Limitation on effectiveness of rapid defibrillation by emergency medical technicians in a rural setting.

First-responding emergency medical technicians (EMTs) trained to defibrillate have been shown to increase survival from prehospital ventricular fibrillation (VF) almost fourfold in Washington's King County. Using Nebraska ambulance rescue run data from 1982 and published information relating ambulance response time to the likelihood that a patient would be in VF, we constructed a model to analyze the difference in expected results for EMT defibrillation among communities of varying population. The model predicts that EMTs in urban Nebraska (mean population 242,000) will use the defibrillator once every six weeks. EMTs in intermediate cities (mean population 22,300) will defibrillate once a year. In rural Nebraska (mean population 1,500), the defibrillator will be used once every 5.6 years. Despite these figures, the model predicts relatively low cost per life saved (ranging from $566 in urban areas to $4,785 in rural Nebraska). The major problem with EMT defibrillation in rural areas is maintenance of skills and continuing education.