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. 2022 Dec;9(4):314-322.
doi: 10.15441/ceem.22.205. Epub 2022 Oct 7.

The number and level of first-contact emergency medical services crew and clinical outcomes in out-of-hospital cardiac arrest with dual dispatch response

Young Su Kim  1 , Ki Hong Kim  2   3 , Kyoung Jun Song  3   4 , Sang Do Shin  2   3 , Jeong Ho Park  2   3
Affiliations

The number and level of first-contact emergency medical services crew and clinical outcomes in out-of-hospital cardiac arrest with dual dispatch response

Young Su Kim et al. Clin Exp Emerg Med. 2022 Dec.

Abstract

Objective: This study aimed to evaluate the association between the number and level of emergency medical technicians (EMTs) in the first-contact emergency medical services (EMS) unit and the clinical outcomes of out-of-hospital cardiac arrest (OHCA) with a dual dispatch response.

Methods: Adult nontraumatic EMS-treated OHCAs between 2015 and 2018 in a nationwide database, were enrolled. The main exposure was the number and certification level of first-contact EMS crew: three versus two members, proportion of EMT intermediate level (EMT-I) over 50% versus under or equal to 50%. Good neurologic recovery was selected as the primary outcome. Multilevel multivariable logistic regression analysis was conducted to calculate adjusted odds ratios and confidence intervals.

Results: A total of 26,867 patients were enrolled and analyzed. Good neurologic recovery was different across the study groups: 5.4% in the two-member crews, 7.2% in the three-member crews, 5.9% in the low EMT-I proportion crews, and 6.8% in the high EMT-I proportion crews. In the main analysis, statistically significant differences for favorable outcomes were found between the three-member and two-member crews, and the high EMT-I proportion and low EMT-I proportion crews; for good neurologic recovery, adjusted odds ratios (95% confidence interval) were 1.23 (1.06-1.43) for three-member crews, and 1.28 (1.17-1.40) for a high EMT-I proportion.

Conclusion: The higher number and level of first-contact EMS crew was associated with better neurologic recovery in adult nontraumatic OHCA with a dual-dispatched EMS response.

Keywords: Cardiopulmonary resuscitation; Emergency medical services; Out-of-hospital cardiac arrest.

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Conflict of interest statement

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Categorization of study groups according to the number and certification level of emergency medical services (EMS) crews in each ambulance in a dual dispatch. EMT-B, emergency medical technician basic level; EMT-I, emergency medical technician intermediate level; OHCA, out-of-hospital cardiac arrest.
Fig. 2.
Fig. 2.
Patient flow. EMS, emergency medical services; OHCA, out-of-hospital cardiac arrest.
Fig. 3.
Fig. 3.
Interaction plot by emergency medical technician intermediate level (EMT-I) proportion across number of first-contact emergency medical services (EMS) crews and clinical outcomes. (A) Good neurologic recovery, (B) survival to discharge, and (C) prehospital return of spontaneous circulation.
See this image and copyright information in PMC

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