Integration of ambulance staff trained in cardiopulmonary resuscitation with a medical team providing prehospital coronary care.

Ambulance staff with advanced training in cardiopulmonary resuscitation and equipped with monitor/defibrillators were used as the initial responders to collapse calls within a medically based prehospital coronary care system. During 21 months, in a population of approximately 120,000, ambulance staff successfully resuscitated six patients from ventricular fibrillation; there were four long term survivors. The median response time of emergency ambulances to collapse calls was eight minutes compared with 20 minutes for the medically manned mobile coronary care unit. None of the patients resuscitated by ambulance staff would have survived if they had been dependent on the mobile coronary care unit acting alone. Nineteen other patients with important arrhythmias were referred for earlier medical management which in some cases may have saved lives. An additional eight long term survivors of out of hospital ventricular fibrillation were resuscitated by medical staff. The integration of paramedical with medical prehospital coronary care improved survival after out of hospital cardiac arrest.