• emergency ambulance systems
• prehospital care

In their EMJ paper, Derkenne and colleagues present an interesting study on the accuracy and speed of Emergency Physicians in assessing whether a defibrillator trace is shockable or non-shockable.1 The study used a web-based application (https://simul-shock.firebaseapp.com) to present 60 ECG rhythms from real-life out-of-hospital cardiac arrest (OHCA) cases to pre-hospital emergency physicians and compared their responses with a gold standard interpretation defined by three experts. In total, 190 complete responses were included in the analysis which identified a median sensitivity of 0.91 [IQR 0.81–1.00] to deliver a shock for shockable rhythms and specificity of 0.91 [0.80–0.96] to withhold a shock for a non-shockable rhythm. Sensitivity was highest where the shockable rhythm was ventricular tachycardia or coarse ventricular fibrillation (VF) (1.0 [1.0–1.0]) but significantly lower for fine VF (0.6 [0.2–1.0]). We would recommend that you test yourself on the simulator app to see how you would have scored!

This study raises a valuable question: whether pre-hospital practitioners should use an automated external defibrillator (AED) or use manual mode for the interpretation of rhythm and need for shock delivery in patients with OHCA. Emergency Physicians (EPs) manage patients conveyed to the Emergency Department in cardiac arrest on a daily–weekly basis and defibrillators are used in manual mode—the same skills are likely to be transferrable to the pre-hospital setting with a smaller team. However, in many settings. the majority of OHCA management is provided by paramedics and some Emergency Medical Services (EMS) insist that the …