American journal of public health
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Comparative Study
Paramedic programs and out-of-hospital cardiac arrest: II. Impact on community mortality.
Out-of-hospital cardiac arrest was studied in suburban King County, Washington in an attempt to determine the impact of paramedic services on community cardiac mortality. A portion of the study area received paramedic services and the remainder received basic emergency medical technician (EMT) services. A surveillance system identified all prehospital cardiac arrest incidents. ⋯ Proportionately more lives of persons with cardiac arrest were saved in the paramedic area than in the MET area. During this 17 month period, the reduction in community cardiac mortality was 8.4 per cent in the paramedic area and 1.3 per cent in the EMT area. These findings suggest that paramedic services have a small but measurable effect on community cardiac mortality.
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As part of an evaluation of whether the addition of paramedic services can reduce mortality from out-of-hospital cardiac arrest compared to previously existing emergency medical technician (EMT) services, factors associated with successful resuscitation were studied. A surveillance system was established to identify cardiac arrest patients receiving emergency care and to collect pertinent information associated with the resuscitation. Outcomes (death, admission, and discharge) were compared in two areas with different types of prehospital emergency care (basic emergency medical technician services vs. paramedic services). ⋯ Using multivariate analysis, rapid time to initiation of CPA and rapid time to definitive care were most predictive of admission and discharge. Age was also weakly predictive of discharge. These findings suggest that if reduction in mortality is to be maximized, cardiac arrest patients must have CPR initiated within four minutes and definitive care provided within ten minutes.