Publication date: Jul 26, 2025

The coronavirus disease 2019 (COVID-19) pandemic, which emerged in late 2019, compelled people to change their behavior globally. Due to concerns about potential aerosol transmission during chest compressions, a modified dispatcher-assisted cardiopulmonary resuscitation (DACPR) protocol incorporating mouth-and-nose covering instructions was introduced in Nara, Japan. This study examined its impact on DACPR performance during the COVID-19 pandemic. This is a retrospective before-after study. DACPR performance data from the Nara Wide Area Fire Department were analyzed, comparing the non-pandemic period (March 2019 to February 2020) with the pandemic period (November 2020 to October 2021). The primary outcome was the time from emergency call acceptance to the first chest compression (T3). Secondary outcomes included the time to cardiac arrest recognition (T1), the time to start of DACPR instructions (T2), DACPR implementation rate, and adherence to infection prevention instructions. The implementation of the modified protocol did not significantly alter the overall DACPR rate (406, 50. 3% in the non-pandemic vs. 390, 47. 2% in the pandemic; p =. 214). Although the difference was relatively small, a statistically significant prolongation of T3 was observed during the pandemic period (246. 0 s vs. 261. 5 s, p 

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