Out-of-Hospital Cardiac Arrest in a Rural Area: A 16-Year Experience with Lessons Learned and National Comparisons☆,☆☆,★,★★
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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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Cited by (0)
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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.
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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