sent to me by a physician

[CAOX3]

Agreed.

Until we have a universal criteria encompassing everything from response times to discharge and all points in between we will never truley know what is effective.

 

[VentMedic]

Some more articles of interest:

Six Minutes to Live or Die
http://www.usatoday.com/news/nation/ems-main.htm

Now, Boston saves 40% of cardiac arrest victims, second among the nation's biggest cities after Seattle's 45%

The city {Seattle} has trained ordinary citizens — from taxi drivers to restaurant employees — in CPR, making them members of what is known as Medic Two. Seattle firefighters work as instructors for the program and teach about 18,000 people a year. Since 1971, the city has trained 650,000 people. As a result, Seattle now has one of the highest "bystander CPR" rates in the nation — 44%. That means that nearly half of all cardiac arrest victims get CPR from a co-worker, a loved one or a stranger in the minutes between collapse and when emergency medical crews arrive.

Survival by the Numbers
http://www.usatoday.com/news/health/2005-03-01-ems-numbers_x.htm

USA TODAY studied 12 cities that measure their cardiac-arrest survival rates by the international gold standard called the Utstein template. This tool is the best indicator of EMS life-and-death performance because the victim's outcome is determined in the field, not in the hospital.

The template considers only the most savable of cardiac-arrest victims: those who collapse in front of a witness and need a shock from a defibrillator. It counts as survivors only those who leave the hospital with good brain function.

Cities Deceptive About EMS Response Times
http://cms.firehouse.com/content/article/article.jsp?sectionId=46&id=16007

"Los Angeles is one of many cities that routinely lie to themselves about their true response times to medical emergencies," the article says. "The result is needless deaths."

Cooking the Books? Measuring Cardiac Arrest Survival Rates

http://www.emsresponder.com/print/F...easuring-Cardiac-Arrest-Survival-Rates/3$2308

With the Utstein template, only those victims who have a good chance to be saved are counted. Further, the Utstein template counts only those survivors who leave the hospital without serious brain damage.

Cardiac Arrest Resuscitation Evaluation in Los Angeles: CARE-LA

http://www.annemergmed.com/article/S0196-0644(04)01740-8/abstract

Of 2,021 consecutive cardiac arrest patients on whom resuscitation was attempted, 1,700 (84%) met entry criteria as a primary cardiac event. Overall, neurologically intact survival was 1.4% (99% confidence interval [CI] 0.8% to 2.4%) Three patients were lost to follow-up. Survival from bystander-witnessed ventricular fibrillation was 6.1% (99% CI 3.3% to 11.0%). Absolute survival differences from witnessed ventricular fibrillation was higher but not statistically different than that from Chicago (−3%; 99% CI −8% to 2%) and New York City (−2%; 99% CI −6% to 3%). The rate of bystander cardiopulmonary resuscitation (CPR) for our population was 28%, for which the overall survival rate was 2.1%. The survival rate for patients with witnessed arrests and bystander CPR was 3.2%. Among patients with no bystander CPR, the survival rate was 1.0%.

 

[GR1N53N]

Survival from bystander-witnessed ventricular fibrillation was 6.1% (99% CI 3.3% to 11.0%).

Excuse my ignorance, but how do you categorize bystander-witnessed v-fib? Or rather, how does a bystander know it's v-fib, as opposed to another rhythm?

I'd read their methods, but apparently my workplace doesn't subscribe to that particular journal (I work in an institutional cell bio lab, so that's not really much of a surprise).

 

[JPINFV]

Excuse my ignorance, but how do you categorize bystander-witnessed v-fib? Or rather, how does a bystander know it's v-fib, as opposed to another rhythm?

I'd read their methods, but apparently my workplace doesn't subscribe to that particular journal (I work in an institutional cell bio lab, so that's not really much of a surprise).

They're talking about presenting rhythm. So if paramedics arrive at a witnessed arrest and the patient is in v-fib, it is a witnessed v-fib arrest.

The article itself is a bit of a mess, though. I especially enjoyed California's new EMS level, EMT-Defibrillator. Strange, though, because when I started working in 2005, the levels in California were EMT-I (1), EMT-II (2), and EMT-Paramedic.