Randomized Controlled Simulation Trial
From June 1 to December 31, 2021, 132 participants aged 18-60 years were recruited. Participants who had undergone clinical practice, were engaged in medical or emergency-related occupations, or were physically unable to perform high-intensity testing and training were excluded. To ensure that all participants possessed the necessary skills in single-rescuer CPR, we initially conducted a basic life support training called WeCan CPR. This training encompassed essential skills, such as contacting the emergency dispatch center (dispatch help number: 1-2-0), performing chest compressions, providing mouth-to-mouth ventilation, and using an AED [Subsequently, participants who passed the single-rescue CPR skill test were randomized into teams of 3. Each team was randomly assigned to 1 of the 2 study groups: the control group and the intervention group. In the control group, participants did not receive any guidance from a telecommunicator. In contrast, in the intervention group, one of the researchers (LZ) instructed the participants to use the team-based tele-instruction tool. Each team was asked to perform resuscitation before the team-based CPR training (phase I test) at baseline. Following the phase I test, each team underwent a 30-minute team training separately, following the same protocol as our previous study [In the team-based CPR simulated scenario, each team was required to assign and finish tasks, including contacting the emergency telecommunicator, performing chest compressions, mouth-to-mouth ventilation, and retrieving and using an AED. In the simulated scenario, the telecommunicator was blinded to the team’s CPR performance and activated the medical emergency response as soon as the call went through from the team-based T-CPR group. The scenario commenced as each team entered the room and concluded 10 minutes after they initiated the first chest compression. Participant B left the room to retrieve the AED (Laerdal AED Trainer 2, Laerdal Medical) and was instructed to return to the room after 5 minutes.No feedback was provided to the participants once the scenario began. Quantitative data were collected from manikin feedback (Resusci Anne QCPR, Laerdal Medical), video recordings, and the evaluations of researchers and submitted to a blinded assessor. A total of 3 cameras captured the algorithm time data, CPR technique, and communication with the telecommunicator from different angles (head, side, and above). The quality of chest compressions and ventilation was recorded using SimPad PLUS (Laerdal Medical). The AED performance was assessed by researchers using a dichotomous (yes or no) format. Time intervals, including hands-off time and a delay at the beginning, were measured using a stopwatch. The participants’ age, sex, and self-reported body weight were also documented.Flow diagram of the study. Phase I tests were team-based cardiopulmonary resuscitation (CPR) performance and capabilities assessment with or without the team-based tele-instruction tool among individuals who have undergone single-rescuer CPR training. Phase II tests were team-based CPR performance and capabilities assessment with or without the team-based tele-instruction tool among individuals who have undergone single-rescuer and team-based CPR training. T-CPR: telephone-assisted cardiopulmonary resuscitation.