title: Chest compression fraction in ambulance while transporting patients with out-of-hospital cardiac arrest to the hospital in rural Taiwan.
abstract: BACKGROUND
  Maintaining the standard two-handed chest compression is difficult in high-speed ambulances in rural areas.
  
  
  METHODS
  A retrospective, video-based, observational study was conducted from June to September 2013 in Nantou, a rural county of central Taiwan, to evaluate the chest compression fraction in an ambulance carriage during the travel from the scene to the hospital. The chest compression fraction was calculated as the chest compression time period divided by the ambulance travelling time period; the one-handed and two-handed chest compression fractions were also calculated.
  
  
  RESULTS
  During the 4-month study period, a total of 102 videos that were recorded in an ambulance carriage were reviewed, including 97 cases of manual chest compressions. When there was only one emergency medical technician (EMT) in the carriage, the combined chest compression fraction was 50.6±20.7%; when there were two EMTs, the fraction was 58.3±16.0% and the fraction was 58.3±21.0% in a three-EMT scenario (p=0.221). Moreover, in the carriage, EMTs usually performed one-handed chest compressions.
  
  
  CONCLUSIONS
  The chest compression fraction was low for patients with out-of-hospital cardiac arrest in a moving ambulance, irrespective of the number of providers. Reasons for this observation, as well as the effectiveness of the one-handed chest compression require further evaluation.
authors.affiliation: Department of Emergency Medicine, Nantou Hospital, Nantou, Taiwan.|Department of Health Care Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan.
authors.forename: Shih-Chang
authors.initials: SC
authors.lastname: Hung
authors.affiliation: Department of Emergency Medicine, Nantou Hospital, Nantou, Taiwan.|National Environmental Health Research Center, National Health Research Institutes, Miaoli, Taiwan.
authors.forename: Ching-Yi
authors.initials: CY
authors.lastname: Mou
authors.affiliation: Department of Health Care Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan.|Department of Internal Medicine, Nantou Hospital, Nantou, Taiwan.
authors.forename: Hung-Chang
authors.initials: HC
authors.lastname: Hung
authors.affiliation: Department of Internal Medicine, Nantou Hospital, Nantou, Taiwan.
authors.forename: I-Hsiang
authors.initials: IH
authors.lastname: Lin
authors.affiliation: College of Medicine, China Medical University, Taichung, Taiwan.|Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Shih-Wei
authors.initials: SW
authors.lastname: Lai
authors.affiliation: Fire Department of Nantou County, Second Corps, Puli Branch, Nantou, Taiwan.
authors.forename: Jack YinChun
authors.initials: JY
authors.lastname: Huang
mesh_terms: D000552:Ambulances; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000592:standards*; D004634:Emergency Medical Technicians / Q000592:standards*; D006801:Humans; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D012189:Retrospective Studies; D013624:Taiwan; D013997:Time Factors; D000078329:Workforce
keywords: chain of survival; emergency ambulance systems; pre-hospital