Prehospital Defibrillation Performed by Emergency Medical Technicians in Rural Communities

Abstract

Survival after out-of-hospital cardiac arrest is poor in communities served only by basic ambulance services, but conventional advanced prehospital care is not an option for most rural communities. Ambulance technicians in 18 small communities (average population, 10,400) were trained to recognize and defibrillate ventricular fibrillation. Neither endotracheal intubation nor medication was used. Twelve additional communities of similar size where such early defibrillation was not attempted provided control data. In the communities where early defibrillation was available, 12 of 64 patients (19 per cent) who were found in ventricular fibrillation were resuscitated and discharged alive from the hospital; this was true of only 1 of 31 such patients (3 per cent) in the control communities, where only basic life support was available (P less than 0.05). Ten (83 per cent) of the long-term survivors received electrical shocks administered solely by the technicians. Early defibrillation by minimally trained ambulance technicians is an effective approach to emergency cardiac care in rural communities.

Myocardial perfusion pressure: A predictor of 24-hour survival during prolonged cardiac arrest in dogs

“…The importance of myocardial perfusion pressure in producing successful long-term survival is remarkable considering the many factors that influence 24-h survival post-cardiac arrest: the time before the initiation of CPR after cardiac arrest [17], time between the initiation of CPR and the arrival of definitive cardiac defibrillation [18,19], total resuscitation time [20], hemodynamic status post-resuscitation [21], CPR trauma [22] and the clinical status prior to cardiac arrest [21].…”

Emergency Medical Services and Sudden Cardiac Arrest: The

“…In suburban communities in King County, Washington, for example, the survival rate for patients in VF increased from 7% to 26% (41). Similarly, in communities in Iowa, it increased from 3% to 19% (99). In southeastern Minnesota, the survival rate was 4% without EMT-defibrillation and 17% with such a program (104), whereas in northeastern Minnesota, the survival rate was 2.5% without and 10% with EMT-defibrillation (7).…”

“…Research in the early 1980s demonstrated the ability of personnel less well-trained than paramedics, namely EMTs, to use defibrillators successfully (39,41,99,108). Implementation of early defibrillation programs for other levels of personnel, such as firefighters and minimally trained first responders, spread slowly.…”

Advantage of CPR-first over call-first actions for out-of-hospital cardiac arrests in nonelderly patients and of noncardiac aetiology

“…Current guidelines from the American Heart Association [9] recommend CPR-first BLS only in paediatric arrests of presumed noncardiac aetiology, not characterized by sudden collapse. General recommendation for call-first BLS action after the 2000 Guidelines was based on the recognition that early defibrillation is essential in the treatment of sudden cardiac arrest and the call-first BLS enables early arrival of emergency medical technicians (EMTs) equipped with defibrillator [10][11][12].…”