of over- and under-triage. Objective To study the safety and feasibility of introducing video triage of young children with respiratory symptoms at the medical helpline 1813 (MH1813) in Copenhagen, Denmark, as well as impact on patient outcome. Methods Prospective quality improvement study including 617 patients enrolled to video or standard telephone triage (1:1) from February 2019-March 2020. Data originated from MH1813 patient records, survey responses, and hospital charts. Primary outcome was difference in patients staying at home eight hours after the call. Secondary outcomes weas hospital outcome, feasibility and acceptability. Adverse events (intensive care unit admittance, lasting injuries, death) were registered. Logistic regression was used to test the effect on outcomes. The COVID-19 pandemic shut the study down prematurely. Results In total, 54% of the included patients were video-triaged., and 63% of video triaged patients and 58% of telephone triaged patients were triaged to stay at home, (p = 0.19). Within eight and 24 hours, there was a tendency of fewer video-triaged patients being assessed at hospitals: 39% versus 46% (p = 0.07) and 41% versus 49% (p = 0.07), respectively. At 24 hours after the call, 2.8% of the patients were hospitalized for at least 12 hours. Video triage was highly feasible and acceptable (> 90%) and no adverse events were registered. Conclusion Video triage of young children with respiratory symptoms at a medical call center was safe and feasible. Only about 3% of all children needed hospitalization for at least 12 hours. Video triage may optimize hospital referrals and increase health care accessibility.

BACKGROUND:Parents often contact out-of-hours services due to worry concerning febrile children, despite the children rarely being severely ill. As telephone triage of children is challenging, many children are referred to hospital assessment. This study investigated if video triage resulted in more children staying at home. Secondary aims included safety, acceptability and feasibility of this new triage tool.METHODS:In this prospective quality improvement study, nurse call-handlers enrolled febrile children aged 3 months-5 years to video or telephone triage (1:1), with follow-up within 48 h after call. The setting was an out-of-hours call-center for non-urgent illness in Copenhagen, Denmark, receiving over 1 million calls annually and predominately staffed by registered nurses. Main outcome measure was difference in number of children assessed at hospital within 8 h after call between video-and telephone triage group. Rates of feasibility, acceptability and safety (death, lasting means, transfer to intensive care unit) were compared between the triage groups.RESULTS:There was no difference in triage outcome (home care vs. hospital referral) or number of patients assessed at hospital between triage groups. However, more video triaged patients received in-hospital treatment, testing and hospitalization.CONCLUSION:Video triage was feasible to conduct, acceptable to parents and as safe as telephone triage. The study did not show that more children stayed at home after video triage, possibly because the allocation strategy was not upheld, as video triage sometimes was chosen in cases of complex and severe symptoms, and this likely has changed study outcome.TRIAL REGISTRATION:Clinicaltrials.gov.: Id NCT04074239. Registered 2019-08-30. https://clinicaltrials.gov/ct2/show/study/NCT04074239.

During the past 20 years the survival after out-of-hospital cardiac arrest (OHCA) has almost quadrupled from 4% in 2001 to 14% in 2020. There has been a huge focus on layman education in cardiopulmonary resuscitation and use of automated external defibrillators (AED), implementation of healthcare staff at 1-1-2 dispatch centers, early recognition of OHCA, establishment of a national AED register with publicly available AEDs, and dispatch of volunteer responders in case of nearby OHCA. This review describes implemented initiatives with the purpose of improving survival from OHCA in Denmark.

BACKGROUND:Pediatric out-of-hours calls are common, as parents worry and seek reassurance and shared responsibility. Nevertheless, most children assessed in this context are not seriously ill. Conventional telephone triage lacks visual cues and is further limited by third part communication in calls concerning children. We investigated implementation of video triage in two previous studies. The aim of the present study was to investigate 1) How video triage versus telephone triage in children was experienced by parents and call-handlers, and 2) call-handlers' evaluation of the video triage projects.METHODS:We triangulated data from surveys and interviews in five sub-studies. Sub-study 1: Parents' experience of video triage reported in closed-ended questionnaire items using quantitative analysis; Sub-study 2: Parents' experience of video triage reported as questionnaire free-text using qualitative content analysis; Sub-study 3: Call-handlers' experience of video triage reported in closed-ended questionnaire items using quantitative analysis; and Sub-studies 4 and 5: Individual interviews of call-handlers' experience of 1) video triage using thematic analysis and 2) the video triage project using process evaluation.RESULTS:Most parents' comments regarding video triage were positive (n = 164, 83%). Video triage was perceived as reassuring and reducing the likelihood of misunderstandings and unnecessary hospital visits. Call-handlers experienced that video triage improved patient assessment and caller reassurance. Some call-handlers complained that the time allocated for study participation was inadequate and requested a more accessible video set-up. Both parents and call-handlers were significantly more satisfied and reassured after video triage than after telephone triage and suggested video triage as a permanent option.CONCLUSION:Video triage was appreciated by parents and call-handlers and was recommended as a permanent option. The call-handlers suggested that designated time for participation in the studies would have been desirable in this busy call-center. We recommend video triage as a contemporary solution in out-of-hours service.

Background Calls regarding children make up the relatively largest proportion of contacts to medical call-centers, with calls often concerning respiratory symptoms. Triage of children without visual cues and through second-hand information is difficult, with risks of over- and undertriage. We aimed to test feasibility, acceptance and patient outcome after introduction of video triage of young children at the out-of-hours medical call-center in Copenhagen, Denmark. Method Prospective quality improvement study, with patients aged 6 months to 5 years with respiratory symptoms enrolled to video or standard telephone triage (1:1). Calculated sample size was 774. The proportion of successful video calls, representing feasibility, and parental acceptance of video participation was registered, along with patient outcome within 48 hours, including adverse events (intensive care unit admittance, lasting injuries, death). Results We included 617 patients (54% video triage) before the study prematurely was shut-down due to the COVID-19 pandemic. Feasibility was 95.2% and acceptance rate likewise 95.2%. No adverse events were registered in either group. Patients were triaged to stay at home in 63% of video triage calls vs. 58% of telephone triage calls (p=0.19). Within 8 and 24 hours there was a trend towards fewer video triaged than telephone triaged patients assessed at hospitals: 39% versus 46% (p=0.07) and 41% versus 49% (p=0.07), respectively. Conclusion Video triage of young children with respiratory symptoms at a medical call-center was feasible, acceptable and safe. Video triage can potentially optimize triage and hospital referrals, and might be beneficial in many pediatric call-center contacts. Conflict of interest None to declare. Funding Tryg Foundation, Research Foundation of the Capital Region, Research Foundation of Amager-Hvidovre Hospital.

INTRODUCTION During the first wave of the COVID-19 pandemic, visits to hospitals were prohibited. Therefore, new ways of communicating with relatives about and with patients were needed. This study aimed to explore experiences made with video calls in an adult ICU. METHODS This study employed semi-structured group interviews conducted with six registered nurses from the ICU in a large hospital in Denmark who used video calls during the lockdown. Interviews were transcribed verbatim and analysed using systematic text condensation. RESULTS The analyses indicated that video calls were a useful alternative to physical meetings. The advantages of video calls were that relatives had risk-free access to the ICU and the patient's treatment, whereas patients gained a window into their home, and nurses used less planning time than physical visit. Finally, patients were less distracted by video calls than by visits. The challenges identified with video calls were difficulties for nurses to care for relatives, ethical aspects and technical issues. CONCLUSIONS Video calls were an effective tool for communication during the COVID-19 lockdown, presenting a number of advantages and challenges compared with in-person visits or telephone calls. By identifying and overcoming these challenges, video calls may become a beneficial supplement to in-person visits or telephone calls. FUNDING none. TRIAL REGISTRATION Approved by the Danish Data Protection Agency (P-2020-931).

Introduction: Good quality of cardiopulmonary resuscitation (CPR) provided by bystanders is important for the outcome in out-of-hospital cardiac arrest (OHCA). A live video stream from the bystander’s smartphone to the medical dispatcher might improve the quality of chest compressions performed during CPR. Methods: At the Copenhagen Emergency Medical Services in Denmark, the medical dispatcher can add a live video to the emergency call. In case of OHCA, the medical dispatcher guides bystanders in dispatcher-assisted CPR (DA-CPR). After initiating chest compressions, the medical dispatcher can add live video streaming. A cohort study was conducted with an evaluation of performed chest compressions from the video footage before and after the dispatcher used the video to instruct CPR (video-instructed DA-CPR). Correct chest compressions were defined according to European Resuscitation Council Guidelines. Results: CPR was provided with a live video stream in 52 OHCA calls, in which 90 bystanders performed chest compressions. Thirty OHCA occurred at a public location, and more than four bystanders were present in 32 (62%) cases. In 26 cases, chest compressions were performed by more than one bystander. Eight (9%) bystanders performed correct chest compressions before video-instructed DA-CPR. For the bystanders first initiating insufficient CPR improvements were observed for: hand placement 58% (n=17/29), compressions rate 73% (n=17/21), and compressions depth 62% (n=19/31) following video-instructed DA-CPR. For the second bystander providing CPR (n=26) improvements were still observed for: hand placement 57% (n=4/7), compressions rate 73% (N=8/11), and compressions depth 53% (n=11/21) following video-instructed DA-CPR. For the third and fourth bystander (n=10), providing CPR improvements were seen for: hand placement 100% (n=2/2), compressions rate 50 % (n=2/4), and compressions depth 60% (n=3/5). Eighteen bystanders had a chest compressions performance measurement that could not be observed. Conclusions: A live video from the bystander`s smartphone to the medical dispatcher could improve the quality of chest compressions in CPR, and guidance seems important not just for the first bystander but for all bystanders performing CPR.

Aim: To investigate whether live video streaming from the bystander's smartphone to a medical dispatcher can improve the quality of bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA). Methods: After CPR was initiated, live video was added to the communication by the medical dispatcher using smartphone technology. From the video recordings, we subjectively evaluated changes in CPR quality after the medical dispatcher had used live video to dispatcher-assisted CPR (DA-CPR). CPR quality was registered for each bystander and compared with CPR quality after video-instructed DA-CPR. Data were analysed using logistic regression adjusted for bystander's relation to the patient and whether the arrest was witnessed. Results: CPR was provided with live video streaming in 52 OHCA calls, with 90 bystanders who performed chest compressions. Hand position was incorrect for 38 bystanders (42.2%) and improved for 23 bystanders (60.5%) after video-instructed DA-CPR. The compression rate was incorrect for 36 bystanders (40.0%) and improved for 27 bystanders (75.0%). Compression depth was incorrect for 57 bystanders (63.3%) and improved for 33 bystanders (57.9%). The adjusted odds ratios for improved CPR after video-instructed DA-CPR were; hand position 5.8 (95% CI: 2.8-12.1), compression rate 7.7 (95% CI: 3.4-17.3), and compression depth 7.1 (95% CI: 3.9-12.9). Hands-o time was reduced for 34 (37.8%) bystanders. Conclusions: Live video streaming from the scene of a cardiac arrest to medical dispatchers is feasible. It allowed an opportunity for dispatchers to coach those providing CPR which was associated with a subjectively evaluated improvement in CPR performance.

Purpose of the study: To investigate if live streaming of video from bystander's smartphone to the emergency medical dispatcher can improve the quality of bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA).

Background Currently, the emergency medical dispatchers rely solely on the spoken word when assessing and triaging emergency calls. We aimed to explore if livestreaming by bystanders could be useful during emergency calls. Method In a 3 months period, livestreaming could be added to the emergency call at the Emergency Medical Services, Copenhagen. Nine medical dispatchers were trained to instruct laypersons to ad livestreaming at a 1 day simulation-based course before the period. For livestreaming caller received a text message with a link. When activating the link, the smartphone camera opened, allowing video to be streamed encrypted to the dispatcher. GoodSAM provided the technical solution. Results In 68 cases, the caller had a smartphone and the dispatcher suggested livestreaming which succeeded in 33 cases. Reasons for no livestreaming were refusal from bystander (n=6) or patient (n=2), text message not received before ambulance arrival (n=17), and technical issues or caller skills (n=11). The dispatchers found the live video recording useful in all cases. In 8 cases (24%) the patient was considered more critical ill when livestreaming was added, whereas in 8 (24%) cases the patient was considered less sick. Change in ambulance priority response was done in 3 cases after the dispatchers had video. Among 25 callers interviewed 22 experienced livestreaming as an advantage. Conclusion Adding video livestreaming to the emergency call seems useful for the medical dispatchers to improve patient assessment and to provide the appropriate emergency response. The callers found livestreaming an advantage. Technical issues/experiences, however, need to be improved. Conflict of interest The authors declare that they have no competing interests. Funding Emergency Medical Services Copenhagen: has received unrestricted research grants from the Laerdal Foundation for acute medicine and from the Danish foundation TrygFonden. CAMES has received unrestricted research grants from the Laerdal Foundation.

Aim Telephone-triage poses a challenge in estimating urgency and determining the best response in acute health care. Lack of visual cues, vague symptom description, interpretation of symptoms, and spoken word contribute to the complexity.1 The aim of the study was to include information that would enrich the telephone-triage with a measure of the callers' subjective feeling of urgency defined as 'degree-of worry' (DOW). We tested the hypothesis that high DOW would be associated with hospitalisation within 48 hours. Method A prospective cohort study was performed between 24.01–9.02 2017. Callers rated their DOW on a 1–5 scale (1=minimum worry, 5=maximum worry) before transferred to a call-handler. Length of hospital stay was obtained from National Patient Register. The association between DOW and hospitalisation was assessed using logistic regression. Results Of 11 413 calls to the helpline, 581 individuals (5.1%) were hospitalised. Most of the hospitalised individuals (n=374, 64.4%) presented a high DOW (DOW 4–5). A high DOW had an odds ratio for being hospitalised of 5.38 (95% CI: 4.05 to 7.15) compared to those with a low DOW (DOW 1–2). Medium DOW (DOW 3) had intermediate odds ratio of 2.24 (95% CI 1.65 to 3.06). We observed this in all age groups, both genders, all levels of comorbidity, regardless if the caller was the patient or a close relative/friend. Conclusion A high DOW increased the odds for hospitalisation five-fold. DOW could be beneficial in supporting assessment and clinical decision-making in telephone-triage as well as directly involving the caller in the decision-making process. Reference . Leprohon J, Patel VL. Decision-making strategies for telephone triage in emergency medical services. Medical Decision Making: An International Journal of the Society for Medical Decision Making 1995;15:240–253. Conflict of interest None Funding Trygfonden, Danish Nurses Association and Laerdal Foundation.

Aim Symptom description and degree-of-worry (DOW) by elderly contacting a medical helpline are poorly described.1 Several diagnoses may be associated with preventable admissions for elderly citizens,2 and increased risk of over-and-under-triage.3 We aimed to investigate how symptoms and worry are described by elderly citizens (age 65 and older) when they call a medical hotline. Method A mixed method design on data gathered from a three-week 2017 cohort, where callers rated their DOW on a 1–5 scale. A sub-cohort of 65+years was used. The National Patient Register gave data on admissions. Calls made by the patients (patient-caller) was included for the qualitative analysis (n=90). Results A total of 1530 acutely ill or injured elderly called the medical helpline. n=755 (50%) were patient-callers and n=364 (48%) of these had a high DOW. Of all patient-callers n=216 (28.6%) were triaged to face-to-face consultation and n=73 (9.7%) were subsequently admitted. The preliminary qualitative analysis led to the hypothesis that patient-callers often expressed exacerbation of chronic diseases (which are part of the preventable admission) and often lived alone. Those that were not triaged to face-to-face consultation were frequently offered one, but rejected because of the obstacles of leaving their home. The majority of patient-callers triaged to face-to-face consultation expressed that their general practitioner was not able to help them. Conclusion The majority of the elderly patient-callers was very worried and lived alone. Most of the calls concerned exacerbation of a chronic condition and most of the symptoms fitted the described preventable admission diagnoses. References . Gamst-Jensen H, et al. Self-rated worry predicts hospitalisation in out-of-hours services telephone triage. Copenhagen; 2018. (abstact, not published). . KL. Regions of Denmark, Ministry of Finance and Ministry of Health, 2016; Indblik i sundhedsvæsenets resultater 2016, Report published by Ministry of Health. Avaliable at [cited 2018 Jan 12] http://www.sum.dk/~/media/Filer – Publikationer_i_pdf/2016/Indblik-i-sundhedsvaesenets-resultater-maj-2016/Indblik-i-sundhedsvaesenets-resultater-maj-2016.pdf . Gamst-Jensen H, Lippert FK, Egerod I. Under-triage in telephone consultation is related to non-normative symptom description and interpersonal communication: A mixed methods study. Scand J Trauma Resusc Emerg Med2017December 15;25(1):52. Conflict of interest None Funding None

Aim Medical dispatching is a highly complex procedure and has an impact upon patient outcome. It includes handling emergency calls, prioritisation of resources and the provision of guidance and instructions to callers. Whilst emergency medical dispatchers play a key role in the process, their perception of the process is rarely reported. We explored emergency medical dispatchers' perception of their role in emergency call handling and their perception of barriers. Methods An explorative qualitative interview study was designed. Modified grounded theory was used for the data analysis. Results A total of 5 paramedics and 6 registered nurses were interviewed. A model of the emergency call handling process was drawn based on the data. The analysis of barriers resulted in themes relating to the callers and the medical dispatchers, from whom four and three respective themes were identified. For callers, the motive for calling, the situation, the perception and presentation of the problem was influencing factors. For the dispatchers the expertise, teamwork and organisation influenced the process. Conclusion The results indicate factors influencing the medical dispatch process, as perceived by medical dispatchers. Callers lack knowledge about best utilisation of the emergency number and the medical dispatching process, which can be improved by public awareness campaigns and incorporation of knowledge in first aid courses. For medical dispatchers the most potent modifiable factors were based upon the continuous professional development of the medical dispatchers and the system that supports them. Conflict of interest None declared. Funding EMS, Copenhagen receives centre support from the Laerdal Foundation for Acute Medicine.

BackgroundWe aimed to see if a novel credit card size cardiopulmonary resuscitation (CPR) feedback device helped to improve the quality of chest compressions by lay participants compared to compressions done without feedback. Materials and methodsThis study had non-healthcare workers aged 25 -70 years old randomized into either a real-time feedback group that got the CPRcard, which provided real-time feedback for both chest compression rate and depth, or the no feedback group.Participants in the control group (no feedback) either used a blinded CPRcard or performed compressions without a CPRcard. ResultsParticipants in the CPRcard group achieved a better median compression rate (CPRcard: 117 vs control: 122, p-value = 0.001) and higher proportion of compressions within the adequate range of 100 to 120 per minute (CPR Card: 83% vs control: 47%, p-value < 0.001).CPRcard group had a higher percentage of adequate compressions (CPRcard: 88% vs. no card: 46.8%, p-value = 0.037; CPRcard: 73% vs blinded card: 43%, p-value = 0.003).The participants in the CPRcard group more often performed better quality CPR, defined as simultaneously meeting targets for both compression rate of 100 to 120 and depth of at least 5cm (CPRcard: 36% vs control: 4%, p-value = 0.022). ConclusionsUse of the CPRcard by non-healthcare workers improved the quality of CPR chest compressions.

Purpose: Dispatcher-assisted telephone cardiopulmonary resuscitation (DA-CPR) is highlighted in the 2015 Resuscitation Guidelines. The dispatchers have an important role and their situation awareness in this complex nonvisual environment depends on the communication with the caller. We aimed to explore what dispatchers could learn from seeing a CCTV recording of a case of out-of-hospital cardiac arrest (OHCA) that they have handled themselves.

The aim of this study was to explore challenges in recognition and initial treatment of out-of-hospital cardiac arrest (OHCA) by using closed-circuit television (CCTV) recordings combined with audio recordings from emergency medical calls.Method: All OHCA captured by CCTV in the Capital Region of Denmark, 15 June 2013-14 June 2014, were included. Using a qualitative approach based on thematic analysis, we focused on the interval from the victim's collapse to the arrival of the ambulance.Results: Based on the 21 CCTV recordings collected, the main challenges in OHCA seemed to be situation awareness, communication and attitude/approach. Situation awareness among bystanders and the emergency medical dispatchers (dispatcher) differed. CCTV showed that bystanders other than the caller, were often physically closer to the victim and initiated cardiopulmonary resuscitation (CPR). Hence, information from the dispatcher had to pass through the caller to the other bystanders. Many bystanders passed by or left, leaving the resuscitation to only a few. In addition, we observed that the callers did not delegate tasks that could have been performed more effectively by other bystanders, for example, receiving the ambulance or retrieving an Automated External Defibrillator (AED).Conclusion: CCTV combined with audio recordings from emergency calls can provide unique insights into the challenges of recognition and initial treatment of OHCA and can improve understanding of the situation. The main barriers to effective intervention were situation awareness, communication and attitude/approach. Potentially, some of these challenges could be minimized if the dispatcher was able to see the victim and the bystanders at the scene.A team approach, with the dispatcher responsible for the role as team leader of a remote resuscitation team of a caller and bystanders, may potentially improve treatment of OHCA. (C) 2015 The Authors. Published by Elsevier Ireland Ltd.

Background: Bystander and telephone assisted cardiopulmonary resuscitation (CPR) is important, however little is known about the first critical minutes. On 8th of July 2013, a 57 year old man collapsed with OHCA at a train station in Copenhagen. The incident was captured on closed circuit television (CCTV). We combined CCTV and audio recordings from the emergency medical dispatcher (EMD) in order to identify the learning possibilities.