Emergency medical services and mortality from heart disease: a community study.
OBJECTIVE
Little is known regarding the potential effects of emergency medical services (EMS) on total heart disease mortality. Although EMS may provide health benefits in less acute cardiac conditions, its immediate, measurable, and direct effect on heart disease mortality is through resuscitation of persons suffering out-of-hospital cardiac arrest. The purpose of this study was to examine the involvement and potential mortality benefit of out-of-hospital EMS care of cardiac arrest on community heart disease mortality.


METHODS
The investigation was an observational study of all persons with death events resulting from heart disease as defined by heart disease deaths and deaths averted (persons successfully resuscitated from out-of-hospital cardiac arrest by EMS) in a single county from January 1, 2000, through December 31, 2000. The county of study has a population of nearly 2 million people and is composed of urban, suburban, and rural components. State vital records and EMS reports were used to ascertain deaths resulting from heart disease and deaths averted.


RESULTS
In the year 2000, 3,577 persons died as a result of heart disease, and 128 persons were successfully resuscitated and discharged from the hospital, for a total of 3,705 death events. EMS responded to 39% (1,428/3,705) of all heart disease death events and 57% (1,428/2,516) of out-of-hospital events, resulting in a 3.5% (128/3,705) reduction in overall heart disease mortality and a 5.1% (128/2,516) reduction in out-of-hospital mortality.


CONCLUSIONS
EMS was involved in the majority of out-of-hospital heart disease death events, resulting in a measurable reduction in heart disease mortality.
Rea
Thomas D
TD
Department of Medicine, University of Washington, Seattle, WA, USA. rea123@u.washington.edu
Eisenberg
Mickey S
MS
Becker
Linda J
LJ
Lima
Ann R
AR
Fahrenbruch
Carol E
CE
Copass
Michael K
MK
Cobb
Leonard A
LA
D000368:Aged; D016887:Cardiopulmonary Resuscitation; D002423:Cause of Death; D003644:Death Certificates; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D006302:Health Services Research; D006323:Heart Arrest / Q000209:etiology* / Q000628:therapy*; D006331:Heart Diseases / Q000150:complications* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D015397:Program Evaluation; D012042:Registries; D015996:Survival Rate; D016896:Treatment Outcome; D014861:Washington / Q000453:epidemiology