• W E Kriegsman and S E Mace.
• City of Ketchikan Fire Department, Alaska, USA.
• Prehosp Emerg Care. 1998 Oct 1;2(4):274-9.

ObjectiveTo determine whether paramedics influence the outcome of cardiac arrest patients in a rural area.MethodsRetrospective analysis of cardiorespiratory arrest patients in rural southeast Alaska from 1987 to 1996.ResultsParamedics treated 37 patients and advanced life support emergency medical technicians (EMT-IIIs) treated 34 patients. Demographics/CPR variables of the two groups were similar. Return of spontaneous circulation (ROSC) was 46% (17/37) for the paramedic-treated patients and 18% (6/34) for the EMT-III-treated patients (p = 0.01). Intensive care unit (ICU) admission was 38% (14/37) for the paramedic-treated patients and 15% (5/34) for the EMT-III-treated patients (p < 0.03). Discharge from the hospital neurologically intact was 20% (7/35) for the paramedic-treated patients and 9% (3/34) for the EMT-III-treated patients (p = NS). Two patients in the paramedic-treated group had ROSC and survived in the local hospital ICU for several days before being transferred to a tertiary care hospital in another state and were lost to follow-up for the discharge-from-hospital-neurologically-intact category but were included in the ROSC and ICU admission analysis.ConclusionIn this rural setting, a paramedic on the scene significantly improved the ROSC (paramedics = 46% vs 18% for EMT-III, p = 0.01) and survival to ICU admission (38% vs 15%, p = 0.03). The presence of a paramedic on the scene increased survival to hospital discharge neurologically intact (20% vs 9%), although this was not statistically significant.

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