Help-seeking and barriers to emergency care during out-of-hospital cardiac arrests in public housing areas: a qualitative study

Introduction: Understanding whether socioeconomic and ethnic backgrounds influence help-seeking and communication with emergency medical services (EMS) is essential to mitigate disparities. Objective: We explored how public housing residents seek help and communicate with EMS, focusing on barriers and enablers to out-of-hospital cardiac arrest (OHCA) recognition and swift EMS responses. Design: Explorative qualitative analysis of audio recordings of emergency service calls regarding non-EMS witnessed OHCAs. Audio recordings were screened and selected to ensure call variety—then transcribed and analysed using thematic analysis inspired by the concepts of social wrongs and social orders. We also analysed the dispatch protocol, a tool for managing emergency service calls. Setting: Four public housing areas with >50% ethnic minority residents in Copenhagen, Denmark. Participants: Non-EMS witnessed OHCAs from 2017 to 2022. Results: We included 17 calls regarding 13 OHCAs and defined two themes. The effective call aligned with the dispatch protocol, leading to swift OHCA recognition and dispatcher-assisted cardiopulmonary resuscitation (CPR). In contrast, the challenging call, which did not match the framework of the dispatch protocol, entailed one or more of the following characteristics, leading to delayed or missed OHCA recognition: (1) multiple people involved (multiple callers, third-party caller or bystanders communicating with caller), (2) language barriers, (3) emotionally unstable callers and (4) lack of emergency medical competencies. Across themes, witnesses contacted someone in their network instead of calling emergency services immediately. This was a barrier to OHCA recognition in the challenging calls, which some dispatchers managed using calm intonation and simple inquiries. Conclusions: We identified two themes concerning communication in emergency service calls from public housing areas: the effective call and the challenging call, resulting in swift or delayed/missed OHCA recognition, respectively. The dispatch protocol enabled swift recognition in the effective calls but was a barrier in the challenging calls. Across themes, witnesses used network-based help-seeking before calling emergency services, delaying EMS responses and dispatcher-assisted CPR.