title: Out-of-hospital cardiac arrests occurring in primary health care facilities in Singapore.
abstract: OBJECTIVE
  To study out-of-hospital cardiac arrests (OHCA) occurring in primary healthcare facilities (HCF) in Singapore and to compare these with arrests occurring in the community.
  
  
  METHODS
  This prospective observational study was part of the Cardiac Arrest and Resuscitation Epidemiology (CARE) project. Included were all patients with OHCA occurring in HCF. Patient characteristics, cardiac arrest circumstances, EMS response and outcomes were recorded according to the Utstein style.
  
  
  RESULTS
  From 1 October 2001 to 14 October 2004, the data from 2428 subjects were received of which 138 patients were OHCA occurring in HCF. This is an incidence of 1.12/100,000 population per year and constituted 6.0% of all OHCA. Arrest occurring in HCF were more likely to be witnessed (p<0.01), or have bystander CPR (p<0.01). The HCF group was also more likely to receive CPR with both compression and ventilation (p<0.01) and have a non-trauma cause of arrest (p=0.03). HCF arrests also had a shorter collapse to call (EMS number) than the non-HCF group (HCF 1.54min versus non-HCF 5.36min, p=0.01). However, no HCF patient received defibrillation prior to EMS arrival. HCF patients were more likely to have return of spontaneous circulation at any time (p=0.05), survival to hospital admission (p<0.01) and survival to discharge (p<0.01) compared to non-HCF patients.
  
  
  CONCLUSIONS
  This study suggests that primary health care providers do have an important role locally in managing out-of-hospital cardiac arrest. We propose an initiative to encourage early defibrillation by primary health care providers.
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore. marcus.omg.e.h@sgh.com.sg
authors.forename: Marcus Eng Hock
authors.initials: ME
authors.lastname: Ong
authors.forename: Xiuyuan
authors.initials: X
authors.lastname: Yan
authors.forename: Gilbert
authors.initials: G
authors.lastname: Lau
authors.forename: Eng Hoe
authors.initials: EH
authors.lastname: Tan
authors.forename: Anushia
authors.initials: A
authors.lastname: Panchalingham
authors.forename: Benjamin Sieu-Hon
authors.initials: BS
authors.lastname: Leong
authors.forename: Victor Yeok Kein
authors.initials: VY
authors.lastname: Ong
authors.forename: Ling
authors.initials: L
authors.lastname: Tiah
authors.forename: Susan
authors.initials: S
authors.lastname: Yap
authors.forename: Swee Han
authors.initials: SH
authors.lastname: Lim
authors.forename: Anantharaman
authors.initials: A
authors.lastname: Venkataraman
mesh_terms: D000552:Ambulances; D016887:Cardiopulmonary Resuscitation; D016009:Chi-Square Distribution; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011320:Primary Health Care; D011446:Prospective Studies; D012846:Singapore / Q000453:epidemiology