Elsevier

Annals of Emergency Medicine

Volume 28, Issue 3, September 1996, Pages 294-300
Annals of Emergency Medicine

Out-of-Hospital Cardiac Arrest in a Rural Area: A 16-Year Experience with Lessons Learned and National Comparisons,☆☆,,★★

Presented at the Western Student Medical Research Forum, Carmel, California, February 8-12, 1995.
https://doi.org/10.1016/S0196-0644(96)70028-8Get rights and content

Abstract

Study objective: To evaluate the effectiveness of the emergency medical services (EMS) system in a rural island community in resuscitating victims of out-of-hospital cardiac arrest over the past 16 years. Methods: We conducted a retrospective analysis of all EMS responses to cardiac arrests on San Juan Island, a rural island community of 5,000 people in the Pacific Northwest. Data were collected between January 1977 and July 1994 on the basis of the Utstein criteria. From these data, we calculated survival rates and compared them with published data from other rural and nonrural areas in the United States. Results: During this study, 22% of all the patients who sustained a cardiac arrest of cardiac origin on the island survived to hospital discharge. The survival rate for witnessed cases of ventricular fibrillation and ventricular tachycardia was 43%. Conclusion: The combined paramedic/emergency medical technician system used on San Juan Island has yielded survival rates comparable to those of urban areas. This system may serve as a model for other rural communities, especially those with well-defined geographic areas and established 911 central dispatching. [Killien SY, Geyman JP, Gossom JB, Gimlett D: Out-of-hospital cardiac arrest in a rural area: A 16-year experience with lessons learned and national comparisons. Ann Emerg Med September 1996;28:294-300.]

Section snippets

INTRODUCTION

Approximately 400,000 Americans sustain out-of-hospital cardiac arrest each year.1 Overall survival is estimated at 3%. The likelihood of survival varies greatly, depending on the location of the arrest. Areas with well-established, highly effective emergency medical services (EMS) systems report considerably higher survival rates than other areas. Although some urban areas report survival-to-hospital discharge results as high as 30% for some categories of cardiac arrest patients, most rural

MATERIALS AND METHODS

The San Juan Islands are located in northwest Washington state. Of the approximately 100 islands in the group, San Juan Island is the most populous, with about 5,000 permanent residents (1990 census). Of these, about one third live in the city limits of Friday Harbor, a centrally located town on the island. The island also has a large transient population of tourists and temporary inhabitants, especially during the summer months. The island is accessible only by boat or air. A ferry from the

RESULTS

Between January 1, 1977, and July 31, 1994, 102 cardiac arrests occurred on the island. Eighty were of cardiac origin. Resuscitation was attempted in all but two cases. In those cases, the patients were obviously dead.

Of the 78 cases analyzed, 62 (79%) involved men and 16 (21%) women, with an average age of 66 years. Fifty-nine of the arrests (76%; 95% CI, 58% to 84%) were witnessed; 17 were not. In two cases, this information was not recorded. Twenty-five of the patients (32%; 95% CI, 23% to

DISCUSSION

In their 1990 summary of cardiac arrest and resuscitation rates in 29 cities, Eisenberg et al10 concluded that "a community survival rate of 30 percent for witnessed adult cardiac arrests in VF should be the standard of excellence given current technology." These rates are normally found in cities with "mature" EMS systems; for example, in 1990, of all cardiac arrests of cardiac origin in Seattle, 14% of all patients and 30% of those presenting in VF survived to hospital discharge. In King

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From the Department of Family Medicine, University of Washington, Seattle, Washington*; and the Inter Island Medical Center, Friday Harbor, Washington.

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Funded by the Washington Academy of Family Physicians Foundation, Summer Research Assistant Grant.

Address for reprints: John P Geyman, MD, Department of Family Medicine, School of Medicine, University of Washington, Box 355304, Seattle, Washington 98195-5304, 206-685-3993, Fax 206-543-8911

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Reprint no. 47/1/75264

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