The impact of first responder turnout and curb-to-care intervals on survival from out-of-hospital cardiac arrest.
Patients with out-of-hospital cardiac arrest (OHCA) more likely survive when emergency medical services (EMS) arrive quickly. We studied time response elements in OHCA with attention to EMS intervals before wheels roll and after wheels stop to understand their contribution to total time response and clinical outcome.



We analyzed EMS responses to OHCA from 2009-2014 in an urban, fire department based system. The Call-to-Care Interval, from call receipt to hands-on EMS care, was comprised of four time intervals: 1) call received to EMS notification (Activation), 2) EMS notification to vehicle wheels rolling (Turnout), 3) wheels rolling to arrival at scene (Travel), and 4) arrival at scene to hands-on EMS care (Curb-to-Care). We created a new time interval (On-Feet) comprised of the turnout and curb-to-care intervals. Using logistic regression, we evaluated whether the total EMS response interval and discrete time intervals were related to survival to discharge.



Of 1,831 cases, 1,806 (98.6%) had complete information. The mean lengths for the intervals were 7.2±3.6min. (call-to-care), 58±39s (activation), 63±29s (turnout), 2.5±1.3min (travel), 2.4±1.6min (curb-to-care), and 3.5±1.7min (on-feet). After adjustment, "On Feet" interval was associated with OHCA survival (OR=0.91 [95% CI=0.83-1.00] for each additional minute).



Turnout and curb-to-care intervals were half of the total response interval in our EMS system. Measurement should incorporate these two intervals to accurately characterize and possibly reduce the professional response interval.
University of Washington School of Medicine, United States. Electronic address: deruyter@uw.edu.
Nicolaas P
NP
DeRuyter
Public Health Seattle and King County, United States.
Sofia
S
Husain
Division of Emergency Medicine, University of Washington, United States.
Lihua
L
Yin
Division of Emergency Medicine, University of Washington, United States.
Michele
M
Olsufka
Division of Emergency Medicine, University of Washington, United States.
Andrew M
AM
McCoy
Department of Health Services, University of Washington, United States.
Charles
C
Maynard
Division of Cardiology, University of Washington, United States.
Leonard A
LA
Cobb
Public Health Seattle and King County, United States; Department of Medicine, University of Washington, United States.
Thomas D
TD
Rea
Division of Emergency Medicine, University of Washington, United States; Seattle Fire Department, United States.
Michael R
MR
Sayre
D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality; D004632:Emergency Medical Services / Q000379:methods / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D016019:Survival Analysis; D013997:Time Factors; D061665:Time-to-Treatment / Q000592:standards*; D014481:United States / Q000453:epidemiology
Call-to-care interval; Curb-to-care interval; EMS; OHCA; Response intervals; Turnout interval