AMA will start pilot programs to train RCTs.

AIM: One of the objectives of this study was to assess the emergency medical dispatchers (EMDs) ability for the identification and prioritisation of cardiac arrest (CA) cases, and offering and achievements of dispatcher-assisted bystander cardiopulmonary resuscitation (CPR). The other objective was to give an account of the frequency of agonal respiration in cardiac arrest calls and the caller's descriptions of breathing. METHODS: Prospective study evaluating 100 tape recordings of the EMD calls of emergency medical service (EMS)-provided advanced life support- (ALS) cases, of out-of-hospital cardiac arrest. RESULTS: The quality of EMD-performed interviews was highly commended in 63% of cases, but insufficient or unapproved in the remaining 37%. The caller's state of mind was not a major problem for co-operation. Among the 100 cases, 24 were suspected to be unconscious and in respiratory arrest. A further 38 cases were presented as unconscious with abnormal breathing. In only 14 cases dispatcher-assisted bystander CPR was offered by the EMD, and in 11 of these it was attempted, and completed in eight. Only four of the cases were unconscious patients with abnormal breathing. The incidence of suspected agonal breathing was estimated to be approximately 30% and the descriptions were; difficulty, poorly, gasping, wheezing, impaired, occasional breathing. CONCLUSIONS: Among suspected cardiac arrest cases, EMDs offer CPR instruction to only a small fraction of callers. A major obstacle was the presentation of agonal breathing. Patients with a combination of unconsciousness and agonal breathing should be offered dispatcher-assisted CPR instruction. This might improve survival in out-of hospital cardiac arrest.

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PubMed2003

[Initial medical treatment by paramedics in combined first aid operations of paramedics and emergency physicians].

OBJECTIVE: The present study was conducted to evaluate the quality of paramedic care and the feasibility and cost-effectiveness of sending a well-trained paramedic team to the sight of a medical emergency to initiate active medical treatment prior to the arrival of the mobile intensive care unit (MICU). METHODS: We examined 200 cases of medical treatment initiated by paramedics before arrival of the MICU team at the site of the medical emergency. Using a questionnaire, all emergency procedures performed by the paramedic team on scene were recorded and defined as "required", "carried out", and "accurately performed". The documented emergency procedures were divided into three categories: basic procedures (e. g. positioning, CRP, oxygen administration), additional procedures (e. g. placement of iv-lines, application of intravenous medication), and routine emergency diagnostic measures (e. g. monitoring of cardiopulmonary status). Further documented were the time of onset of emergency physician treatment, and the definitive transport vehicle used. To evaluate the time required for the measures performed, three different groups were identified according to the time gap between the arrival of the paramedic and the emergency physician teams (< 3 min, 3 - 5 min and > 5 min). RESULTS: In the 200 emergencies included in the study, 76 - 95 % of the required procedures were accurately performed prior to the arrival of the MICU team, at a success rate ranging from 87 to 100 %. CONCLUSIONS: In this study, a large number of emergency procedures could be performed by the paramedic team within a short period of time (in some cases < 3 min), and adequate effectiveness. Based on our results, the activation of paramedic-staffed first-tier ambulances with shorter response times is recommended in addition to the MICU system.

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