title: Impact of the number of on-scene emergency life-saving technicians and outcomes from out-of-hospital cardiac arrest in Osaka City.
abstract: BACKGROUND
  In Japan, ambulance staffing for cardiac arrest responses consists of a 3-person unit with at least one emergency life-saving technician (ELST). Recently, the number of ELSTs on ambulances has increased since it is believed that this improves the quality of on-scene care leading to better outcomes from out-of-hospital cardiac arrest (OHCA). The objective of this study was to evaluate the association between the number of on-scene ELSTs and OHCA outcome.
  
  
  METHODS
  This was a prospective cohort study of all bystander-witnessed OHCA patients aged ≥ 18 years in Osaka City from January 2005 to December 2007 using on an Utstein-style database. The primary outcome measure was one-month survival with favorable neurological outcome defined as a cerebral performance category ≤ 2. Multivariable logistic regression model were used to assess the contribution of the number of on-scene ELSTs to the outcome after adjusting for confounders.
  
  
  RESULTS
  Of the 2408 bystander-witnessed OHCA patients, one ELST group was present in 639 (26.5%), two ELST were present in 1357 (56.4%), and three ELST group in 412 (17.1%). The three ELST group had a significantly higher rate of one-month survival with favorable neurological outcome compared with the one ELST group (8.0% versus 4.5%, adjusted OR 2.26, 95% CI 1.27-4.04), while the two ELST group did not (5.4% versus 4.5%, adjusted OR 1.34, 95% CI 0.82-2.19).
  
  
  CONCLUSIONS
  Compared with the one on-scene ELST group, the three on-scene ELST group was associated with the improved one-month survival with favorable neurological outcome from OHCA in Osaka City.
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-Oka, Suita City, Osaka 565-0871, Japan. Electronic address: kajihanapu@yahoo.co.jp.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kajino
authors.affiliation: Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, 2-5 Yamada-oka, Suita, Osaka 565-0871, Japan.
authors.forename: Tetsuhisa
authors.initials: T
authors.lastname: Kitamura
authors.affiliation: Kyoto University, Health Services, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Iwami
authors.affiliation: Department of Emergency Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code CD-EM, Portland, OR 97239-3098, USA.
authors.forename: Mohamud
authors.initials: M
authors.lastname: Daya
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
authors.forename: Marcus Eng Hock
authors.initials: ME
authors.lastname: Ong
authors.affiliation: Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Knoecho, Sakyo-ku, Kyoto 606-8501, Japan.
authors.forename: Chika
authors.initials: C
authors.lastname: Nishiyama
authors.affiliation: Department of Trauma and Critical Care Medicine and Burn Centers, Social Insurance Chukyo Hospital, 1-1-10 Sanjyo Minamiku, Nagoya, Aichi 457-8510, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Sakai
authors.affiliation: Kyoto University, Health Services, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan.
authors.forename: Kayo
authors.initials: K
authors.lastname: Tanigawa-Sugihara
authors.affiliation: Osaka Municipal Fire Department, 1-12-54 Kujo minami, Nishi-ku, Osaka 550-8566, Japan.
authors.forename: Sumito
authors.initials: S
authors.lastname: Hayashida
authors.affiliation: Department of Critical Care and Emergency Medicine, Osaka City University Graduate School of Medicine, 1-5-17 Asahimachi, Abeno-ku, Osaka 545-8585, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nishiuchi
authors.affiliation: Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, 1-1-6, Tsukumodai, Suita, Osaka 565-0862, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Department of acute Medicine, Kinki University Faculty of Medicine, 377-2 Ouno higashi Osaka-Sayama, Osaka 589-8511, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hiraide
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-Oka, Suita City, Osaka 565-0871, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimazu
mesh_terms: D000368:Aged; D005260:Female; D057209:Hospital Rapid Response Team / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D011446:Prospective Studies; D016896:Treatment Outcome; D014505:Urban Population
keywords: Advanced life support; Cardiopulmonary resuscitation; Emergency life-saving technicians; Emergency medical services; Out-of-hospital cardiac arrest