Editor,—Most fatal events in patients with ischaemic heart disease occur outside hospital and therefore the greatest opportunities for reducing mortality from acute coronary events lie in the prehospital setting1. In their recent paper Soo and colleagues2 published the results of a study to determine whether survival after cardiac arrest outside hospital was influenced by the availability of different grades of ambulance personnel and other health professionals. We are concerned with their conclusions about technician-only crews, and we wish to make some more general comments about their paper.

We feel that the data presented by Soo et aldid not support their statement that “provision of defibrillation plus basic life support by technicians appears to be inadequate compared with the complementary early provision of advanced cardiac life support by paramedics”. Clearly, in the population studied, overall …