Establishment and results of an EMT-D program in a two-tiered physician-escorted rescue system. The experience in Berlin, Germany.

Early defibrillation by emergency medical technicians or even less qualified personnel has been shown to improve survival rates for out-of-hospital cardiac arrest caused by ventricular fibrillation. It has been questioned whether these favourable results can be applied within the context of physician-attended emergency medical systems. Taking into consideration the results of a pilot study and after a careful analysis of the logistic and epidemiological background, the first German EMT-D program was introduced in the former West Berlin in December 1988. The first 2 years of experience with 499 technician-initiated resuscitation attempts in which the mobile intensive care unit of Klinikum Steglitz was involved, confirmed the results of the pilot study with an improved long-term survival rate (18%) for patients with ventricular fibrillation. We conclude that EMT defibrillation should be introduced in emergency physician-attended two-tiered emergency medical systems, whenever a thorough analysis of the existing rescue systems exhibits a 'relevant frequency' of resuscitation and response interval of 15 min or less.

[Is pre-hospital thrombolysis in acute myocardial infarct valuable as a routine measure?]. / Ist die prästationäre Thrombolyse bei akutem Myokardinfarkt als Routinemassnahme sinnvoll?

UNLABELLED: In 4920 consecutive missions of the mobile intensive care unit Klinikum Steglitz, 1226 patients (25%) had chest pain of presumed cardiac origin. In 272 patients (22%) an acute myocardial infarction (AMI) was diagnosed in the field. In four patients the diagnosis was wrong; 11 patients with proven coronary artery disease had significant ST-segment elevation, but did not develop AMI. In hospital, a total of 406 patients had evidence of AMI; 173 of these (41%) were seen by an emergency physician in the field already within the first hour after onset of symptoms. In 6%, diagnostic ST-elevation was not recognized by the emergency physician; 27% had non-diagnostic ECG changes (11% bundle-branch block). Prehospital thrombolysis within 4 h after symptom onset was performed in 126 of 205 patients (61%); 74 of these patients were seen by the emergency physician within the first hour. The main reason for exclusion was advanced age. Inclusion of older patients and also those with bundle-branch block could further increase the prehospital thrombolysis rate. CONCLUSION: With an effective emergency medical system a large proportion of all patients with AMI can correctly be identified and properly treated with a thrombolytic drug in the field. The time gain is considerable.

[Is early defibrillation in the emergency-first aid call system useful?]. / Ist Frühdefibrillation im Notarzt-Rendezvous-System sinnvoll?

In a model study, 115 firemen and ambulance emergency personnel were trained in a 12-hour course to use conventional defibrillators prior to the arrival of an emergency care physician for treating patients with ventricular fibrillation. Subsequently, 178 firemen were trained in a 6-hour course to use semi-automatic defibrillators. A total of 252 resuscitations were evaluated with the help of tape recordings. The survival rate of 124 patients with ventricular fibrillation was statistically significantly higher after defibrillation by ambulance personnel if the emergency physician arrived in less than 14 minutes after the emergency call. A group of 109 patients who underwent only cardiopulmonary resuscitation until the arrival of the emergency physician served as a control.