title: The impact of paramedics on out-of-hospital cardiac arrests in a rural community.
abstract: OBJECTIVE
  To determine whether paramedics influence the outcome of cardiac arrest patients in a rural area.
  
  
  METHODS
  Retrospective analysis of cardiorespiratory arrest patients in rural southeast Alaska from 1987 to 1996.
  
  
  RESULTS
  Paramedics treated 37 patients and advanced life support emergency medical technicians (EMT-IIIs) treated 34 patients. Demographics/CPR variables of the two groups were similar. Return of spontaneous circulation (ROSC) was 46% (17/37) for the paramedic-treated patients and 18% (6/34) for the EMT-III-treated patients (p = 0.01). Intensive care unit (ICU) admission was 38% (14/37) for the paramedic-treated patients and 15% (5/34) for the EMT-III-treated patients (p < 0.03). Discharge from the hospital neurologically intact was 20% (7/35) for the paramedic-treated patients and 9% (3/34) for the EMT-III-treated patients (p = NS). Two patients in the paramedic-treated group had ROSC and survived in the local hospital ICU for several days before being transferred to a tertiary care hospital in another state and were lost to follow-up for the discharge-from-hospital-neurologically-intact category but were included in the ROSC and ICU admission analysis.
  
  
  CONCLUSIONS
  In this rural setting, a paramedic on the scene significantly improved the ROSC (paramedics = 46% vs 18% for EMT-III, p = 0.01) and survival to ICU admission (38% vs 15%, p = 0.03). The presence of a paramedic on the scene increased survival to hospital discharge neurologically intact (20% vs 9%), although this was not statistically significant.
authors.affiliation: City of Ketchikan Fire Department, Alaska, USA.
authors.forename: W E
authors.initials: WE
authors.lastname: Kriegsman
authors.forename: S E
authors.initials: SE
authors.lastname: Mace
mesh_terms: D000368:Aged; D000413:Alaska; D002983:Clinical Competence / Q000592:standards; D004634:Emergency Medical Technicians / Q000193:education / Q000592:standards*; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017009:Professional Autonomy; D012151:Resuscitation / Q000592:standards*; D012189:Retrospective Studies; D012423:Rural Health; D016019:Survival Analysis; D016896:Treatment Outcome