Establishment and results of an EMT-D program in a two-tiered physician-escorted rescue system. The experience in Berlin, Germany.

Early defibrillation by emergency medical technicians or even less qualified personnel has been shown to improve survival rates for out-of-hospital cardiac arrest caused by ventricular fibrillation. It has been questioned whether these favourable results can be applied within the context of physician-attended emergency medical systems. Taking into consideration the results of a pilot study and after a careful analysis of the logistic and epidemiological background, the first German EMT-D program was introduced in the former West Berlin in December 1988. The first 2 years of experience with 499 technician-initiated resuscitation attempts in which the mobile intensive care unit of Klinikum Steglitz was involved, confirmed the results of the pilot study with an improved long-term survival rate (18%) for patients with ventricular fibrillation. We conclude that EMT defibrillation should be introduced in emergency physician-attended two-tiered emergency medical systems, whenever a thorough analysis of the existing rescue systems exhibits a 'relevant frequency' of resuscitation and response interval of 15 min or less.