Articles: emergency-medical-services.
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Review Comparative Study
The complexity of comparing different EMS systems--a survey of EMS systems in Europe.
In Europe, emergency medical care has developed since the Middle Ages in each country, even within regions of a country, resulting in a patchwork of definitions, legislations, and systems. As a consequence, emergency medical care was implemented differently according to sociocultural, geographic, political, and religious differences between and within individual European countries. The objective of this survey was to describe the emergency medical services (EMS) systems in place throughout Europe, the type and qualification of the personnel, citizen-CPR knowledge, and experiences with automated external defibrillator programs. ⋯ To describe the EMS system, a uniform nomenclature is required. The Utstein "template" style could be proposed as the guideline to describe individual systems. The European Resuscitation Council could contribute in coordinating and standardizing the various aspects of emergency medical care in Europe, with detailed registration, medical coordination, and medical regulation being the principal working rules.
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Annu Rev Public Health · Jan 1993
ReviewEmergency medical services and sudden cardiac arrest: the "chain of survival" concept.
Early access to the EMS system helps insure early CPR, defibrillation, and advanced care. Early access is easiest to achieve with 911 systems and widespread community education and publicity. It may also be taught during citizen-CPR classes. ⋯ Achievement of such a goal requires the deployment of multiple properly directed programs within an EMS system; each program lends strength to the chain of survival, thereby enhancing successful recovery and long-term survival. What benefits would occur if a majority of EMS systems in the United States could establish cost-effective programs with respectable survival rates? The AHA estimates that full implementation of potential life-saving mechanisms in the community may save 10,000-100,000 lives each year in the US (2). If the maximum survival rate for all nontraumatic cardiac arrests in mature EMS systems is about 20% (33) among the annual 400,000 out-of-hospital cardiac arrests, 80,000 persons would be saved (33).(ABSTRACT TRUNCATED AT 400 WORDS)
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There is no better place to test life-saving resuscitation interventions than in the prehospital setting. Patients rarely survive cardiac arrest if resuscitation techniques have failed before leaving the scene. ⋯ Most important, by reinforcing standardized care, rigidly scrutinized trials improve patient care, regardless of the effect of the study intervention. The success of productive EMS research centers requires routine communication between hospital and EMS administrators and their medical directors, designation of mutually acceptable data collectors who guarantee confidentiality, reciprocal exchange of study data provided as educational seminars to the hospitals, commitments to support the budget requests of an EMS program and appropriate system modifications, inclusion of EMS personnel in study design from the very beginning, prospective education of the medical community and media before protocol implementation, an authoritative grassroots medical director, and a paramedic supervisor system.
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The Utstein style for uniform reporting of data from out-of-hospital cardiac arrest was developed to solve a major problem in resuscitation research. Outcome measures related to cardiac arrest are difficult to evaluate or compare because there have been no uniform definitions or uniform agreements on what data to report. Widespread acceptance of the Utstein style will lead to a better understanding of out-of-hospital cardiac arrest.