The national cardiac arrest registry includes information on bystander CPR. An EMS clinician currently enters bystander CPR (B-CPR) information into the prehospital care report. The accuracy of this documentation has not been validated. This study compared EMS documented B-CPR rates to the bystander CPR rates on the 911 audio recordings of the calls in Birmingham Alabama.
Additional Information
EMS documentation in the Birmingham CARES registry recorded a B-CPR rate of only 12.3%, while review of corresponding 9-1-1 audio recordings identified a substantially higher rate of 27.5% — more than double the EMS-documented rate.
Of 236 adult non-traumatic out-of-hospital cardiac arrest (OHCA) cases analyzed, 56 cases (23.7%) had disagreements between EMS documentation and 9-1-1 audio review, while 180 cases (76.3%) were concordant.
In 46 of the 56 discordant cases, 9-1-1 audio confirmed that B-CPR was performed but EMS did not document it. The majority of these involved callers who initiated CPR but discontinued it before EMS arrival, making it invisible to arriving crews. Only 7 of these 46 appeared to be outright EMS misclassifications.
In 10 cases, EMS documented B-CPR but the 9-1-1 audio did not support it — all involved calls that ended before EMS arrival without cardiac arrest recognition or CPR instruction by the dispatcher
Bottom line: Sustained telecommunicator CPR instruction matters through EMS arrival, as early caller discontinuation of CPR was the primary driver of undercounting, and better dispatcher engagement could both improve CPR continuity and documentation accuracy.
References
Coute RA, Smith T, Nathanson BH, Richardson JD, Ferguson WC, Strickland JD, von Schweinitz B, Jackson EA. Discrepancies in Bystander CPR Documentation: Comparing the Birmingham CARES Data with 9-1-1 Audio Review. Prehosp Emerg Care. 2026;30(3):409-413. doi: 10.1080/10903127.2025.2584506. Epub 2025 Dec 9. PMID: 41247107; PMCID: PMC12969134.