The American journal of emergency medicine
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Columbus, Ohio added prehospital coronary care to its Emergency Medical Services System (EMS) in 1969. The EMS System, which is citizen activated and tax supported (+5 per citizen per year), currently sees 32,000 patients a year in a city with a population of 650,000. Ninety-six per cent of the population is aware of the system. ⋯ Lives are also saved by treatment of other life-threatening prehospital complications. In Columbus, the estimated annual mortality from ischemic heart disease is only 19%. The EMS System contributes significantly to this low figure.
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Sudden cardiac death accounts for two thirds of death due to coronary artery disease. Advanced cardiac life support can now be brought directly to patients with out-of-hospital cardiac arrest, and in this country, as many as 30% of such patients can be discharged from the hospital annually. ⋯ Resuscitation-related predictors of long-term survival are a short time collapse to cardiopulmonary resuscitation (CPR), and a short time from collapse to CPR combined with a short time to provision of definitive care. The majority of cardiac arrest survivors are able to resume previous levels of function.
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Out-of-hospital cardiac arrests constitute 350,000 cases yearly in the United States and 60,000 in the United Kingdom. Prompt resuscitation (CPR) by lay persons and fast defibrillation by paramedics have had epidemiologic consequences on both sides of the Atlantic. In Seattle there are 20.6 and in Brighton 10.0 long-term life-saves yearly per 100,000 persons. ⋯ Diagnostic procedures like electro-provocation identify high-risk patients. Changes of behavior and diet, new drugs, new operations, and external and implantable automated devices reduce sudden deaths. In the future, automated defibrillation by first responders and trained lay persons (including members of families of high-risk patients) should increase the number of early survivors who become candidates for long-term therapy with drugs, operations, and devices.