We compared the effect of rapid defibrillation by emergency medical technicians (EMTs) combined with paramedic care with that of standard EMT and paramedic care on survival from 540 witnessed episodes of out-of-hospital cardiac arrest caused by ventricular fibrillation. More than 400 EMTs were trained in the recognition of ventricular fibrillation and operation of a defibrillator. For a portion of the three-year study, emergency care for 179 cases was randomized between the two types of services. For randomized cases, when the time interval between EMT and paramedic arrival was greater than four minutes there was significantly improved survival with EMT defibrillation and paramedic care (42%) compared with basic EMT and paramedic care (19%). Similar findings occurred when all cases were considered (38% v 18%). Defibrillation by EMTs combined with paramedic services can enhance survival from ventricular fibrillation, compared with basic EMT and paramedic care. (JAMA1984;251:1723-1726)
Richard E. Kerber M.D., Richard E. Kerber M.D. American Heart Association, National Center, Dallas, Texas Endorsed by the Board of Trustees of the American College of CardiologySearch for more papers by this authorLance B. Becker M.D., Lance B. Becker M.D. American Heart Association, National Center, Dallas, Texas Endorsed by the Board of Trustees of the American College of CardiologySearch for more papers by this authorJoseph D. Bourland E.E., Ph.D., Joseph D. Bourland E.E., Ph.D. American Heart Association, National Center, Dallas, Texas Endorsed by the Board of Trustees of the American College of CardiologySearch for more papers by this authorRichard O. Cummins M.D., M.P.H., Richard O. Cummins M.D., M.P.H. American Heart Association, National Center, Dallas, Texas Endorsed by the Board of Trustees of the American College of CardiologySearch for more papers by this authorAlfred P. Hallstrom Ph.D., Alfred P. Hallstrom Ph.D. American Heart Association, National Center, Dallas, Texas Endorsed by the Board of Trustees of the American College of CardiologySearch for more papers by this authorMary B. Michos R.N., Mary B. Michos R.N. American Heart Association, National Center, Dallas, Texas Endorsed by the Board of Trustees of the American College of CardiologySearch for more papers by this authorGraham Nichol M.D., Graham Nichol M.D. American Heart Association, National Center, Dallas, Texas Endorsed by the Board of Trustees of the American College of CardiologySearch for more papers by this authorJoseph P. Ornato M.D., Joseph P. Ornato M.D. American Heart Association, National Center, Dallas, Texas Endorsed by the Board of Trustees of the American College of CardiologySearch for more papers by this authorWilliam H. Thies Ph.D., William H. Thies Ph.D. American Heart Association, National Center, Dallas, Texas Endorsed by the Board of Trustees of the American College of CardiologySearch for more papers by this authorRoger D. White M.D., Roger D. White M.D. American Heart Association, National Center, Dallas, Texas Endorsed by the Board of Trustees of the American College of CardiologySearch for more papers by this authorBram D. Zuckerman M.D., Bram D. Zuckerman M.D. American Heart Association, National Center, Dallas, Texas Endorsed by the Board of Trustees of the American College of CardiologySearch for more papers by this author
We interviewed 308 survivors of out-of-hospital cardiac arrest and matched controls who had suffered a myocardial infarction. The Sickness Impact Profile (SIP) scores of controls were somewhat lower (better) than those of cases, but responses of cases and controls to additional questions about stair climbing, irritability and mood were virtually identical. Half as many (18 per cent) controls as cases (38 per cent) reported poorer memory function; nevertheless, 63 per cent of cases and 79 per cent of controls who had been working outside the home at the time of the event were employed at the time of the interview.
The need to evaluate expensive, dramatic, and politically sensitive emergency medical services programs when classical controlled trials are neither ethically nor practically possible can be satisfied by quasi-experimental designs. The sequential implemen tation of paramedic services in several suburban areas provided a natural experimental situation in which to evaluate whether addition of the service could significantly alter the outcome of cardiac emergencies compared to the basic emergency medical technician program previously available. Before measurements and after measurements were made in a study area plus two control areas: one with paramedic services in both time periods and the other with emergency medical technican service throughout. Preliminary results indicate successful resuscitation increased from 20% to 32% (p < .05) and discharge from the hospital went from 8% to 18% (p<.01). The implications for program and policy decisions are noted. Development of studies that evolved from this work are outlined
