Effect of age on prehospital cardiac resuscitation outcome.

To compare resuscitation outcomes in elderly and younger prehospital cardiac arrest victims, we used a retrospective case series over 5 years in rural advanced life support (ALS) units and a University hospital base station. Participants included 563 adult field resuscitations. Excluded were patients with noncardiac etiologies, those less than 30 years old, and those with unknown initial rhythms. Patients were grouped by age. Return of spontaneous circulation (ROSC) and survival to hospital discharge were compared by Yates' chi-square test. ALS treatment of cardiac arrest was by regional protocols and on-line physician direction. Sixty percent (320/532) of patients were over 65 years old. The proportion with initial rhythm ventricular fibrillation (VF) was 50% in the elderly and 48% in younger patients. ROSC was achieved in 18% of elderly and 16% of younger patients; survival was 4% among the elderly and 5% for younger patients. The oldest survivor was 87 years old. Most survivors were discharged, in good Cerebral Performance Categories. There was no difference in outcome by age group when initial cardiac rhythm was considered. Early cardiopulmonary resuscitation (CPR) and ALS and initial rhythm VF were associated with the best resuscitation success. Age has less effect on resuscitation success than other well-known factors such as early CPR and ALS. Advanced age alone should probably not deter resuscitation attempts.

On-line medical direction: a prospective study.

OBJECTIVES: To determine the frequency with which physician, on-line medical direction (OLMD) [direct medical control] of prehospital care results in orders, to describe the nature of these orders, and to measure OLMD time intervals. METHODS: Blinded, prospective study. SETTING: A university hospital base-station resource center. PARTICIPANTS: Ten emergency physicians, 50 advanced life support providers. INTERVENTIONS: Prehospital treatment was directed by both standing orders and OLMD physician orders. Independent observers recorded event times and the characteristics of OLMD. RESULTS: Physician orders were given in 47 (19%) of the 245 study cases, and covered a variety of interventions, including many already authorized by standing orders. Mean OLMD radio time was four minutes (245 +/- 216 seconds [sec]), and time from beginning of OLMD to hospital arrival averaged 12 minutes (718 +/- 439 sec). Mean transport time in this system was 13 minutes. CONCLUSION: Despite detailed standing orders, OLMD results in orders for clinical interventions in 19% of cases. On-line medical direction requires about four minutes of physician time per call. This constituted about one-third of the potential field treatment time interval in this system. Thus, OLMD appears to play an important role in providing quality prehospital care.

When is air medical service faster than ground transportation?

The purpose of this study was to mathematically define a distance or travel-time interval in which air medical evacuation would benefit the patient more than ground transport. The authors derived mathematical formulas from known variables (ground travel, extrication and rendezvous times) and fixed averages (on-scene time, lift-off time, and speeds) and used those formulas to test actual flights for appropriateness. The formulas were: [formula: see text] where Y = ground travel time; R = rendezvous time; Z = extrication time; D = distance to scene (km); and X = air travel time. The formulas provide a guide to prospectively determine the legitimacy of air medical transport. They can also be used retrospectively as a guide for quality assurance purposes. During this study of 123 consecutive scene flights, helicopter benefitted all the entrapped patients but only one-third of non-entrapped patients. Of 44 flights from areas with known ground times, helicopter transport benefitted 14 of 16 entrapped, five of 16 non-entrapped, but only three of 17 rendezvous.