First Responder Defibrillation in an Urban EMS System. Final Report and ExecutiveSummary

摘要

Provision of rapid defibrillation by firefighter equipped with automated externaldefibrillators has been strongly endorsed by the American Heart Association, but the impact of this strategy in urban communities staffed by paramedics has not been subjected to a controlled clinical trial. Forty engine companies of the Memphis Fire Department were trained to promptly apply an automatic external defibrillator in cases of out-of-hospital cardiac arrest. Half of these companies were initially randomized to use their AED (Heartstart 2000 Laerdal Medical Corp, Armonk, NY) and the other half were instructed to provide cardiopulmonary resuscitation (CPR) until paramedic arrival. Every 75 days thereafter, group roles were reversed. All patients who were successfully resuscitated were followed to hospital discharge. Over a 39 month study interval, 879 patients were treated by a project engine company, 431 of whom (49 percent) were found in ventricular fibrillation. Bystander CPR was started in only 12 percent of cases. Although first responding firefighters reached the scene a mean of 2.5 minutes faster than simultaneously dispatched paramedics, patients in ventricular fibrillation or ventricular tachycardia treated by an AED equipped engine company were not significantly more likely to be resuscitated (32 percent versus 34 percent), survive to hospital admission (31 percent versus 29 percent) or survive to hospital discharge (14 percent versus 10 percent) than CPR controls. Neurologic outcomes were also similar in the two treatment groups.