title: Establishment and results of an EMT-D program in a two-tiered physician-escorted rescue system. The experience in Berlin, Germany.
abstract: Early defibrillation by emergency medical technicians or even less qualified personnel has been shown to improve survival rates for out-of-hospital cardiac arrest caused by ventricular fibrillation. It has been questioned whether these favourable results can be applied within the context of physician-attended emergency medical systems. Taking into consideration the results of a pilot study and after a careful analysis of the logistic and epidemiological background, the first German EMT-D program was introduced in the former West Berlin in December 1988. The first 2 years of experience with 499 technician-initiated resuscitation attempts in which the mobile intensive care unit of Klinikum Steglitz was involved, confirmed the results of the pilot study with an improved long-term survival rate (18%) for patients with ventricular fibrillation. We conclude that EMT defibrillation should be introduced in emergency physician-attended two-tiered emergency medical systems, whenever a thorough analysis of the existing rescue systems exhibits a 'relevant frequency' of resuscitation and response interval of 15 min or less.
authors.affiliation: Medizinische Klinik, Klinikum Steglitz, Department of Cardiopumology, Berlin 45, Germany.
authors.forename: H R
authors.initials: HR
authors.lastname: Arntz
authors.forename: M
authors.initials: M
authors.lastname: Oeff
authors.forename: S N
authors.initials: SN
authors.lastname: Willich
authors.forename: W H
authors.initials: WH
authors.lastname: Storch
authors.forename: R
authors.initials: R
authors.lastname: Schröder
mesh_terms: D000552:Ambulances; D001604:Berlin / Q000453:epidemiology; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data; D004554:Electric Countershock; D004632:Emergency Medical Services / Q000458:organization & administration; D004634:Emergency Medical Technicians; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy; D006801:Humans