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• W1972629547 abstract "The survival rate for patients with prehospital cardiac arrest has improved in some communities with early defibrillation by emergency medical technician-defibrillators (EMT-Ds). In rural areas, previous studies on survival with defibrillation by EMT-Ds have been variable. We conducted an EMT-D study to determine effectiveness in various prehospital settings. Sixty-four ambulance services from communities ranging in size from rural areas to city suburbs participated in our prospective study. EMTs were trained in rhythm recognition and the use of a manual defibrillator during a standardized 20-hour course. Over 18 months, data were collected locally for central analysis. Five hundred sixty-six patients with primary cardiac arrest were included in our study; 36 (6.4%) survived. Retrospective review revealed survival before EMT-D implementation to be 3.6% (P < .02). Three hundred four patients (54%) had an initial rhythm of ventricular fibrillation, with 33 (11%) surviving. The survival rate for EMT-D-witnessed arrest with an initial rhythm of ventricular fibrillation was 42%. Patients with asystole were countershocked in our study; however, there were no survivors from this group. The neurologic status of survivors at time of hospital discharge was normal in 72%. The average response time, defined as time of emergency medical services activation to the time of EMT-D arrival, was 7.3 ± 5.8 and 3.7 ± 2.0 minutes for nonsurvivors and survivors, respectively (P < .002). There were no survivors when the response time was more than eight minutes. Arrest time, defined as time of witnessed arrest to time of first defibrillation, was 12.2 ± 8.3 and 5.6 ± 4.9 minutes for nonsurvivors and survivors, respectively (P ⩽ .001). Patients in rural areas do present with salvageable rhythms. The key to survival is shorter response and arrest times. The survival rate for patients with prehospital cardiac arrest has improved in some communities with early defibrillation by emergency medical technician-defibrillators (EMT-Ds). In rural areas, previous studies on survival with defibrillation by EMT-Ds have been variable. We conducted an EMT-D study to determine effectiveness in various prehospital settings. Sixty-four ambulance services from communities ranging in size from rural areas to city suburbs participated in our prospective study. EMTs were trained in rhythm recognition and the use of a manual defibrillator during a standardized 20-hour course. Over 18 months, data were collected locally for central analysis. Five hundred sixty-six patients with primary cardiac arrest were included in our study; 36 (6.4%) survived. Retrospective review revealed survival before EMT-D implementation to be 3.6% (P < .02). Three hundred four patients (54%) had an initial rhythm of ventricular fibrillation, with 33 (11%) surviving. The survival rate for EMT-D-witnessed arrest with an initial rhythm of ventricular fibrillation was 42%. Patients with asystole were countershocked in our study; however, there were no survivors from this group. The neurologic status of survivors at time of hospital discharge was normal in 72%. The average response time, defined as time of emergency medical services activation to the time of EMT-D arrival, was 7.3 ± 5.8 and 3.7 ± 2.0 minutes for nonsurvivors and survivors, respectively (P < .002). There were no survivors when the response time was more than eight minutes. Arrest time, defined as time of witnessed arrest to time of first defibrillation, was 12.2 ± 8.3 and 5.6 ± 4.9 minutes for nonsurvivors and survivors, respectively (P ⩽ .001). Patients in rural areas do present with salvageable rhythms. The key to survival is shorter response and arrest times." @default.
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• W1972629547 date "1989-08-01" @default.
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• W1972629547 title "EMT-defibrillation: The Wisconsin experience" @default.
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• W1972629547 doi "https://doi.org/10.1016/s0196-0644(89)80200-8" @default.
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