Early defibrillation by emergency physicians or emergency medical technicians? A controlled, prospective multi-centre study.
In a controlled, prospective multi-centre study, defibrillation by emergency medical technicians (EMTs) was compared with the current standard of care in Germany--defibrillation by emergency physicians (EPs)-in order to answer the following questions: can EMTs in a two-tiered emergency medical services (EMS) system with physicians in the field defibrillate earlier than, and as safely as EPs? Does defibrillation by EMTs (study group) affect survival rate and long-term prognosis of patients in ventricular fibrillation (VF), as compared with the current national standards in resuscitation (basic cardiopulmonary resuscitation (CPR) by EMTs, and defibrillation by physicians: control group?


METHODS
Prior to the onset of the study, all EMTs completed retraining in basic life support (BLS). Randomly assessed EMTs were then trained to use semi-automatic defibrillators. With the help of on-line tape recordings, the complete resuscitation sequence was evaluated. Follow-up of the patients was carried out with the help of the Glasgow Coma Scale as well as Pittsburgh Cerebral and Overall Performance Categories.


RESULTS
A total of 159 patients with VF were included in the study. In 121 cases, collapse was witnessed. Of the patients receiving defibrillation by EMTs 25% were discharged from hospital alive, compared to 24% of the patients defibrillated by EPs. Of the study patients 67% were defibrillated within 12 min, while the percentage of control patients was 46%. Study patients were defibrillated earlier (P < 0.01), the return of spontaneous circulation (ROSC) was achieved earlier (P < 0.05), and the rate of patients requiring no adrenalin during resuscitation was higher in the study group (P < 0.05). The total amount of adrenalin administered in the study group was lower (P < 0.05). No statistically significant differences were found concerning the neurologic long-term prognosis.


CONCLUSIONS
In our study, EMT defibrillation was equally effective as defibrillation by EPs, but failed to improve survival rates or long-term outcome of patients in VF significantly, compared to EP defibrillation. Due to a reduction in the time intervals from collapse to defibrillation and to ROSC, as well as in adrenalin doses, by EMT-defibrillation, EMTs in Germany should defibrillate if they reach a patient prior to an EP, provided they have received continuous medical training and supervision.
Schneider
T
T
Department of Anaesthesiology, Johannes Gutenberg-University, Mainz, Germany.
Mauer
D
D
Diehl
P
P
Dick
W
W
Brehmer
F
F
Juchems
R
R
Kettler
D
D
Kleine-Zander
R
R
Klingler
H
H
Rossi
R
R
D016887:Cardiopulmonary Resuscitation / Q000193:education; D002985:Clinical Protocols; D004554:Electric Countershock / Q000379:methods* / Q000706:statistics & numerical data; D004634:Emergency Medical Technicians / Q000193:education; D004636:Emergency Service, Hospital; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000401:mortality / Q000628:therapy*