RESUMO
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.
Assuntos
Cardioversão Elétrica , Auxiliares de Emergência , Parada Cardíaca/terapia , Idoso , Ambulâncias , Bélgica/epidemiologia , Serviços Médicos de Emergência , Auxiliares de Emergência/educação , Estudos de Viabilidade , Feminino , Parada Cardíaca/mortalidade , Humanos , Masculino , Taxa de Sobrevida , Taquicardia Ventricular/mortalidade , Taquicardia Ventricular/terapia , Fatores de Tempo , Fibrilação Ventricular/mortalidade , Fibrilação Ventricular/terapiaRESUMO
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.
Assuntos
Reanimação Cardiopulmonar/normas , Cardioversão Elétrica/normas , Serviços Médicos de Emergência/normas , Parada Cardíaca/terapia , Fibrilação Ventricular/terapia , Idoso , Bélgica , Reanimação Cardiopulmonar/métodos , Cardioversão Elétrica/métodos , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida , Resultado do Tratamento , Fibrilação Ventricular/complicações , Fibrilação Ventricular/mortalidadeRESUMO
Two EMS (Emergency Medical System) belonging to the Free University of Brussels present the results concerning primary interventions. Calls come from the "Service 900" and from general practitioners. Trauma emergencies were inexistent in 1969. They now follow the cardiac emergencies in 1982. EMS are public services. Their collaboration with hospitals should be developed.