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首页> 外文期刊>Journal of public health management and practice: JPHMP >Effectiveness of the Dual Dispatch to Cardiac Arrest Policy in Houston, Texas
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Effectiveness of the Dual Dispatch to Cardiac Arrest Policy in Houston, Texas

机译：德克萨斯州休斯顿双重派遣对心脏逮捕政策的有效性

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摘要

Supplemental Digital Content is Available in the Text. Context: Houston policy is to dual dispatch medically trained firefighters, in addition to emergency medical services (EMS) units to out-of-hospital cardiac arrest (OHCA) cases. While believed to improve public health outcomes, no research exists supporting the policy that when firefighters respond before a better-equipped EMS unit, they increase the probability of survival. Objective: To inform EMS policy decisions regarding the effectiveness of dual dispatch by determining the impact of medically trained firefighter dispatch on return of spontaneous circulation (ROSC), a measure of survivability, in OHCA 911 calls while controlling for the subsequent arrival of an EMS unit. Design: This retrospective study uses logistic regression to determine the association between ROSC and response time for fire apparatus first responders controlling for arrival of the EMS unit. Setting: Out-of-hospital cardiac arrest cases in Houston between May 2008 and April 2013 when dual dispatch was used. Participants: A total of 6961 OHCA cases with the complete data needed for the analysis. Main Outcome Measures: Logistic regression of the dependence of OHCA survival using the indicator ROSC, as related to the fire first responder response times controlling for subsequent arrival of the EMS. Results: Fire apparatus arrived first in 46.7% of cases, a median value of 1.5 minutes before an EMS unit. Controlling for subsequent arrival time of EMS has no effect on ROSC achieved by the fire first responder. If the firefighters had not responded, the resulting 1.5-minute increase in response time equates to a decrease in probability of attaining ROSC of 20.1% for cases regardless of presenting heart rhythm and a 47.7% decrease for ventricular fibrillation cases in which bystander cardiopulmonary resuscitation was initiated. Conclusions: The firefighter first responder not only improved response time but also greatly increased survivability independent of the arrival time of the better-equipped EMS unit, validating the public health benefit of the dual dispatch policy in Houston.
机译：文本中提供了补充数字内容。背景信息：休斯顿政策是双重调度医学培训的消防员，除了紧急医疗服务（EMS）单位到医院外心骤停（OHCA）案件。虽然相信改善公共卫生结果，但不存在支持该政策的研究，当消防员在装备更好的EMS单位之前，他们增加了生存的可能性。目的：通过确定在自发循环返回（ROSC）的返回中，在OHCA 911呼叫中确定医学培训的消防员派遣的影响，以便通过确定医学培训的消防员派遣的影响，以便控制随后的EMS单位的到来，以便在自发循环中的返回。设计：该回顾性研究使用Logistic回归来确定ROSC与响应时间与控制EMS单元到达的响应者的ROSC和响应时间之间的关联。设置：在使用双重调度时，2008年5月至2013年4月休斯顿医院心脏骤停案件。参与者：共有6961个OHCA案例，分析所需的完整数据。主要观察指标：使用指标ROSC的OHCA存活依赖性的逻辑回归，与火灾首次响应响应时间控制在随后到达EMS的情况下。结果：消防仪器首先达到46.7％的病例，在EMS单位前1.5分钟的中位数。控制EMS的后续到达时间对火首次响应者的ROSC没有影响。如果消防员尚未作出反应，则应导出的1.5分钟的响应时间增加等同于患者达到20.1％的概率减少，而不管呈现心律，患有心脏节律的47.7％降低，其中旁观者心肺复苏的心室纤维化病例减少发起。结论：消防员的第一个响应者不仅改善了响应时间，而且还有大大提高了生存能力，独立于装备更好的EMS单位的到达时间，验证了休斯顿双重调度政策的公共卫生利益。

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