JAMA : the journal of the American Medical Association
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Review
Improving survival from sudden cardiac arrest: the role of the automated external defibrillator.
Sudden cardiac death is a major public health problem in the United States, and improving survival after out-of-hospital cardiac arrest has been the subject of intense study. Early defibrillation has been shown to be critical to improving survival. Use of automated external defibrillators (AEDs) has become an important component of emergency medical systems, and recent advances in AED technology have allowed expansion of AED use to nontraditional first responders and the lay public. ⋯ The AED represents an efficient method of delivering defibrillation to persons experiencing out-of-hospital cardiac arrest and its use by both traditional and nontraditional first responders appears to be safe and effective. The rapidly expanding role of AEDs in traditional emergency medical systems is supported by the literature, and initial studies of public access to defibrillation offer hope that further improvements in survival after sudden cardiac death can be achieved.
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The premise underlying regionalization of trauma care is that larger volumes of trauma patients cared for in fewer institutions will lead to improved outcomes. However, whether a relationship exists between institutional volume and trauma outcomes remains unknown. ⋯ Our results indicate that a strong association exists between trauma center volume and outcomes, with significant improvements in mortality and LOS when volume exceeds 650 cases per year. These benefits are only evident in patients at high risk for adverse outcomes.