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Role of ambulance response times in the survival of patients with out-of-hospital cardiac arrest
  1. Colin O'Keeffe1,
  2. Jon Nicholl1,
  3. Janette Turner1,
  4. Steve Goodacre2
  1. 1Medical Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
  2. 2Emergency Department, Northern General Hospital, Sheffield, UK
  1. Correspondence to Colin O'Keeffe, Medical Care Research Unit, School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield S1 4DA, UK; c.okeeffe{at}sheffield.ac.uk

Abstract

Objectives To evaluate the role of ambulance response times in improving survival for out-of-hospital cardiac arrest (OHCA).

Methods OHCAs were identified by sampling consecutive life-threatening category A emergency ambulance calls on an annual basis for the 5 years 1996/7–2000/1 from four ambulance services in England. From these, all calls where an ambulance arrived at the scene and treated or transported a patient were included in the study. These cohorts of patients were followed up to discharge from hospital.

Results Overall, 30 (2.6%) of the 1161 patients with cardiac arrest survived to hospital discharge. If the patient arrested while the paramedics were on scene, survival to hospital discharge was 14%. The most important predictive factors for survival were response time, initial presenting heart rhythm in ventricular fibrillation and whether the arrest was witnessed. The estimated effect of a 1 min reduction in response time was to improve the odds of survival by 24% (95% CI 4% to 48%). The costs of reducing response times across the board by 1 min at the time of this study were estimated at around £54 million.

Conclusions The arrival of a crew prior to OHCA means that the chance of surviving the arrest increases sevenfold. Overall it is possible that rapid response to patients in immediate risk of arrest may be at least as beneficial as rapid response to those who have arrested. Concentrating resources on reducing response times across the board to improve survival for those patients already in arrest is unlikely to be a cost-effective option to the UK National Health Service.

  • Heart arrest
  • ambulances
  • emergency medical services
  • cardiac care
  • emergency ambulance systems
  • nursing
  • pre-hospital
  • Accepted 14 June 2010

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Footnotes

  • Funding The study was funded by the Department of Health, and the MCRU is supported by the Department of Health. However, the views expressed are those of the authors alone.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the 24 local research ethics committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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