Effects of early defibrillation by ambulance personnel on short- and long-term outcome of cardiac arrest survival: the Munich experiment.

OBJECTIVES: This study evaluates the feasibility of implementing early defibrillation of out-of-hospital cardiac arrest patients for basic life-support providers (EMT-D) in a two-tier emergency system in the city of Munich, Germany. DESIGN: Retrospective consecutive analysis of all EMT-D attempts during a 5-year initiation phase (1990 to 1994) and prospective follow-up of all cardiac arrest survivors discharged from hospital. SETTING: A strictly defined inner-city and suburban area of 978 km2 and a residential population of 1,530,000 inhabitants with 22 ICUs in urban hospitals. One dispatching center to alert a two-tier emergency system with 56 EMT-D-staffed ambulances and physician-staffed mobile ICUs stationed at the nearest of nine hospitals. METHODS: AH EMT-D cases were identified and data on patients were documented in a standardized manner from patients' records, including the resuscitation protocol in the hospitals to which the patients were referred. For those patients discharged from the hospital, a standardized telephone interview was undertaken with the physician in charge of the patient and with the patient/relative leading to an assessment of the patient's status according to the Glasgow-Pittsburgh cerebral performance categories. INTERVENTION: None. RESULTS: During the 5-year initiation phase of the EMT-D program in the two-tier emergency system in Munich, there were 243 resuscitation attempts by EMTs, using the semiautomated defibrillator; 125 patients died immediately on the scene. In 118 patients, spontaneous circulation was reestablished and these patients were admitted to an ICU in 1 of the 22 urban hospitals. Median call-response interval for the EMT-D was 5 min (interquartile range, 3 to 6) and was 10 min (interquartile range, 7 to 13) for the second tier (p < or = 0.0001). In 34 cases (28.8%), EMT-D staff had reestablished spontaneous circulation (ROSC) before the second tier arrived on the scene. Patients with ROSC on the arrival of the second tier were more frequently discharged alive from hospital than were patients without ROSC at that time (p < or = 0.0001). The hospital discharge rate of initially successful resuscitated patients presenting with out-of-hospital ventricular fibrillation was 38.1% (45/118). Overall success rate of all EMT-D attempts was 18.5% (45/243). After a mean follow-up time of 39 (range, 22 to 64) months, 29 (66%) patients were still living. Twenty-five (56.8%) were neurologically not disabled or mildly disabled (CPC 1/2); disability was moderate in 3 (6.8%) patients and was severe in 1 (2.3%) patient. One case was lost to follow-up. CONCLUSION: The present study demonstrates that the upgrading of basic life support providers with semiautomated defibrillators has a significant benefit for cardiac arrest victims outside the hospital in an urban environment.

[Catastrophe medicine: experiences with the employment of German Federal Forces in South Italy (author's transl)]. / Katastrophenmedizinsiche Erfahrungen beim Einsatz der Bundeswehr in Süditalien.

The earthquake catastrophe in south Italy on November 2rd 1980 brought death or homelessness to thousand of people. Timely preparatory measures could have limited the loss of life. This paper reports experiences from the catastrophe area. The duties of a mobile team of doctors, the problems of hygiene and laboratory medicine which confront a doctor in the catastrophe area and the demands which are made on a field hospital with surgical and internist facilities are dealt with.

[The bomb outrage at the Munich Octoberfest on 26. 9. 1980 (author's transl)]. / Der Bombenanschlag vom Münchner Oktoberfest am 26. 9. 1980.

The bomb outrage at the October Beer Festival on the evening of September 26, 1980 was a great test of the strain on, and also a crucial trial for the Munich Ambulance Service. Over 200 injured persons, one quarter of them seriously or most seriously injured, were given adequate first aid and within one hour 179 were distributed to 23 hospitals in and around Munich. Some fortunate circumstances favored the technical course of the rescue operation. Small errors which occurred gave rise to reconsideration of questions of catastrophe medicine and problems of organization and planning. The team-work of the rescue services played an essential part in the optimally developed system of the emergency medical services in Munich.