IDENTIFICATION OF SELECTED ASPECTS OF THE SOCIAL ORGANIZATION OF EMERGENCY MEDICAL SERVICE PROVIDERS AND AN EVALUATION OF 1978 PRE-HOSPITAL EMERGENCY MEDICAL SERVICES TO MYOCARDIAL INFARCTION VICTIMS IN THE STATE OF MARYLAND.

摘要

The purpose of this study was to determine the effectiveness of Advanced Life Support (ALS) performed by Cardiac Rescue Technicians (CRTs) for victims of Myocardial Infarction. It was hypothesized that mortality rates would be lowest for victims who received ALS, next lowest for persons who received Basic Life Support (BLS), and highest for persons who received no pre-hospital care. The study also evaluated the effects on mortality rates of: percent of population which was white, population density, and per capita income. Another purpose of the study was to describe the professionalism of CRTs and to relate this to outcome of care. Forty-eight hours of participant observation were carried out in two jurisdictions. Four hundred ninety-two CRTs completed questionnaires. All available state ambulance reports, hospital discharge data, and coroners data were reviewed producing a data set of 8,058 patients. Results were: persons who received ALS did not fare significantly better than did persons in the other two categories; deleting coroners data, however, produced only nominal differences among the groups. A ranking of jurisdictions on the variables listed, produced a strongly positive correlation between low income and low mortality rates and moderate correlations between each of professionalism scores and percent of population which was white, with mortality rates; and, there was no significant correlation between high professionalism scores and outcome of care. What was suggested was that uncontrolled variables (e.g., previous heart pathology, type of treatment received in emergency room, and types of patients included in this study) may have prevented a comparison of truly similar groups. Response time to victims and education of the public to call early for help, may produce more life-saving than can the availability of emergency services alone.