Early defibrillation program: problems encountered in a rural/suburban EMS system.
Many studies have shown improved survival of cardiac arrest patients by the use of early defibrillation (EMT-D) in the field. This prospective study was the first in Pennsylvania and was undertaken to determine if an EMT-D program would be successful in our suburban/rural setting. One hundred two EMTs were trained to use a semi-automatic defibrillator and data were collected over 16 months. There were 96 cardiac arrests, with only 33 patients (34%) presenting with initially treatable dysrhythmias--ventricular fibrillation (VF) or tachycardia (VT). Twenty-three patients (24%) were admitted to the hospital; survival to hospital discharge occurred in only 5 patients (5.2%). Survival to hospital admission was higher among VF/VT presenting rhythms (36%) than for those with other rhythms (17%, P = 0.07), but survival to discharge among VF/VT rhythms (9%) was not statistically different from other rhythms (3%, P = 0.45). Among VF/VT patients, survival to discharge was correlated with shorter call to first defibrillation intervals. Mean call to response interval was longer than in other reported studies (7.2 +/- 4.3 minutes). In addition, there was a high drop-out rate of EMT participants, no central/uniform early access system (that is, 911), and a lower rate of CPR than reported in other studies. It is concluded that introduction of an EMT-D program without careful analysis of systems response factors will not lead to the improved cardiac arrest survival percentages that have previously been reported.
Richless
L K
LK
Emergency Department, Allegheny Valley Hospital, Natrona Heights, PA.
Schrading
W A
WA
Polana
J
J
Hess
D R
DR
Ogden
C S
CS
D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D004554:Electric Countershock / Q000706:statistics & numerical data*; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians / Q000193:education*; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D011446:Prospective Studies; D012423:Rural Health; D013383:Suburban Population; D015996:Survival Rate; D016896:Treatment Outcome