Dual dispatch early defibrillation in out-of-hospital cardiac arrest in a mixed urban–rural population

Saner, Hugo; Morger, Cyrill; Eser, Prisca; Planta, Martin von

doi:10.1016/j.resuscitation.2013.02.023

Cited by 50 publications

(44 citation statements)

References 24 publications

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“…A positive association between BLS+ALS response and survival in cases of OHCA has been found in other more regional settings, where EMS only has been compared with BLS+ALS response with a second tier of firefighters, police officers, or both . However, there are some important differences.…”

Section: Discussionmentioning

confidence: 84%

“…Dispatch of basic life support (BLS)–trained firefighters and police officers (first responders) equipped with AEDs, in addition to dispatch of advanced life support (ALS)–trained emergency medical services (EMS) personnel, would presumably provide these life‐saving services faster because of proximity. In some prospective cohort studies, this has been associated with improved outcome . However, the impact of simultaneous BLS+ALS response in cases of OHCA on a larger scale remains unclear.…”

mentioning

confidence: 99%

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Dispatch of Firefighters and Police Officers in Out‐of‐Hospital Cardiac Arrest: A Nationwide Prospective Cohort Trial Using Propensity Score Analysis

Hasselqvist‐Ax

Nordberg

Herlitz

et al. 2017

JAHA

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BackgroundDispatch of basic life support–trained first responders equipped with automated external defibrillators in addition to advanced life support–trained emergency medical services personnel in out‐of‐hospital cardiac arrest (OHCA) has, in some minor cohort studies, been associated with improved survival. The aim of this study was to evaluate the association between basic life support plus advanced life support response and survival in OHCA at a national level.Methods and ResultsThis prospective cohort study was conducted from January 1, 2012, to December 31, 2014. People who experienced OHCA in 9 Swedish counties covered by basic life support plus advanced life support response were compared with a propensity‐matched contemporary control group of people who experienced OHCA in 12 counties where only emergency medical services was dispatched, providing advanced life support. Primary outcome was survival to 30 days. The analytic sample consisted of 2786 pairs (n=5572) derived from the total cohort of 7308 complete cases. The median time from emergency call to arrival of emergency medical services or first responder was 9 minutes in the intervention group versus 10 minutes in the controls (P<0.001). The proportion of patients admitted alive to the hospital after resuscitation was 31.4% (875/2786) in the intervention group versus 24.9% (694/2786) in the controls (conditional odds ratio, 1.40; 95% confidence interval, 1.24–1.57). Thirty‐day survival was 9.5% (266/2786) in the intervention group versus 7.7% (214/2786) in the controls (conditional odds ratio, 1.27; 95% confidence interval, 1.05–1.54).ConclusionsIn this nationwide interventional trial, using propensity score matching, dispatch of first responders in addition to emergency medical services in OHCA was associated with a moderate, but significant, increase in 30‐day survival.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02184468.

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Section: Discussionmentioning

confidence: 84%

mentioning

confidence: 99%

Dispatch of Firefighters and Police Officers in Out‐of‐Hospital Cardiac Arrest: A Nationwide Prospective Cohort Trial Using Propensity Score Analysis

Hasselqvist‐Ax

Nordberg

Herlitz

et al. 2017

JAHA

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“…For example, the use of automated-external-defibrillation by BLS firefighters has been shown to increase cardiac arrest survival. 20 Pilot studies have demonstrated the ability of EMT-Basic providers to perform supraglottic airway insertion and intraosseous access at acceptable success rates. 21 …”

Section: Discussionmentioning

confidence: 99%

National Characteristics of Emergency Medical Services in Frontier and Remote Areas

Mueller

Donnelly

Jacobson

et al. 2016

Prehospital Emergency Care

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OBJECTIVES While much is known about EMS care in urban, suburban and rural settings, only limited national data describe EMS care in isolated and sparsely populated frontier regions. We sought to describe the national characteristics and outcomes of EMS care provided in frontier and remote (FAR) areas in the continental United States (US). METHODS We performed a cross-sectional analysis of the 2012 National Emergency Medical Services Information System (NEMSIS) data set, encompassing EMS response data from 40 States. We linked the NEMSIS dataset with Economic Research Service-identified FAR areas, defined as a ZIP Code >60 minutes driving time to an urban center with >50,000 persons. We excluded EMS responses resulting in intercepts, standbys, inter-facility transports, and medical transports. Using odds ratios, t-tests and the Wilcoxon rank-sum test, we compared patient demographics, response characteristics (location type, level of care), clinical impressions and on-scene death between EMS responses in FAR and non-FAR areas. RESULTS There were 15,005,588 EMS responses, including 983,286 (7.0%) in FAR and 14,025,302 (93.0%) in non-FAR areas. FAR and non-FAR EMS events exhibited similar median response 5 [IQR 3–10] vs. 5 [3–8] min), scene (14 [10–20] vs 14 [10–20] min) and transport times (11 [5–24] vs 12 [7–19] min). Air medical (1.51% vs 0.42%; OR 4.15 [95% CI: 4.03–4.27]) and Advanced Life Support care (62.4% vs 57.9%; OR 1.25 [1.24–1.26]) were more common in FAR responses. FAR responses were more likely to be of American Indian or Alaska Native race (3.99% vs 0.70%; OR 5.04, 95% CI: 4.97–5.11). Age, ethnicity, location type, and clinical impressions were similar between FAR and Non-FAR responses. On-scene death was more likely in FAR than non-FAR responses (12.2 vs. 9.6 deaths/1,000 responses; OR 1.28, 95% CI: 1.25–1.30). CONCLUSIONS Approximately 1 in 15 EMS responses in the continental US occur in FAR areas. FAR EMS responses are more likely to involve air medical or ALS care as well as on-scene death. These data highlight the unique characteristics of FAR EMS responses in the continental US.

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“…62 Without ROSC before hospital arrival, survival to hospital discharge is rare. 63 Airway management in the prehospital setting continues to be an important area of investigation, with recent data suggesting that although overall success rates are high, first-attempt failure rates are noted to be higher in patients with cardiac arrest compared with those without cardiac arrest.…”

Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

Out-of-Hospital Cardiac Arrest Resuscitation Systems of Care: A Scientific Statement From the American Heart Association

McCarthy¹,

Carr²,

Sasson³

et al. 2018

Circulation

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ABSTRACT:The American Heart Association previously recommended implementation of cardiac resuscitation systems of care that consist of interconnected community, emergency medical services, and hospital efforts to measure and improve the process of care and outcome for patients with cardiac arrest. In addition, the American Heart Association proposed a national process to develop and implement evidence-based guidelines for cardiac resuscitation systems of care. Significant experience has been gained with implementing these systems, and new evidence has accumulated. This update describes recent advances in the science of cardiac resuscitation systems and evidence of their effectiveness, as well as recent progress in dissemination and implementation throughout the United States. Emphasis is placed on evidence published since the original recommendations (ie, including and since 2010). Cardiac arrest is loss of mechanical activity of the heart confirmed by the absence of signs of circulation.1 Approximately 356 461 people are treated for out-of-hospital cardiac arrest (OHCA) annually in the United States.2 One third of cases occur without any prior recognized heart disease; half occur without any prodromal symptoms.3 Despite robust systems of care for patients with trauma and rapidly evolving systems of care for patients with ST-segment-elevation myocardial infarction (STEMI) and stroke, the majority of communities do not achieve optimal survival after OHCA because of large discrepancies in resuscitation-related processes of care.4-6 As a result, survival to hospital discharge varies significantly both across different regions and by presenting rhythm. 7,8 Survival increases significantly if the OHCA is quickly recognized and responded to with prompt activation of 9-1-1, bystander-initiated cardiopulmonary resuscitation (CPR), bystander and/or basic first responder application of an automated external defibrillator (AED) before arrival of other emergency medical services (EMS) providers on scene, advanced life support, and postresuscitation care. The American Heart Association (AHA) previously recommended implementation of cardiac resuscitation systems of care that consist of interconnected community, EMS, and hospital efforts to measure and improve the process and outcome of care for patients with cardiac arrest.10 Simultaneously, the AHA proposed a national process to develop and implement evidence-based guidelines for the implementation and measurement of such systems. The 2015 AHA guidelines for CPR and emergency cardiovascular care delved deeper into the elements of an effective system of care for both OHCA and in-hospital cardiac arrest.11 This update on OHCA resuscitation systems of care describes recent advances, evidence

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Dual dispatch early defibrillation in out-of-hospital cardiac arrest in a mixed urban–rural population

Cited by 50 publications

References 24 publications

Dispatch of Firefighters and Police Officers in Out‐of‐Hospital Cardiac Arrest: A Nationwide Prospective Cohort Trial Using Propensity Score Analysis

Dispatch of Firefighters and Police Officers in Out‐of‐Hospital Cardiac Arrest: A Nationwide Prospective Cohort Trial Using Propensity Score Analysis

National Characteristics of Emergency Medical Services in Frontier and Remote Areas

Out-of-Hospital Cardiac Arrest Resuscitation Systems of Care: A Scientific Statement From the American Heart Association

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