Cardiac arrest survival as a function of ambulance deployment strategy in a large urban emergency medical services system.
BACKGROUND
This study examines the effect of paramedic deployment strategy on witnessed ventricular fibrillation (VF) cardiac arrest outcomes. Our null hypothesis was that there is no difference in survival between an EMS system using targeted response (TR) and one using a uniform or all advanced life support (ALS) response (UR) model. We define targeted response as a system where paramedics are sent to critical incidents while ambulances staffed with basic EMTs are sent to less critical incidents. A secondary outcome measure was paramedic skill proficiency between the systems.


METHODS
We conducted a retrospective review of all 1997 VF arrests in a large urban EMS system. The majority of the city is a busy, urban area that uses TR. Outlying areas of the city are suburban and are served by a UR model. All areas have first responders equipped with automated external defibrillators. Outcomes are compared using Utstein criteria.


RESULTS
Patient populations were well matched. There were 181 patients in the TR group and 24 in the UR group. Units in the TR area were able to demonstrate shorter response and time to defibrillation intervals than in the UR area. Rates for return of spontaneous circulation (ROSC), admission to the ward/intensive care unit (ICU), survival to discharge and survival to 1 year were all better in the cohort of patients cared for in the TR area than those in the UR area. Rates for successful intubation and IV initiation were also better in the TR areas than in the UR areas.


CONCLUSIONS
This study shows improved outcomes for a subset of patients with cardiac arrest when they are cared for in an area that uses TR compared to an area that uses a UR EMS system.
The City of Houston Emergency Medical Services, USA. david.persse@cityofhouston.net
David E
DE
Persse
Craig B
CB
Key
Richard N
RN
Bradley
Charles C
CC
Miller
Atul
A
Dhingra
D022561:Advanced Cardiac Life Support; D000552:Ambulances; D016887:Cardiopulmonary Resuscitation; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019037:Urban Health Services; D014693:Ventricular Fibrillation / Q000628:therapy*