Non-Resuscitative Telecommunicator-Assisted First Aid: A Scoping Review

Clinical Snapshot

Key Findings

• P Value: Not applicable — scoping review with narrative synthesis only

• Effect Size: No pooled effect size calculable; narrative findings indicate some beneficial effects of TAFA alongside identified deficiencies in dispatcher protocol adherence

• Primary Outcome: Systematic mapping of quantitative research on non-resuscitative TAFA: 22 eligible studies identified, spanning 2000–2024, covering nine emergency condition categories across nine high-income countries

• Nnt Or Sensitivity: Not calculable from available data; patient outcome relationships described as unclear across the included literature

• Confidence Interval: Not applicable — no meta-analysis performed

Clinical Application

TAFA for non-resuscitative emergencies is already practiced internationally and recognised as standard of care in some prehospital systems. Feasibility of video-assisted TAFA has been demonstrated experimentally. However, dispatcher protocol adherence is suboptimal in real-world settings, suggesting implementation gaps that require targeted training and quality assurance interventions. Australian ambulance services (including NSW Ambulance, Ambulance Victoria, Queensland Ambulance Service, and St John Ambulance WA) operate Medical Priority Dispatch Systems (MPDS) that include pre-arrival instruction protocols for a range of emergencies. Telecommunicator-assisted CPR (T-CPR) is well-established, but this review highlights that evidence for non-resuscitative TAFA — covering conditions such as anaphylaxis (relevant given Australia's high anaphylaxis burden), opioid overdose (pertinent to Australia's ongoing opioid crisis), and obstetric emergencies — remains sparse. RACGP and Australasian College for Emergency Medicine (ACEM) guidelines do not currently address TAFA quality standards beyond CPR. The TGA's approval of naloxone for over-the-counter dispensing increases the relevance of opioid overdose TAFA protocols in the Australian context. This review supports the case for Australian EMS agencies to audit their non-resuscitative PAI protocols and invest in dispatcher training research. Adults and children experiencing acute medical emergencies (excluding cardiac arrest) in settings where emergency dispatch services provide telephone pre-arrival instructions to bystanders

Abstract

INTRODUCTION: The provision of instant telephone pre-arrival instructions (PAI) on first aid to laypeople by emergency services' telecommunicators for conditions beyond cardiac arrest, such as trauma or acute coronary syndrome, is practiced by emergency services around the world and is recognized by some prehospital systems as a standard of care. However, to the best of the authors' knowledge, no attempts have been made to date to systematically summarize the related research evidence. STUDY OBJECTIVE: The aim of this study was to systematically map and analyze published quantitative research on telecommunicator-assisted first aid (TAFA) for medical emergencies other than cardiac arrest. METHODS: Peer-reviewed journal papers reporting original quantitative data on experimental or real-world applications of TAFA were identified through PubMed, Scopus, and Google Scholar. Studies focusing solely on cardiac arrest management (cardiopulmonary resuscitation [CPR] or automated external defibrillation) were excluded. A scoping review of eligible papers was conducted in accordance with the PRISMA-ScR guidance. RESULTS: Twenty-two studies published from 2000 through 2024 met inclusion criteria. First authors represented nine high-income countries. The studies investigated hypothetical or actual application of TAFA for anaphylaxis, chest pain or myocardial infarction, stroke, trauma, bleeding, childbirth, foreign body airway obstruction, opioid overdose, and respiratory arrest; four studies did not specify the type of emergency. Eight studies (36.4%) analyzed real Emergency Medical Services (EMS) call data, another eight (36.4%) were simulation-based, five (22.7%) used surveys, and one (4.5%) represented a cost-effectiveness analysis. The studies described existing TAFA practices, evaluated expectations and perceptions of the service by the public, demonstrated the feasibility of experimental techniques, including video communication, and identified areas for future investigations and interventions. Along with some beneficial effects of TAFA, several studies have demonstrated downsides of the practice, including suboptimal dispatcher adherence to pre-arrival protocols. The relationships between the real-world application of TAFA and patient outcomes are unclear. CONCLUSION: According to the review of quantitative research, non-resuscitative TAFA remains an under-explored area of prehospital medicine. Considering the paucity and the inconclusiveness of available evidence, significantly more research is required to better understand its effects and practical implications. The evidence map generated by this scoping review may assist the professional community in advancing the development of non-resuscitative TAFA.

References

1. 1.Birkun, A. A., & Douma, M. J. (2026). Non-resuscitative telecommunicator-assisted first aid: A scoping review. Prehospital and Disaster Medicine. Advance online publication. https://doi.org/10.1017/S1049023X26108942