Evolution of a community-wide early defibrillation programme experience over 13 years using police/fire personnel and paramedics as responders.
BACKGROUND
In November 1990, a 2-year trial period was initiated in which police officers in the city of Rochester, Minnesota, were trained in the operation of automated external defibrillators (AEDs). Following the trial, the program was expanded as the city grew in population and area. In 1998 firefighters also were equipped with AEDs, bringing to a total 18 AEDs with police and fire personnel, in addition to paramedic capability.


METHODS
From November 1990 to December 2003, all adult patients with atraumatic cardiac arrest with ventricular fibrillation (VF) as the presenting rhythm were included for analysis. Call-to-shock time intervals, restoration of spontaneous circulation after defibrillation shocks only (without need for vasoactive or inotropic drug administration), and neurologically intact survival (overall performance category (OPC) 1 or 2) were study end-points.


RESULTS
One hundred and ninety-three patients presented in VF. Of these, 80 (41%) were discharged neurologically intact. Of the 159 VF patients whose arrest was bystander-witnessed 73 (46%) were discharged. Survival from non-VF arrest was very low (5%). Assessment of VF survivors demonstrated a quality of life, adjusted for age, gender, and disease, similar to that of the general population.


CONCLUSIONS
These data demonstrate that a relatively high survival can be obtained in a city of this size and area employing a non-tiered community-wide approach within the emergency medical services (EMS) system.
White
Roger D
RD
Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA. white.roger@mayo.edu
Bunch
T Jared
TJ
Hankins
Daniel G
DG
D022561:Advanced Cardiac Life Support / Q000295:instrumentation / Q000379:methods*; D000368:Aged; D000369:Aged, 80 and over; D018672:Community Health Planning; D004554:Electric Countershock / Q000379:methods*; D004634:Emergency Medical Technicians; D005260:Female; D005390:Fires; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D016495:Police; D016019:Survival Analysis; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000150:complications / Q000628:therapy*