Semi-automatic external defibrillation.

Malignant arrhythmia, which is responsible for most of the out-of-hospital cardiac arrests, is ventricular fibrillation (VF). The best treatment of VF is a controlled electric shock on the chest administered in a short delay. The emergency medical technicians (EMTs) qualified to carry out this treatment in Belgium and in districts often succeed in arriving on the spot 8 minutes earlier than the people of the Service Mobile d'Urgence et de Réanimation (SMUR). The delegation of defibrillation to ambulance crew members however implies a specific teaching, training and a medical control. The Brussels experience shows that semi-automatic external defibrillation by EMT-Ds (SAED) is feasible when criteria for applying SAED in the pre-hospital phase are applicable.

Early defibrillation by EMTs: the Brussels experience.

Considering that in Brussels the first-aid ambulance team reaches the patient in cardiac arrest 10 min before the physician-manned ambulance, we instituted a feasibility study of early defibrillation by emergency medical technicians (EMTs). Three hundred EMTs received a 20-h automatic external defibrillation (AED) training course followed by a refresher course every 6 months. Of 316 cardiac arrests included in this study, asystole was encountered in 53% and ventricular fibrillation/ventricular tachycardia (VF/VT) in 33% of the cases on arrival of the EMTs. In the VF/VT group, defibrillation was performed by EMTs with a Laerdal Heartstart 7-9 min before the medical team arrived. The overall cardiac arrest survival rate improved from 7% in 1989 to 19% in 1992. However, the long-term survival rate (14/105) of ventricular fibrillation remained low because of excessive delays in emergency medical service (EMS) access and in early ACLS. In conclusion, this work shows that in Brussels: (1) early defibrillation of cardiac arrest victims in VF is feasible by EMTs when a training and a follow-up program are implemented; (2) the weakest link of the chain of survival is the early EMS access, and the early ACLS; and (3) AED program increases the interest and the efficacy of EMTs and medical teams in the management of cardiac arrests.

[Accessibility of medical services reachable by telephone. The example of the 100 service of Brussels]. / L'accessibilité des services médicaux contactables par téléphone. L'exemple du service 100 de Bruxelles.

The study examines in which degree the belonging to different groups of the population (groups of age, of nationality, socio-economics) influences the interpretability of the help's calls made by telephone to the service 100. The good interpretation of the help's call is evaluated by mean of the decision, good or not, to reinforce the ambulance by a medical team. The analysis considers the phone calls for patients at home. The analysis shows that the accessibility to the service 100 depends on: --the nationality: some groups of nationality don't call the service 100, or not often, because the use of the telephone needs a rather good knowledge of one of the national languages, --the age: the number of calls grows with the age of the victim; the under-evaluation of the state of the victim is significantly more important for older people, --the socio-economic level: the belonging to a low socio-economic group appears as a partial obstacle to verbal communication. The phone calls coming from the poor districts allow a less good evaluation of the state of the victim. To conclude, we may say that: 1. when help's call arrives to the service 100, the operator appreciates the gravity of the situation with a fairly good precision. 2. for people who don't call the service 100 because they don't master enough one of the two national languages, a better accessibility to the service 100 needs a global policy of integration of the strangers (language courses...).