Limitation on effectiveness of rapid defibrillation by emergency medical technicians in a rural setting

Part 4: The Automated External Defibrillator : Key Link in the Chain of Survival

“…Early defibrillation is recommended as a standard of care for EMS 28,90,172 except in sparsely populated and remote settings, where the frequency of cardiac arrest is low and rescuer response times are excessively long. [173][174][175] In-Hospital Use of AEDs An approach pioneered by William Kaye and others 30 -34 is now being used by many hospitals: general care nurses are being trained to use AEDs in resuscitation attempts. Hospital records were examined in several hospitals before AED placement to determine the average in-hospital time to first shock.…”

“…[173][174][175] Therefore, every program director must determine how to ensure correct performance of BLS and automated external defibrillation. Principles of adult education suggest that frequent practice of psychomotor skills such as use of an AED in a simulated cardiac arrest offers the best opportunity for skills maintenance.…”

Rural Emergency Medical Services: Patients, Destinations, Times, and Services

“…A serious concern for rural emergency medical services systems is that the low volume of service provision may impair the ability of the transport team to maintain adequate patient care skills (Rutledge, Ricketts, & Bell, 1992). For an example by way of analogy, Omato, Mlinek, and Craren (1984), in reference to studies of the benefits of paramedic treatment of cardiac patients in Seattle, WA, note that in smaller cities, paramedics had the opportunity to perform prehospital defibrillation only once every six weeks, while those in rural areas would have that opportunity only once every six years. Gallehr and Vukou (1993) conclude that the low volume of defibrillation in rural areas is associated with lower rates of survival.…”

Bedeutung der Erstdefibrillation durch Rettungsassistenten

“…Die schnellstmögliche Defibrillation ist bei Patienten mit außerklinischem Kreislaufstillstand und Kammerflimmern oder pulsloser Tachykardie als zugrundeliegender Rhythmusstörung eine lebensrettende ärztliche Maßnahme, deren Stellenwert unbestritten ist (1,7,9,14,17,23,25,27,28,30). Um die Zeitspanne vom Kreislaufstillstand bis zur ersten Defibrillation zuverkürzen.…”