title: Improved outcome for patients with a cardiac arrest by supervision of the emergency medical services system.
abstract: BACKGROUND
  The outcome for patients with an out-of-hospital cardiac arrest can only be improved through optimal pre-hospital therapy by the emergency medical services (EMS) system. So far it is not clear if physician supervision of the EMS system is necessary for an optimal result.
  
  
  METHODS
  In a retrospective and prospective case series we describe the changes in outcome for patients with an out-of-hospital cardiac arrest after the implementation of limited physician supervision of the EMS system. We also analysed the factors that were responsible for these changes.
  
  
  RESULTS
  We studied 479 consecutive patients with an out-of-hospital cardiac arrest. In the pre-intervention period, the survival rate for patients with an out-of-hospital cardiac arrest was 13%. This increased to 21.6% when physician supervision was implemented (p = 0.013). This increase in survival coincided with an improvement in pre-hospital advanced cardiac life support with an increase in the number of patients who arrived with a stable cardiac rhythm in the emergency department (p < 0.001).
  
  
  CONCLUSIONS
  Limited physician supervision of an EMS system in a non-metropolitan area may improve the outcome for patients with an out-of-hospital cardiac arrest.
authors.affiliation: Department of General Internal Medicine (Medical Intensive Care Unit), University Hospital Leiden, Netherlands.
authors.forename: J G
authors.initials: JG
authors.lastname: van der Hoeven
authors.forename: J
authors.initials: J
authors.lastname: de Koning
authors.forename: P K
authors.initials: PK
authors.lastname: van der Weyden
authors.forename: A E
authors.initials: AE
authors.lastname: Meinders
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004632:Emergency Medical Services; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy; D006801:Humans; D008020:Life Support Care; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D004837:Epinephrine