Quality of on-site performance in prehospital advanced cardiac life support (ACLS).
The aim of our prospective study was to assess the structural and procedural quality of an urban emergency medical services (EMS) system providing prehospital basic and advanced cardiac life support (BLS/ACLS), to compare the onsite performance of physicians and non-physicians in ECG diagnosis and defibrillation, and to identify incidence and causes of avoidable delays in the initial treatment sequences.


METHODS
Between 1 February 1991 and 1 July 1992, 162 on-line tape recordings of prehospital cardiopulmonary resuscitation (CPR) efforts performed by the staff of the EMS system of the city of Mainz were evaluated. After arrival at the patient's side, time intervals to initial ACLS steps (first ECG-diagnosis, first defibrillation, endotracheal intubation, first epinephrine administration) were measured. Times to rhythm identification and countershock by EMT-Ds vs. physicians were compared (Mann-Whitney U-test). Time intervals are presented as median values. One-hundred sixty-two adult patients with out-of-hospital cardiac arrests (ventricular fibrillation [VF] or ventricular tachycardia [VT], 72; asystole or electromechanical dissociation [EMD], 90) receiving CPR by EMTs, EMT-Ds, and physicians of the Mainz EMS were included. Patients with arrests due to non-cardiac aetiologies were excluded.


RESULTS
After arrival at the patient's side, for patients with VF/VT, the EMT-Ds took 1:36 min and the physicians took 1:00 min to obtain the first ECG diagnosis (P = 0.004). The first countershock was delivered within 1:42 min by both EMT-Ds and physicians of the mobile intensive care unit (MICU). After diagnosis was established, the EMT-Ds took 0:08 min to defibrillate, whereas the physicians took 0:36 min (P = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
Schneider
T
T
Department of Anaesthesiology, Johannes Gutenberg-University, Mainz, Germany.
Mauer
D
D
Diehl
P
P
Eberle
B
B
Dick
W
W
D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D004554:Electric Countershock; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000592:standards*; D004634:Emergency Medical Technicians; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017064:Process Assessment, Health Care; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000401:mortality / Q000628:therapy*
D004837:Epinephrine