EARLY DEFIBRILLATION BY EMTS - THE BRUSSELS EXPERIENCE

Considering that in Brussels the first-aid ambulance team reaches the patient in cardiac arrest 10 min before the physician-manned ambulance , we instituted a feasibility study of early defibrillation by emergen cy medical technicians (EMTs). Three hundred EMTs received a 20-h auto matic external defibrillation (AED) training course followed by a refr esher course every 6 months. of 316 cardiac arrests included in this s tudy, asystole was encountered in 53% and ventricular fibrillation/ven tricular tachycardia (VF/VT) in 33% of the cases on arrival of the EMT s. In the VF/VT group, defibrillation was performed by EMTs with a Lae rdal Heartstart 7-9 min before the medical team arrived. The overall c ardiac arrest survival rate improved from 7% in 1989 to 19% in 1992. H owever, the long-term survival rate (14/105) of ventricular fibrillati on remained low because of excessive delays in emergency medical servi ce (EMS) access and in early ACLS. In conclusion, this work shows that in Brussels: (1) early defibrillation of cardiac arrest victims in VF is feasible by EMTs when a training and a follow-up program are imple mented; (2) the weakest link of the chain of survival is the early EMS access, and the early ACLS; and (3) the AED program increases the int erest and the efficacy of EMTs and medical teams in the management of cardiac arrests.