title: Out-of-hospital cardiac arrest in a rural area: a 16-year experience with lessons learned and national comparisons.
abstract: OBJECTIVE
  To evaluate the effectiveness of the emergency medical services (EMS) system in a rural island community in resuscitating victims of out-of-hospital cardiac arrest over the past 16 years.
  
  
  METHODS
  We conducted a retrospective analysis of all EMS responses to cardiac arrests on San Juan Island, a rural island community of 5,000 people in the Pacific Northwest. Data were collected between January 1977 and July 1994 on the basis of the Utstein criteria. From these data, we calculated survival rates and compared them with published data from other rural and nonrural areas in the United States.
  
  
  RESULTS
  During this study, 22% of all the patients who sustained a cardiac arrest of cardiac origin on the island survived to hospital discharge. The survival rate for witnessed cases of ventricular fibrillation and ventricular tachycardia was 43%.
  
  
  CONCLUSIONS
  The combined paramedic/emergency medical technician system used on San Juan Island has yielded survival rates comparable to those of urban areas. This system may serve as a model for other rural communities, especially those with well-defined geographic areas and established 911 central dispatching.
authors.affiliation: Department of Family Medicine, University of Washington, Seattle, USA.
authors.forename: S Y
authors.initials: SY
authors.lastname: Killien
authors.forename: J P
authors.initials: JP
authors.lastname: Geyman
authors.forename: J B
authors.initials: JB
authors.lastname: Gossom
authors.forename: D
authors.initials: D
authors.lastname: Gimlett
mesh_terms: D000368:Aged; D004632:Emergency Medical Services / Q000191:economics / Q000458:organization & administration*; D004634:Emergency Medical Technicians; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D012151:Resuscitation; D019035:Rural Health Services / Q000191:economics / Q000458:organization & administration*; D012424:Rural Population; D015996:Survival Rate; D014861:Washington