Effects of Prehospital Care on Outcome in Patients With Cardiac Illness☆,☆☆,★,★★
Section snippets
INTRODUCTION
Prehospital advanced life support (ALS) care is available in some Canadian communities but is not yet generally available across the country. Prehospital ALS care is assumed to provide a greater benefit than basic care, but little evidence supports this assumption.1, 2 The expansion of prehospital ALS services in North America has slowed, partly because proof of benefit is lacking.3
Early defibrillation is one ALS intervention that has been proved effective.4, 5, 6, 7, 8 The development of
MATERIALS AND METHODS
The H-W region covers 1,136 km2 (438 square miles) and has approximately 445,000 inhabitants. The H-W EMS system is activated by dialing 911. A 911 call requesting medical assistance is received by the H-W police operator and forwarded to the Central Ambulance Communication Centre (CACC). CACC handles 45,000 calls per year, of which 13,000 are dispatched as code 4, the highest emergency priority. More than 25,000 of the 45,000 calls are scheduled calls and routine transfers. All scheduled calls
RESULTS
We screened 8,720 patients and found 3,083 patients (35%) who were eligible for our study. Seventeen patients were then excluded because of incomplete data. In analyzing results, we separated eligible patients into two groups according to the skills of the ambulance crews that treated and transported them. Patients were treated and transported by (1) two EMT-Ps or by one EMT-P and one EMT-D; or (2) by two EMT-Ds. Patients in the first group received ALS care, whereas patients in the second
DISCUSSION
Paramedics have been introduced to more and more communities in Canada and the United States over the last two decades. In many parts of North America, prehospital ALS is considered the standard of care.30, 31 Communities that do not have ALS-trained prehospital care providers often consider themselves underserved. However, little scientific evidence exists to show that prehospital ALS care affects patient outcome.1, 2, 3
If ALS care provides a significant benefit to the prehospital patient, we
CONCLUSION
The results of our study suggest that prehospital ALS care does not affect the occurrence of MI, LOS, or mortality in patients who present to the EMS system with cardiac illness in a community where transport times average less than 10 minutes. In communities where prehospital ALS care is available, delay at scene to treat possible symptoms of acute MI should be minimized.
Acknowledgements
The authors thank all the EMTs in the H-W area for their efforts in recording data during this study; John Lane for his contributions to the preparation of the grant proposal; Brent Browett, clinical coordinator, for his support and assistance throughout the study; Wendy Fisher and David Tysdale for their commitment to quality data collection and data entry; and Kang-In (David) Lee for his assistance with the data analysis. They also acknowledge the help they received from the medical records
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2001, Prehospital Emergency CareCritical care transport: Outcome evaluation after interfacility transfer and hospitalization
1999, Annals of Emergency MedicineEmergency medical service agency definitions of response intervals
1999, Annals of Emergency MedicineParamedic decisions with placement of out-of-hospital intravenous lines
1999, American Journal of Emergency MedicineDoes advanced life support provide benefits to patients?: A literature review
2005, Prehospital and Disaster MedicineAdvanced Life Support for Out-of-Hospital Chest Pain: The OPALS Study<sup>†</sup>
2022, Prehospital Emergency Care
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From the Chedoke-McMaster Hospitals, Hamilton Paramedic Base Hospital Program*; Division of Emergency Medicine‡, and Department of Clinical Epidemiology and Biostatistics§, McMaster University, Hamilton, Ontario; and Institute for Work and Health, Toronto, Ontario, Canada.∥
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Funded by the Ontario Ministry of Health, Emergency Health Services Research Initiatives Fund Grant 01788N
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Reprint no. 47/1/66179
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Reprints not available from the authors.