A rapid response system for out-of-hospital cardiac emergencies.

We have reviewed several aspects of our initial 5 years' experience with an out-of-hospital emergency medical care system. This system is stratified and provides for rapid primary response and, when indicated, secondary response by specially trained paramedical personnel. Patient care is physician-supervised and closely monitored. Although considerable attention has been directed to acute complications of ischemic heart disease, particularly the problem of sudden cardiac death, the system is broadly based and responds to all medical emergencies. We are impressed with the ability of nonphysicians to acquire certain medical skills and judgment. Indeed, the effectiveness of this system is largely dependent on paramedical personnel. Such systems of prehospital emergency medical care will probably have an impact greater than that of hospital coronary care units in reducing the mortality from ischemic heart disease.