Oct 13, 1993

Impact of first-responder defibrillation in an urban emergency medical services system

JAMA : the Journal of the American Medical Association
A L KellermannP Dobyns


To evaluate the impact of adding first-responder defibrillation by fire-fighters to an existing advanced life-support emergency medical services system. Nonrandomized, controlled clinical trial with periodic crossover. Memphis, Tenn, a city of 610,337 people, which is served by a fire department-based emergency medical services system. All city ambulances provide advanced life support. Adult victims of out-of-hospital cardiac arrest due to heart disease. Twenty of 40 participating engine companies were equipped with an automated external defibrillator and ordered to apply it immediately in all cases of cardiac arrest. The other 20 companies were ordered to start cardiopulmonary resuscitation (CPR) immediately and wait for paramedics to arrive. Every 75 days, group roles were reversed. Care otherwise proceeded according to 1986 American Heart Association guidelines. Return of spontaneous circulation in the field, survival to hospital admission, survival to hospital discharge, and neurological status at discharge. During the 39-month study interval, 879 patients were treated by a project engine company. Four hundred thirty-one (49%) of these were found in ventricular fibrillation. Bystander CPR was started in only 12% of cases. O...Continue Reading

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Mentioned in this Paper

Ventricular Fibrillation
Population Program Specialists
Emergency Care
Basic Cardiac Life Support
Outcome and Process Assessment (Health Care)
Tachycardia, Ventricular
Electroversion Therapy
Heart Diseases

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