Related Experiment Videos
Early defibrillation by emergency physicians or emergency medical technicians? A controlled, prospective multi-centre
T Schneider1, D Mauer, P Diehl
1Department of Anaesthesiology, Johannes Gutenberg-University, Mainz, Germany.
Resuscitation
|May 1, 1994
Summary
Emergency medical technicians (EMTs) can defibrillate patients with ventricular fibrillation (VF) as safely and effectively as emergency physicians (EPs). This study found EMT defibrillation led to faster treatment times and reduced medication use without impacting survival rates.
Area of Science:
- Emergency Medicine
- Cardiology
- Public Health
Background:
- The current standard of care in Germany for ventricular fibrillation (VF) involves defibrillation by emergency physicians (EPs).
- A two-tiered emergency medical services (EMS) system exists, with emergency medical technicians (EMTs) providing initial care.
- The effectiveness and safety of EMT-performed defibrillation compared to EP-performed defibrillation require investigation.
Purpose of the Study:
- To compare the timing and safety of defibrillation by EMTs versus EPs in a two-tiered EMS system.
- To evaluate the impact of EMT defibrillation on patient survival rates and long-term prognosis in VF cases.
- To assess whether EMTs can defibrillate earlier and as safely as EPs.
Main Methods:
- A controlled, prospective, multi-center study was conducted.
- EMTs received retraining in basic life support (BLS) and training in using semi-automatic defibrillators.
- Resuscitation sequences were evaluated using on-line tape recordings, with patient follow-up via the Glasgow Coma Scale and Pittsburgh Cerebral and Overall Performance Categories.
Main Results:
- A total of 159 patients with VF were included; 121 had witnessed collapse.
- Patients defibrillated by EMTs received treatment significantly earlier (within 12 min for 67% vs. 46% for EPs; P < 0.01).
- Earlier return of spontaneous circulation (ROSC; P < 0.05) and lower adrenalin administration (P < 0.05) were observed in the EMT group. Survival rates (25% vs. 24%) and neurological outcomes showed no significant differences.
Conclusions:
- EMT defibrillation is as effective as EP defibrillation for VF patients, with no significant difference in survival or long-term neurological prognosis.
- EMT defibrillation significantly reduces time to defibrillation and ROSC, and decreases the need for adrenalin.
- EMTs in Germany should be empowered to perform defibrillation prior to EP arrival, contingent upon continuous medical training and supervision.