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

Abstract

For six months a survey was made of all the patients in the Nottingham District Health Authority who died or who were brought to hospital after a cardiac arrest outside hospital. During this period just under half of the emergency ambulance shifts were covered by specially trained crews with defibrillators. During the study period the ICD coding of death certificates indicated that 894 (25%) of the 3575 deaths were due to ischaemic heart disease. During this period the ambulance service received 17 749 emergency calls, which included 445 patients who had cardiac arrests outside hospital. One hundred and forty seven of these patients were carried by ambulances equipped with defibrillators and resuscitation was attempted in 83. Seven patients survived to leave hospital.The special ambulance service was cost effective-a simple calculation suggests that the cost per life saved was approximately £2600, but it seems unlikely that special ambulance services will materially affect community fatality rates from ischaemic heart disease.

Prognostic implications of ventricular fibrillation in acute myocardial infarction: new strategies required for further mortality reduction

“…The widespread introduction of defibrillators into the community and paramedic training in Seattle produced an early decline in mortality,18 19 but subsequently survival rates to hospital discharge have not improved. Evidence from the more recent introduction of paramedic training in this country suggests that the mortality from out of hospital ventricular fibrillation can be reduced,20 but this reduction is likely to be limited,21 and more immediate defibrillation would probably have a much more important impact. This requires patients to recognise symptoms and seek medical help promptly 22…”

Prehospital resuscitation and sudden cardiac death

“…The costs of adding defibrillation to already existing ambulance services has been shown to be more cost effective. Rowley and co‐workers in Nottinghamshire 9 estimated the cost per life saved was £2,600 following the introduction of defibrillators onto the ambulance service, with seven patients surviving to hospital discharge from 147 cases. These figures more accurately reflect the Australasian experience.…”