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Out-of-hospital resuscitation in Tartu: Effect of reorganization of Estonian EMS system,☆☆,,★★

Presented in part as poster at the 4th Congress of the European Resuscitation Council, Copenhagen, Denmark, June 4-6, 1998.
https://doi.org/10.1053/ajem.2000.7350Get rights and content

Abstract

The objective of this study was to evaluate the effect of reorganization of Estonian emergency medical services (EMS) system. The outcomes of out-of-hospital resuscitation in the Tartu urban area were investigated during the 6-year study period. The main aim of reorganization was to provide rapid access to early defibrillation with simultaneous advanced cardiac life support (ACLS) procedures on the scene. The changes were implemented since summer 1994 in Tartu at first. Quick availability of a mobile intensive care unit for high-risk calls; implementation of standards for resuscitation, and routine systematic, realistic, compulsory ACLS training for all ambulance staff were established. There were 368 out-of-hospital resuscitations. Comparison of periods before and after basic reorganization of EMS system showed that the number of resuscitation attempts had evident tendency to increase. The rates of return of spontaneous circulation and survival in patients with cardiac arrest of presumed cardiac origin increased from 32.5% to 58.6% (P = .05) and from 7.5% to 25.7% (P = .05) respectively. Thus, implementation in the EMS system of mobile intensive care, ACLS units, and standard resuscitation training program diminished mortality from sudden cardiac arrest. (Am J Emerg Med 2000;18:469-473. Copyright © 2000 by W.B. Saunders Company)

Section snippets

Methods

The setting for this study is a two-tiered EMS system in the Tartu urban area of Estonia (size: 38.8 km2, population 100,000). One ambulance dispatch center and the 03 or 112-telephone service serves the area. Until the end of 1999, Estonian ambulance dispatch centers were located only by ambulance stations in which they had to have telephone number 03 service, that was different from the telephone numbers of fire departments and police. In the future, the majority of all emergency calls will

Patients

Data were retrospectively (before July 12, 1994) and prospectively (after July 12, 1994) collected between January 1, 1993 and December 31, 1998 according to an Utstein style.7 Patients with expected death are excluded from analysis.

Statistical methods

Data were entered into a computerized database. Chi-squared analysis for nonparametric data with Yate's correction and Student's t test for parametric data (STATISTICA 5.1/W, StatSoft, Inc) were used to determine significance of differences between groups. A P value < .05 was considered significant.

Results

During the 6-year study period there were 865 confirmed out-of-hospital cardiac arrests considered for resuscitation (Figure 1).

. Utstein—style description of cardiac arrests, 1993 to 1998.

Resuscitation was attempted in 368 patients. Of these, 71.3% were men (mean age 55.4 years), 26.3% women (mean age 64.1 years), and 2.3% children younger than the age of 14 years. Mean age (median) of all adult resuscitated patients was 59.8 years (range 18 to 89 years). In this group, the majority of deaths

Discussion

It is known that the incidence rates of out-of-hospital cardiac arrest varied from 35 to 128 per 100,000 inhabitants/year with a mean of 62.10 In Helsinki the number for sudden cardiac arrest of cardiac origin was 53.1/100,000.2 In South Estonia with a population of 400,000 during 1980 to 1996 the incidence of such cardiac arrests was 51.5/100,000 but in men in the age groups from 20 to 39 and from 40 to 84 years it was 19.2/100,000 and 120/100,000 respectively.12 The ischemic heart disease

References (21)

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Returned September 20, 1999.

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Address reprint requests to Aleksander Sipria, MD, PhD, Senior Assistant Professor, Department of Anaesthesiology and Intensive Care, University of Tartu, Puusepa 8, Tartu 51014, Estonia. Email: [email protected]

Am J Emerg Med 2000;18:469-473.

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