• Jen-Tang Sun, Wen-Chu Chiang, Ming-Ju Hsieh, Edward Pei-Chuan Huang, Wen-Shuo Yang, Yu-Chun Chien, Yao-Cheng Wang, Bin-Chou Lee, Shyh-Shyong Sim, Kuang-Chao Tsai, Matthew Huei-Ming Ma, and Lee-Wei Chen.
• Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang Ming University, Taipei City, Taiwan.
• Resuscitation. 2018 Jan 1; 122: 48-53.

AimThe effect of the number and level of on-scene emergency medical technicians (EMTs) on the outcomes of patients with out-of-hospital cardiac arrest (OHCA) remains unclear. We aimed to test the association between the number and level of EMTs and the outcomes of patients with OHCA.MethodsWe analysed Utstein-based registry data on OHCA in Taipei from 2011 to 2015. The eligible patients were adults, aged ≥20 years, with non-traumatic OHCA who underwent resuscitation attempts. The exposures were the total number of EMTs or the EMT-Paramedic (EMT-P) ratio >50%. The outcome of interest was survival to discharge.ResultsDuring study period, total 8262 OHCA cases were included, of which 1085 (13.1%) were approached by crews with an EMT-P ratio >50%. While an increase in the number of EMTs on-scene was not associated with better chances of survival (adjusted odds ratio [aOR] 0.98, 95% confidence interval [CI] 0.89-1.08), an EMT-P ratio >50% was significantly associated with improved outcome (aOR 1.36, 95% CI 1.06-1.76). Subgroup analyses showed that EMT-P >50% significantly benefited survival in witnessed OHCA cases with non-shockable rhythm (aOR 1.69, 95% CI 1.01-2.58). Survival was the highest among cases seen by four EMTs with an EMT-P ratio >50% (aOR 2.54, 95% CI 1.43-4.50).ConclusionAn on-scene EMT-P ratio >50% was associated with improved survival to discharge of OHCA cases, especially in those with witnessed, non-shockable rhythm. The presence of four EMTs with an EMT-P ratio >50% at the scene of OHCA was associated with the best outcome.Copyright © 2017 Elsevier B.V. All rights reserved.

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