• Matthias Fischer, Johannes Kamp, Luis Garcia-Castrillo Riesgo, Iain Robertson-Steel, Jerry Overton, Alexandra Ziemann, Thomas Krafft, and EED Group.
• Department of Anaesthesia and Intensive Care, Klinik am Eichert, Eichertstraße 3, 73035 Goeppingen, Germany. matthias.fischer@kae.de
• Resuscitation. 2011 Mar 1;82(3):285-93.

AimThe aim of this prospective study was the comparison of four emergency medical service (EMS) systems-emergency physician (EP) and paramedic (PM) based-and the impact of advanced live support (ALS) on patients status in preclinical care.MethodsThe EMS systems of Bonn (GER, EP), Cantabria (ESP, EP), Coventry (UK, PM) and Richmond (US, PM) were analysed in relation to quality of structure, process and performance when first diagnosis on scene was cardiac arrest (OHCA), chest pain or dyspnoea. Data were collected prospectively between 01.01.2001 and 31.12.2004 for at least 12 month.ResultsOver all 6277 patients were included in this study. The rate of drug therapy was highest in the EP-based systems Bonn and Cantabria. Pain relief was more effective in Bonn in patients with severe chest pain. In the group of patients with chest pain and tachycardia ≥ 120 beats/min, the heart rate was reduced most effective by the EP-systems. In patients with dyspnoea and S(p)O(2) <90% the improvement of oxygen saturation was most effective in Bonn and Richmond. After OHCA significant more patients reached the hospital alive in EMS systems with EPs than in the paramedic staffed (Bonn = 35.6%, Cantabria = 30.1%; Coventry = 11.9%, Richmond = 9.2%). The introduction of a Load Distributing Band chest compression device in Richmond improved admittance rate after OHCA (21.7%) but did not reach the survival rate of the Bonn EMS system.ConclusionsHigher qualification and greater training and experience of ALS unit personnel increased survival after OHCA and improved patient's status with cardiac chest pain and respiratory failure.Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

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