紧急医疗服务与心脏病死亡率：一项社区研究

Rea Thomas D, Eisenberg Mickey S, Becker Linda J, Lima Ann R, Fahrenbruch Carol E, Copass Michael K, Cobb Leonard A

Department of Medicine, University of Washington, Seattle, WA, USA.

Ann Emerg Med. 2003 Apr;41(4):494-9. doi: 10.1067/mem.2003.149.

STUDY OBJECTIVES

Little is known regarding the potential effects of emergency medical services (EMS) on total heart disease mortality. Although EMS may provide health benefits in less acute cardiac conditions, its immediate, measurable, and direct effect on heart disease mortality is through resuscitation of persons suffering out-of-hospital cardiac arrest. The purpose of this study was to examine the involvement and potential mortality benefit of out-of-hospital EMS care of cardiac arrest on community heart disease mortality.

METHODS

The investigation was an observational study of all persons with death events resulting from heart disease as defined by heart disease deaths and deaths averted (persons successfully resuscitated from out-of-hospital cardiac arrest by EMS) in a single county from January 1, 2000, through December 31, 2000. The county of study has a population of nearly 2 million people and is composed of urban, suburban, and rural components. State vital records and EMS reports were used to ascertain deaths resulting from heart disease and deaths averted.

RESULTS

In the year 2000, 3,577 persons died as a result of heart disease, and 128 persons were successfully resuscitated and discharged from the hospital, for a total of 3,705 death events. EMS responded to 39% (1,428/3,705) of all heart disease death events and 57% (1,428/2,516) of out-of-hospital events, resulting in a 3.5% (128/3,705) reduction in overall heart disease mortality and a 5.1% (128/2,516) reduction in out-of-hospital mortality.

CONCLUSION

EMS was involved in the majority of out-of-hospital heart disease death events, resulting in a measurable reduction in heart disease mortality.

研究目的

关于紧急医疗服务（EMS）对心脏病总死亡率的潜在影响，目前所知甚少。尽管EMS可能在不太急性的心脏疾病中带来健康益处，但其对心脏病死亡率的直接、可测量和即时影响是通过对院外心脏骤停患者的复苏。本研究的目的是检查院外EMS对心脏骤停的护理在社区心脏病死亡率方面的参与情况及潜在的死亡率益处。

方法

该调查是一项观察性研究，对象为2000年1月1日至2000年12月31日期间，在一个单一县内所有因心脏病导致死亡事件的人员，这些事件包括心脏病死亡以及避免的死亡（通过EMS成功从院外心脏骤停中复苏的人员）。研究的县人口近200万，由城市、郊区和农村部分组成。使用州生命记录和EMS报告来确定心脏病导致的死亡和避免的死亡。

结果

在2000年，3577人死于心脏病，128人成功复苏并出院，总共有3705起死亡事件。EMS对所有心脏病死亡事件的39%（1428/3705）做出了响应，对院外事件的57%（1428/2516）做出了响应，导致总体心脏病死亡率降低了3.5%（128/3705），院外死亡率降低了5.1%（128/2516）。