Variations exist in cardiac arrest care provided by emergency medical services agencies
Emergency medical services (EMS) personnel are at the front lines when it comes to resuscitation during a cardiac arrest. Organizational and provider factors can have an impact on patient survival. Recently, researchers examined some of these characteristics in a group of EMS agencies participating in the national Cardiac Arrest Registry to Enhance Survival (CARES). They found a host of differences among agencies, including variations in medical direction, deployment tactics, and even the implementation of guideline updates, policies, and protocols.
A total of 25 EMS agencies were surveyed using a Web-based questionnaire; 21 were received. The agencies were asked about such things as protocols used to deliver out-of-hospital cardiac arrest care and the use of resuscitation techniques.
The survey also collected descriptors of each agency, including their response area, organizational type, medical director employment, and deployment. All but one of the agencies served areas with a population of more than 50,000 people.
Five different EMS service models were used, with nine agencies supported by fire department-based providers and six supported by non-fire-based providers. All were non-volunteer organizations, with six of them having full-time medical directors. Twelve of the 21 agencies delivered services from a pre-designated location (fixed deployment) as opposed to constantly redistributing ambulances. The total number of paramedics varied widely among the agencies, with fire-based agencies having a slightly higher median number. There were also wide variations found in the protocols used to care for patients. Only 10 of the 21 agencies were able to direct 911 callers to an automated external defibrillator. A little over half of the agencies modified 2005 advanced cardiovascular life support guidelines with regard to airway techniques and the delivery of medications. When questioned about the use of six resuscitation techniques, every agency used at least one of them but no agency used all six techniques.
The researchers note that further studies are needed to determine which EMS and provider factors are specifically associated with increased patient survival and best practice development. The study was supported in part by the Agency for Healthcare Research and Quality (HS17965).
See "Practice variability among the EMS systems participating in cardiac arrest registry to enhance survival (CARES)," by Prasanthi Govindarajan, M.D., Lisa Lin, M.S., Adam Landman, M.D., and others in Resuscitation 83, pp.76-80, 2012.
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