Biomedical subjects

Manish N Shah

Publications and source records attributed to Manish N Shah.

At least 19 recordsLinked to original sources

PubMed2006

Epidemiology and outcomes of out-of-hospital cardiac arrest in Rochester, New York.

OBJECTIVE: To characterize out-of-hospital cardiac arrest (OHCA) and factors that affect survival in a medium sized city that uses system status management for dispatch. METHODS: A retrospective cohort study of all adult OHCA patients treated by EMS between 1998 and 2001 was conducted using Utstein definitions. The primary endpoint was 1-year survival. RESULTS: Of the 1177 patients who experienced OHCA during the study period, 539 (46%) met inclusion criteria. Age ranged from 18 to 98 years (median 67). The median call-response interval was 5 min (range 0-21), and 93% were 9 min or less. There was no significant difference in the median call-response intervals between call location zip (Post) codes (p=0.07). Twenty percent of experienced ROSC (95% CI 17-23), 7% survived more than 30 days (95% CI 5-9%), and 5% survived to 1 year (95% CI 3-7%). In bivariate analysis, first rhythm and bystander CPR affected survival to 1 year. There was no significant difference in survival between male (4%) and female (7%), black (4%) and white (6%), or witnessed (7%) and unwitnessed arrest (4%). Logistic regression identified younger age, CPR initiated by bystander (19%) or first responder (41%), and presenting rhythm of VF/VT (32%) as factors associated with survival to 1 year. CONCLUSIONS: This study finds a 5% survival to 1 year among OHCA patients in Rochester, NY. A presenting rhythm of VF/VT and bystander CPR were associated with increased survival.

Adolescent↗

PubMed2006

Geriatric emergency medicine and the 2006 Institute of Medicine reports from the Committee on the Future of Emergency Care in the U.S. health system.

Three recently published Institute of Medicine reports, Hospital-Based Emergency Care: At the Breaking Point, Emergency Medical Services: At the Crossroads, and Emergency Care for Children: Growing Pains, examined the current state of emergency care in the United States. They concluded that the emergency medicine system as a whole is overburdened, underfunded, and highly fragmented. These reports did not specifically discuss the effect the aging population has on emergency care now and in the future and did not discuss special needs of older patients. This report focuses on the emergency care of older patients, with the intent to provide information that will help shape discussions on this issue.

Aged↗

PubMed2006

Cardiac arrests in skilled nursing facilities: continuing room for improvement?

OBJECTIVES: To characterize the care received by skilled nursing facility (SNF/NF) patients suffering cardiac arrest and to evaluate the outcome of SNF/NF patients experiencing cardiac arrest. DESIGN: A retrospective analysis of an existing cardiac arrest registry to characterize SNF/NF cardiac arrest patients and to compare them to community-dwelling cardiac arrest patients was performed. SETTING: The study took place in Rochester, NY, an urban city in upstate New York with approximately 220,000 residents. PARTICIPANTS: All patients for whom emergency medical services (EMS) assistance was requested via the 911 system and who were treated for cardiac arrest between January 1998 and December 2001 were included. MEASUREMENTS: Demographic characteristics such as age, gender, race; clinical characteristics and interventions such as cardiopulmonary resuscitation (CPR), defibrillation, initial cardiac rhythm, and call response interval; outcomes measures such as return of spontaneous circulation and 1-year survival were obtained. RESULTS: Forty-two (8%) of cardiac arrest patients resided in an SNF/NF. Sixteen (38%) of the events were witnessed arrests. Only 28 (67%) patients received CPR and none were defibrillated prior to EMS arrival. One (2%) patient was alive 1 year after the event, a survival rate similar to the community-dwelling population (5%). CONCLUSION: SNF/NF patients suffering cardiac arrest often did not receive CPR or defibrillation while awaiting EMS arrival. SNF/NF patients suffering cardiac arrest have a very low survival rate, similar to the community-dwelling population. The impact of not providing CPR and defibrillation on the survival rate is unclear, but needs to be evaluated prior to any decisions regarding the medical futility of resuscitating SNF/NF patients.

Aged↗

PubMed2006

The formation of the emergency medical services system.

The evolution of the emergency medical services system in the United States accelerated rapidly between 1960 and 1973 as a result of a number of medical, historical, and social forces. Current emergency medical services researchers, policy advocates, and administrators must acknowledge these forces and their limitations and work to modify the system into one that provides uniformly high-quality acute care to all patients, improves the overall public health through injury control and disease prevention programs, participates as a full partner in disease surveillance, and is prepared to address new community needs of all types.

Emergency Medical Services↗

PubMed2006

An emergency medical services program to promote the health of older adults.

OBJECTIVES: To evaluate the feasibility and effect of an emergency medical services (EMS) program that screened, educated, and referred older adults with unmet needs. DESIGN: A cluster sample design evaluation of an intervention conducted by EMS in one of two communities. SETTING: Two rural communities in upstate New York. PARTICIPANTS: Two hundred fifty-eight intervention-group and 143 control-group community-dwelling older adults receiving emergency care from participating EMS agencies between February 2004 and June 2005. INTERVENTION: EMS providers screened intervention group patients to identify those at risk for falls, influenza, and pneumococcal infections and provided patients educational materials. Patients' physicians were notified of screening results to provide interventions. Control group patients were provided usual care. MEASUREMENTS: Variables included patient demographic and clinical characteristics, the proportion of eligible patients screened, patient risk during EMS care and 14 days later, and patient recollection of receiving educational materials and conversations with physicians regarding needs. RESULTS: Follow-up was successful in 245 (61%) patients. Approximately 80% of intervention-group patients were successfully screened for each item. No differences were identified for characteristics collected at the time of EMS care, but a notable number of patients were at risk for each item. No differences existed between the control or intervention group for process measures such as recollection of receiving educational materials. For outcome measures, only an improvement in pneumococcal vaccination levels was found. CONCLUSION: EMS screening of older adults during emergency responses is feasible, but a simple intervention of providing educational materials to patients during emergency responses and faxing notifications to physicians appears insufficient to address patients' needs.

Aged↗

PubMed2005

Description and evaluation of a pilot physician-directed emergency medical services diversion control program.

OBJECTIVES: To describe the characteristics and feasibility of a physician-directed ambulance destination-control program to reduce emergency department (ED) overcrowding, as measured by hospital ambulance diversion hours. METHODS: This controlled trial took place in Rochester, New York and included a university hospital and a university-affiliated community hospital. During July 2003, emergency medical services (EMS) providers were asked to call an EMS destination-control physician for patients requesting transport to either hospital. The destination-control physician determined the optimal patient destination by using patient and system variables as well as EMS providers' and patients' input. Program process measures were evaluated to characterize the program. Administrative data were reviewed to compare system characteristics between the intervention program month and a control month. RESULTS: During the intervention month, 2,708 patients were transported to the participating hospitals. EMS providers contacted the destination-control physician for 1,866 (69%) patients. The original destination was changed for 253 (14%) patients. Reasons for redirecting patients included system needs, patient needs, physician affiliation, recent ED or hospital care, patient wishes, and primary care physician wishes. During the intervention month, EMS diversion decreased 190 (41%) hours at the university hospital and 62 (61%) hours at the community hospital, as compared with the control month. CONCLUSIONS: A voluntary, physician-directed destination-control program that directs EMS units to the ED most able to provide appropriate and timely care is feasible. Patients were redirected to maximize continuity of care and optimally use available emergency health care resources. This type of program may be effective in reducing overcrowding.

Ambulances↗

PubMed2005

Mild traumatic brain injury in the United States, 1998--2000.

PRIMARY OBJECTIVE: To determine the incidence and epidemiology of emergency department (ED)-attended mild traumatic brain injury (mTBI) in the US. RESEARCH DESIGN: Secondary analysis of ED visits for mTBI in the National Hospital Ambulatory Medical Care Survey for 1998--2000. METHODS AND PROCEDURES: MTBI defined by International Classification of Diseases, 9th Revision, Clinical Modification (ICD9-CM) codes for 'skull fracture', 'concussion', 'intracranial injury of unspecified nature' and 'head injury, unspecified'. MAIN OUTCOME AND RESULTS: The average incidence of mTBI was 503.1/100000, with peaks among males (590/100000), American Indians/Alaska Natives (1,026/100000) and those <5 years of age (1,115.2/100000). MTBI incidence was highest in the Midwest region (578.4/10000) and in non-urban areas (530.9/100000) of the US. Bicycles and sports accounted for 26.4% of mTBI in the 5-14 age group. CONCLUSIONS: The national burden of mTBI is significant and the incidence higher than that reported by others. Possible explanations are discussed. Bicycle and sports-related injuries are an important and highly preventable cause of mTBI underscoring the need to promote prevention programmes on a national level.

Adolescent↗

PubMed2005

Emergency medicine management of the geriatric patient: an educational program for medical students.

This article describes the experience of fourth-year medical students participating in a geriatric education program integrated into a 4-week emergency medicine student clerkship. Between July 2002 and April 2003, all students in this required clerkship participated in a geriatric educational program consisting of a small group discussion of medical and psychosocial issues of older adult emergency department (ED) patients. Students used learned skills to evaluate older adult ED patients for medical and psychosocial issues and later followed up with these patients by telephoning them at their homes or visiting them in the hospital. Students tracked their evaluations of the medical problems, functional abilities, and social supports of patients in the ED. Students also noted when their assessments resulted in the acquisition of new skills or knowledge and when their evaluation of geriatric syndromes resulted in a change of the patient care plan. Seventy-seven students evaluated 217 patients in the ED, of whom 167 (77%) received a follow-up visit or phone call. Students documented learning new skills while caring for 80 (48%) of the older adult patients. Qualitative survey responses from students indicated that students had increased understanding of the importance of assessing functional status and social supports and providing interdisciplinary care. Integrating geriatric education modules into existing emergency medicine clerkships is an effective method to expand the geriatric curriculum in medical schools and to emphasize the importance of geriatric assessment and syndromes in emergency care.

Adult↗

PubMed2005

Identification of out-of-hospital cardiac arrest clusters using a geographic information system.

OBJECTIVES: To locate all out-of-hospital cardiac arrests (OHCAs) in Rochester, New York, and identify clusters of OHCAs, as well as clusters of patients who did not receive bystander cardiopulmonary resuscitation (CPR), in order to identify locations that may benefit from prevention efforts. METHODS: The locations of all adult OHCAs of cardiac etiology occurring in the study city over a four-year period were plotted on a map using ArcGIS. Location information was obtained from the emergency medical services (EMS) medical record and included street address and zip code. Descriptive data related to patient treatment and transport were also abstracted. Kernel analysis was used to identify areas with the highest density of OHCAs. Census-defined block groups were used to calculate OHCA incidence in order to determine the effect of population density. Patients with OHCAs who did not receive bystander CPR were selected and kernel analysis was repeated to identify areas with the highest density of no bystander CPR. RESULTS: A total of 537 OHCAs that met the inclusion criteria occurred during the study period. Ninety-four percent had sufficient location information to be plotted. Two clusters of OHCAs were identified. One cluster covered two block groups that were found to have the highest incidence of OHCA in the city (incidence: 142 [95% CI = 42 to 241] and 105 [95% CI = 35 to 175] per 10,000 people). EMS providers or first responders started CPR (i.e., no bystander CPR) for 80% of patients. Kernel analysis revealed three areas with a high density of no bystander CPR; these areas coincided with the OHCA cluster sites. Cluster communities were found to have a lower median household income and a larger percentage of people living below the poverty level, to have more residents of African American race, and to have more residents without a high school diploma compared with the city's population in general. CONCLUSIONS: Out-of-hospital cardiac arrest can be plotted by geographic location. Clusters of OHCAs can be identified, which could be used to guide resource allocation. Clusters of OHCAs in which the patients did not receive bystander CPR can also be identified and could be used to direct educational programs. Census data can be superimposed on this information to identify characteristics of cluster locations and were used to demonstrate that the identified clusters were not simply the result of population density.

Cardiopulmonary Resuscitation↗

PubMed2004

Patients with head injuries refusing emergency medical services transport.

PRIMARY OBJECTIVE: To characterize patients with head injury who refuse emergency medical services (EMS) transport to an emergency department (ED). To identify predictors of patients with head injury who refuse EMS transport. RESEARCH DESIGN: Retrospective chart review. METHODS: Patients with a head injury cared for by EMS during 2001 were identified. Medical records were abstracted for demographic and clinical information and reasons for refusing transport. Patients accepting transport were compared to those refusing. Reasons for refusing transport were described. RESULTS: Three hundred and thirty-three patients with head injuries were identified. Sixteen per cent refused EMS transport. Patients refusing transport were more likely to be male, younger and victims of assault and less likely to have lost consciousness. Patients refusing transport often felt they did not need care or could obtain care later. CONCLUSIONS: Patients with head injuries frequently refuse EMS transportation. Individuals accepting care differ significantly from those refusing care. Sufficient awareness of the risk of head injury seems to be lacking among patients.

Adolescent↗

PubMed2003

Continuity of antibiotic therapy in patients admitted from the emergency department.

STUDY OBJECTIVE: We describe discontinuities in antibiotic therapy in patients with community-acquired pneumonia admitted from the emergency department (ED) to an inpatient unit. METHODS: We performed a retrospective cohort study of patients with community-acquired pneumonia admitted from the ED to the internal medicine service at an academic tertiary care hospital between July 1997 and June 1999. We characterized the frequency of antibiotic delays after arrival on the inpatient unit in relation to antibiotic dosing intervals. We performed paired analysis on the patients treated both with an antibiotic dosed every 6 hours and an antibiotic dosed every 24 hours. RESULTS: Three hundred seventy-five patients were identified. The mean age was 61 years. Sixty-two percent were female. Five hundred fifty-one antibiotic doses were started in the ED and continued on the inpatient unit, with 177 ordered every 6 hours, and 351 ordered every 24 hours. Seventy-five percent of the antibiotics dosed every 6 hours and 19% of the antibiotics dosed every 24 hours were delayed more than 30 minutes (P <.001). Analysis of the 146 patients receiving both an antibiotic dosed every 6 and 24 hours showed that the first inpatient dose of antibiotics administered every 6 hours were 10 times more likely to be delayed than antibiotics dosed every 24 hours (95% confidence interval 5.0 to 23). The median delay for antibiotics dosed every 6 hours was 258 minutes (range 45 to 3,360 minutes), and the median delay for antibiotics dosed every 24 hours was 192 minutes (range 32 to 2,124 minutes). CONCLUSION: Discontinuous therapy, represented through a delayed first inpatient antibiotic dose, is common in patients with community-acquired pneumonia admitted from the ED. Although the effect on outcome is unknown, theoretical concerns should lead emergency physicians to consider using longer-acting antibiotics to minimize delayed therapy.

Anti-Bacterial Agents↗

PubMed2003

Efficient communication: assessment-oriented oral case presentation.

OBJECTIVE: To introduce and assess the time savings from and effectiveness of assessment-oriented (AO) oral case presentation as a model of interphysician communication. METHODS: This was a prospective, interventional study of all 10 on-site faculty and 36 residents in a postgraduate year 1 to 3 format emergency medicine residency training program. Residents were requested to perform all oral case presentations in either the traditional or AO formats. Presentations were timed, and residents and faculty rated essential measures of oral case presentation effectiveness: data content, expression of decision making, organization, and overall satisfaction. RESULTS: A total of 199 oral case presentations were sampled-112 traditional and 87 AO. Mean length of presentation for traditional presentations was 117 seconds versus 71 seconds for AO presentations (p < 0.001), a clinically significant difference, without significant differences in the essential measures of case presentation effectiveness. CONCLUSIONS: AO oral case presentation may provide a means for emergency medicine residents to "get to the point" and to communicate effectively and efficiently.

Clinical Competence↗

PubMed2003

Predictors of emergency medical services utilization by elders.

OBJECTIVE: Elders (age > or = 65 years) frequently use emergency medical services (EMS) for care. Understanding reasons for EMS use by elders may allow better management of EMS demand. To the best of the authors' knowledge, no studies have identified patient characteristics associated with EMS use by elders. This study aimed to identify patient attributes associated with elder EMS users. METHODS: This was a prospective cohort study of non-institutionalized elders presenting to an urban university hospital emergency department. Nine hundred thirty elder patients completed the survey. The authors asked patients about access to care, health beliefs, and reasons for requesting EMS assistance. Univariate and logistic regression were used to identify predictors of EMS use. RESULTS: The sample had a mean age of 76 years; 37% were male; 79% were African American. Thirty percent arrived via EMS. Sixty-five percent of those transported and 46% of those not transported by EMS were admitted to the hospital (p < 0.001). Reported reasons for using EMS transport included immobility (33%), illness (22%), request by others (21%), instruction from health care providers (10%), and lack of transportation (10%). Logistic regression identified symptom onset within four hours of seeking care (OR = 3.1), age > or = 85 years (OR = 1.63), increased deficiencies in activities of daily living (OR = 1.40 per deficiency), worse physical functioning (OR = 1.14/10 points), and worse social functioning (OR = 1.06/10 points) as factors associated with EMS use. CONCLUSIONS: Elders report using EMS because of immobility, perceived medical needs, or requests by others. Similarly, the presence of acute illness symptoms, older age, and poor social and physical function, rather than health beliefs, predict EMS use among elders. These factors must be considered when managing the demand for EMS services.

Academic Medical Centers↗

PubMed2002

Effects of physician experience on costs and outcomes on an academic general medicine service: results of a trial of hospitalists.

BACKGROUND: Hospitalists may decrease costs and improve outcomes in hospitalized patients, but existing evidence is limited and has not identified mechanisms for such effects. OBJECTIVE: To study the costs and outcomes for patients on an academic general medicine service assigned to teams led by hospitalists and nonhospitalists. DESIGN: Cohort study. SETTING: Academic general medicine service. PATIENTS: 6511 patients admitted to the hospital from July 1997 through June 1999. INTERVENTION: All patients admitted every fourth day were assigned to 1 of 2 hospitalists caring for inpatients 6 months each year or 1 of 58 nonhospitalists caring for inpatients 1 to 2 months each year. MEASUREMENTS: Length of stay; inpatient costs; and 30-, 60-, and 365-day mortality. RESULTS: Patients assigned to hospitalists (24.8%) and nonhospitalists (75.2%) did not differ in age, race, sex, diagnosis mix, or Charlson index score. In year 1, average adjusted length of stay was 0.29 day shorter for patients cared for by hospitalists than by nonhospitalists (95% CI, -0.66 to 0.06 day; P = 0.06); in year 2, average adjusted length of stay was 0.49 day shorter for patients cared for by hospitalists (CI, -0.79 to -0.15 day; P = 0.01). Average adjusted costs were not significantly reduced for hospitalists compared with nonhospitalists in year 1 but were reduced by $782 in year 2 (CI, -$1313 to -$187; P = 0.01). When years 1 and 2 were combined or when year 1 was analyzed alone, 30-day mortality was not significantly different for hospitalists and nonhospitalists; however, 30-day mortality was 4.2% for hospitalists compared with 6.0% for nonhospitalists in year 2 (CI for difference, 1.8 percentage points [-3.6 to -0.1 percentage points]; P = 0.04) and the adjusted relative risk was 0.65 (CI, 0.44 to 0.96; P = 0.03). In multivariate analyses, resource use decreased with the physician's cumulative experience in caring for a patient's primary diagnosis. Mortality showed a similar pattern. CONCLUSIONS: Hospitalist care was associated with lower costs and short-term mortality in the second but not the first year of hospitalists' experience. Disease-specific physician experience may reduce resource use and improve patient outcomes; in addition, it may be an important determinant of the effectiveness of hospitalists.

Chicago↗

PubMedDate not supplied

An evaluation of paramedics' ability to screen older adults during emergency responses.

OBJECTIVES: This study evaluated the feasibility of using the emergency medical services (EMS) system as a public health provider by having paramedics screen older adults (age >or= 65 years) for influenza immunization status during emergency responses. It also determined the proportion of older-adult EMS patients who lacked an influenza vaccination. METHODS: A retrospective descriptive study was performed, with medical-record review for patients treated between January 2003 and April 2003. Patients were included if they were age 65 years and older, requested assistance via a 9-1-1 call, and were treated by one of 13 paramedics using a directed medical record. The authors calculated the proportion of patients successfully screened and the proportion who reported being nonimmunized. They also compared the patients screened and not screened by the EMS providers and patients who reported being immunized and reported being nonimmunized. RESULTS: Two hundred eighty-eight patients were eligible; the median age was 80 years, 53% were women, 73% were white, and 59% required advanced life support care. Paramedics successfully screened 177 patients (61%; 95% CI, 56-67%). Sixty-five patients (37%; 95% CI, 30-44%) reported being nonimmunized. Failure to screen was associated with a Glasgow Coma Scale score of 13 or less. Lack of immunization was associated with younger age and female gender. CONCLUSION: Paramedics can screen a majority of older adults for influenza immunization status during emergency responses. Older adult users of EMS reported lacking influenza vaccination at levels similar to national estimates. An EMS-based, paramedic-implemented screening program has the potential to identify older adults at risk for preventable illnesses and to augment traditional screening programs, but additional measures are needed to enhance screening rates.

Aged↗

PubMedDate not supplied

Validation of using EMS dispatch codes to identify low-acuity patients.

OBJECTIVE: To validate the predictive ability of previously derived emergency medical services (EMS) dispatch codes to identify patients with low-acuity illnesses. METHODS: This prospective descriptive study was conducted in Rochester, New York. An expert panel reviewed and modified a previously derived set of low-priority EMS dispatch codes. Patients assigned these 21 codes between July 2002 and June 2003 were included for further analysis. Dispatch data and level of EMS care were recorded for each dispatch code. The proportion of low-acuity patients (i.e., those who received only basic life support (BLS) care or those who were not transported using lights and sirens) was determined using previously established definitions. Codes were defined as associated with low-acuity patients if the lower bound of the 95% confidence interval (CI) exceeded 90%. Medical records for patients identified as high-acuity were reviewed to evaluate whether the advanced life support (ALS) level care that was provided had a clinical impact. RESULTS: Emergency medical services cared for 43,602 patients during the study, and 7,540 were dispatched as low-priority. We found that 7,197 (95%; 95% CI: 95-96%) of these patients met low-acuity criteria and that 11 of the evaluated codes were validated, with low-acuity care provided at least 90% of the time. Of the 343 patients identified as high-acuity, 62 (18%; 95% CI: 14-23%) were determined to have received interventions that had a clinical impact. CONCLUSIONS: This study prospectively validates 11 EMS dispatch codes as being associated with low-acuity patients. These codes could be used to triage EMS patients based on dispatch information.

Acute Disease↗

PubMedDate not supplied

Derivation of emergency medical services dispatch codes associated with low-acuity patients.

OBJECTIVE: To identify emergency medical services (EMS) dispatch codes associated with basic life support (BLS) level of prehospital care, a proxy for low illness acuity. METHODS: This retrospective cohort study was conducted in an urban city with a single advanced life support level EMS provider. The 911 center was certified in using dispatch protocols from Priority Dispatch Corporation (Salt Lake City, UT). Dispatch data on all transported EMS patients from August 2001 to April 2002 were abstracted. The authors prospectively defined a low-acuity patient as one who received BLS-level care and defined a low-acuity dispatch code as one in which at least 90% of coded patients required only BLS care. For each dispatch code or code group, the authors calculated the fraction of patients who received BLS-level care. For each "A"-level (lowest category) dispatch code group, the fraction of patients receiving BLS-level care was also evaluated. RESULTS: A total of 19,332 calls met inclusion criteria and were categorized into 118 dispatch codes or code groups. Twenty-eight codes or code groups with 7,801 patients met the authors' definition of low acuity. Overall, 7,394 patients received only BLS care (94.8%, 95% confidence interval: 94.3%-95.3%). Analysis of "A"-level dispatch code groups found BLS use rates of 52.8% to 99.3%. CONCLUSIONS: Certain dispatch codes are associated with the delivery of BLS-level care, indicating identification of patients likely to be low acuity. These codes are not necessarily "A"-level dispatch codes, which are commonly considered to represent the lowest-acuity patients. Future studies are needed to prospectively validate that these codes do represent low-acuity patients.

Acute Disease↗

PubMedDate not supplied

A comparison of first-responder automated external defibrillator (AED) application rates and characteristics of AED training.

OBJECTIVE: To determine whether there were associations between the characteristics of first-responder automated external defibrillator (AED) training and AED application rates. METHODS: This multicenter retrospective cohort study analyzed data from ten emergency medical services systems where first responders were trained and equipped with AEDs. Data were provided for all out-of-hospital cardiac arrests (OHCAs) occurring over two years, including whether the first-responder AED was applied (pads attached to patient). Systems were surveyed to determine the characteristics of their initial and continuing AED training. Data were analyzed using odds ratios (ORs) with 95% confidence intervals (95% CIs). RESULTS: Overall, the first-responder AED was applied to 53% of 2,181 OHCAs. First responders applied AEDs to 60% of OHCAs when a national AED training curriculum was used and to 49% of OHCAs when a locally created curriculum was used (OR=1.58; 95% CI=1.32-1.88). First responders applied AEDs to 61% of OHCAs when they were trained to the level of Certified First Responder or higher and to 28% of OHCAs when they were trained only in cardiopulmonary resuscitation (OR=3.97; 95% CI=3.20-4.93). First responders applied AEDs to 66% of OHCAs when they each had an opportunity to apply the AED during continuing training and to 17% of OHCAs when they did not have this opportunity (OR=9.04; 95% CI=7.15-11.42). First responders applied AEDs to 59% of OHCAs when they had not received continuing training within one year of their initial training and to 42% of OHCAs when they had received continuing training in the first year (OR=2.00; 95% CI=1.67-2.40). CONCLUSION: Use of a national AED training curriculum, training to the level of Certified First Responder or higher, and the ability for each first responder to apply the AED during continuing training were associated with higher AED application rates. Continuing training within the first year did not appear to be as important as actually using the AED during the training.

Advanced Cardiac Life Support↗