This study set out to understand how emergency dispatch staff interpret the primary obstacles that prevent CPR from being started during calls for out-of-hospital cardiac arrest. A total of thirty call-handlers from seven ambulance control centres across the UK were selected through purposive sampling and took part in in-depth, semi-structured interviews. These conversations examined their day-to-day experiences guiding callers through CPR and their views on the factors that most commonly hinder its initiation. The participants (20 women, 9 men, and 1 non-binary individual), aged between 21 and 57 years and possessing between six months and twenty-five years of experience, reported confidence levels ranging from 3 to 10 out of 10. All had familiarity with NHS Pathways and MPDS, and most handled at least one CPR-related call per shift. Nearly all interviewees noted that barriers to CPR emerged frequently. They described a range of impediments, with intense emotional reactions from callers being the most prominent. Additional challenges included physical limitations related to the caller, patient, or environment; uncertainty about the necessity of CPR—especially confusion around breathing status; and anxiety about causing potential harm. Call-handlers emphasized that these elements often interact, making every call complex in a different way. They also outlined difficulties arising in ambiguous scenarios such as care-home situations, involvement of carers, DNACPR considerations, and identified factors that could help overcome these barriers. The obstacles highlighted by call-handlers mirror those documented in previous research while also drawing attention to issues not fully addressed in existing protocols. Their insights offer a useful foundation for refining guidance systems and enhancing the effectiveness of telephone-delivered CPR instructions.
