Dead-on-arrival patients in Panchiao, Taipei

The present emergency medical service (EMS) system in the Panchiao area includes operations in Panchiao, Sulin, Sunshia, Chung Ho and Touchen, which is in the early developmental stage. Educational programs such as emergency medical technician (EMT)-I, and -II have been provided for less than 25% of firefighters in that area. Several mass educational programs in cardiopulmonary resuscitation (CPR) were also provided for the inhabitants of the area. The purpose of this study was to establish a database of dead-on-arrival (DOA) patients during this early stage of the EMS system development so that comparisons of EMS performance could be assessed to identify any future needs of the EMS system in the Panchiao area.

A patient was verified as DOA if there was no pulse nor a response to stimulation. For every DOA patient, several parameters were recorded in a registration book, which began January 1, 1995, and included the following: name, gender, age, mode of transportation, time to hospitalization, on-scene CPR, prehospital basic life support, possible etiology, response to advanced cardiac life support (ACLS), disposition and outcome. The registration book was reviewed and a follow-up study was designed, which covered the entire year of 1995.

There were 292 DOA patients brought to the emergency room of the Far Eastern Memorial Hospital in Panchiao, Taipei, between January 1, 1995, and December 31, 1995. The study population comprised 190 (65.1%) men and 102 (34.9%) women. The mean age of the men was 51.8 +/- 22.3 years (mean +/- standard deviation). The mean age of the women was 59.8 +/- 24.4 years. Emergency service ambulances transported most DOA patients, though a few were transported by private ambulance from nursing homes. There were only two incidents in which prehospital CPR was conducted. The time to hospitalization varied from five to 170 minutes and averaged 38.3 minutes. Following ACLS, 244 (83.6%) patients were pronounced dead in the emergency room. Cardiovascular and respiratory problems were the leading etiologies and trauma was the second. There were 48 patients (16.4%) who responded to ACLS, but only eight (2.7%) survived until hospital discharge.

Delayed initiation of the EMS system resulted in an average time to hospitalization of 38.3 minutes. Cardiovascular collapse was the leading etiology in DOA patients. There were only two patients who received prehospital CPR, suggesting that layperson CPR and EMT education cannot be overemphasized.