Advanced training for ambulance crews: implications from 403 consecutive patients with cardiac arrest managed by crews with simple training.

Abstract

Sixty seven ambulance staff in Nottinghamshire completed a simple extended training programme in managing cardiac arrest and using a defibrillator. This enabled around one third of the ambulance emergency shifts to be manned by such a crew, with a defibrillator as part of their standard equipment. Forty four of 403 consecutive patients who suffered cardiac arrest in the community were managed by these crews and survived to leave hospital.The training programme does not include endotracheal intubation, intravenous infusion, or drug administration. The new official advanced training course for ambulance crews, which includes these skills, is inappropriate in its methods and may delay widespread introduction of emergency ambulances equipped with defibrillators.

Integration of ambulance staff trained in cardiopulmonary resuscitation with a medical team providing prehospital coronary care.

“…The median response time from receipt of a collapse call to the arrival of the emergency ambulance at the scene was eight minutes compared with the mobile coronary care unit's median response time of 20 minutes for 100 consecutive calls documented during this study (fig 2). For the 18 cases of ventricular fibrillation the mean response time for the emergency ambulance was eight (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] minutes while the mean response time for the mobile coronary care unit to these patients after they were summoned by the emergency ambulance was 18 (range 6-30) minutes. An additional 78 arrhythmias were documented by the emergency ambulance crews in patients without cardiac arrest (table 2).…”

Paramedics and technicians are equally successful at managing cardiac arrest outside hospital

“…This policy has not, however, been based on objective evidence as to the efficacy of such interventions as compared with simpler, less expensive, and less time consuming approaches. The ability of basic life saving skills and defibrillation alone to achieve good results has been considered 11 12 13. Even in North America the need for full paramedic skills as opposed to ambulance crew using defibrillators alone has been challenged 14 15…”

“…With the passage of time, coarse ventricular fibrillation progressively decreases in amplitude and is associated with a reduction in the probability of successful defibrillation 20. The other electrocardiographic rhythms associated with cardiac arrest—asystole and electromechanical dissociation—are accompanied by dismal outcomes irrespective of treatment given 3 5 7 10 12 18. Furthermore, defibrillation as a treatment will not influence survival in this group 21 22.…”

The limited potential of special ambulance services in the management of cardiac arrest.

“…8 The records of the Nottingham ambulance stations were analysed to identify the proportion of accident and emergency shifts for which a defibrillator and a trained crew were available. The working day of the emergency ambulance service is divided into a variable number of shifts and a variable number of ambulances are available at different times of the day and on different days of the week.…”