title: Prevalence of emergency medical service utilisation in patients with out-of-hospital cardiac arrest in Thailand.
abstract: BACKGROUND
  Most patients with out-of-hospital cardiac arrest (OHCA) have grave outcomes. The efficacy of emergency medical services (EMS) may affect outcomes. However, no data exists in Thailand.
  
  
  OBJECTIVE
  To ascertain the prevalence of EMS utilisation in patients with OHCA transferred to Siriraj Hospital and also to elucidate the rates of return of spontaneous circulation (ROSC), hospital admission and survival to hospital discharge.
  
  
  METHODS
  This prospective cohort study was conducted in patients with OHCA at a university hospital in Bangkok, Thailand from May 2011 to February 2013. The data was gathered by interviewing bystanders. Data about the mode of transportation, reasons for EMS usage, response time, ROSC and 30-day mortality were collected. Patients with rigour mortis or livor mortis were excluded. The factors affecting ROSC and survival rate were determined by univariate analysis.
  
  
  RESULTS
  One hundred and fifty-two patients were included. The prevalence of EMS usage was 14.5% (95% CI 9.3 to 21.0). The most common cause of non-usage of EMS was not knowing or forgetting an EMS number (49.2%). The proportion of bystanders having known an EMS number and using EMS was 34%. The ROSC and 30-day survival rates were 53.3% and 10.5%, respectively. Non-cardiac causes and witnessed arrests were associated with ROSC (p<0.05).
  
  
  CONCLUSIONS
  The prevalence of EMS utilisation in OHCA at Siriraj Hospital was very low. This may affect the outcomes of patients with OHCA. Improving the EMS system by publicity to increase public awareness and providing life-support education nationwide may improve outcomes of patients with OHCA in Thailand.
authors.affiliation: Department of Emergency Medicine, Siriraj Hospital, Bangkok, Thailand.
authors.forename: Apichaya
authors.initials: A
authors.lastname: Monsomboon
authors.affiliation: Emergency Unit, Taksin Hospital, Bangkok, Thailand.
authors.forename: Prasit
authors.initials: P
authors.lastname: Chantawatsharakorn
authors.affiliation: Department of Emergency Medicine, Siriraj Hospital, Bangkok, Thailand.
authors.forename: Saovanee
authors.initials: S
authors.lastname: Suksuriyayothin
authors.affiliation: Trauma Unit, Department of Surgery, Siriraj Hospital, Bangkok, Thailand.
authors.forename: Kris
authors.initials: K
authors.lastname: Keorochana
authors.affiliation: Out patient Division, Department of Nursing, Siriraj Hospital, Bangkok, Thailand.
authors.forename: Achara
authors.initials: A
authors.lastname: Mukda
authors.affiliation: Department of Emergency Medicine, Siriraj Hospital, Bangkok, Thailand.
authors.forename: Nattakarn
authors.initials: N
authors.lastname: Prapruetkit
authors.affiliation: Department of Emergency Medicine, Siriraj Hospital, Bangkok, Thailand.
authors.forename: Usapan
authors.initials: U
authors.lastname: Surabenjawong
authors.affiliation: Emergency Unit, Taksin Hospital, Bangkok, Thailand.
authors.forename: Tanyaporn
authors.initials: T
authors.lastname: Nakornchai
authors.affiliation: Department of Emergency Medicine, Siriraj Hospital, Bangkok, Thailand.
authors.forename: Tipa
authors.initials: T
authors.lastname: Chakorn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001775:Blood Circulation / Q000502:physiology; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy; D015995:Prevalence; D011446:Prospective Studies; D012044:Regression Analysis; D018570:Risk Assessment; D016019:Survival Analysis; D013785:Thailand / Q000453:epidemiology
keywords: EMS; OHCA; emergency medical service utilization; out-of-hospital cardiac arrest; prevalence