Analysis of reasons for emergency call delay in relation to place in Japan: high incidence of correctable causes and the impact of large delay on patient outcomes

Review: The interval between collapse and emergency call influences the prognosis of out-of-hospital cardiac arrest (OHCA). To reduce the interval, it is essential to identify the causes of delay. Methods : Basal data were collected prospectively by fire departments from 3746 OHCAs witnessed or recognised by citizens and in which resuscitation was attempted by emergency medical technicians (EMTs) between 1 April 2003 and 31 March 2008. EMTs identified the reasons for call delay by interview. Results: The delay, defined as an interval exceeding 2 min (median value), was less frequent in the central region, public places and for witnessed OHCAs. Delay was more frequent in care facilities and for elderly patients and OHCAs with longer response times. Multiple logistic regression analysis indicated that central regions, care facilities and arrest witnesses are independent factors associated with delay. The ratio of correctable causes (human factors) was high at care facilities and home, compared with other places. Calling others was a major reason for delay in all places. Performing CPR and other treatments was another major reason at care facilities. Large delay, defined as an interval exceeding 5 min (upper quartile value) was an independent factor associated with a low 1-year survival rate. Conclusion: The incidence of correctable causes of delay is high in the community. Correction of emergency call manuals in care facilities and public relations efforts to facilitate early emergency call may be necessary. The BLS education should be modified to minimize the interval related to making an emergency call.