Department of Public Health Medicine, Health Service Executive, Donegal, Ireland; Discipine of General Practice, National University of Ireland, Galway, Ireland.
Department of Public Health Medicine, Health Service Executive, Donegal, Ireland.
Resuscitation. 2015 Jun;91:42-7. doi: 10.1016/j.resuscitation.2015.03.012. Epub 2015 Mar 26.
More than a third of Ireland's population lives in a rural area, defined as the population residing in all areas outside clusters of 1500 or more inhabitants. This presents a challenge for the provision of effective pre-hospital resuscitation services. In 2012, Ireland became one of three European countries with nationwide Out-of-Hospital Cardiac Arrest (OHCA) register coverage. An OHCA register provides an ability to monitor quality and equity of access to life-saving services in Irish communities.
To use the first year of national OHCAR data to assess differences in the occurrence, incidence and outcomes of OHCA where resuscitation is attempted and the incident is attended by statutory Emergency Medical Services between rural and urban settings.
The geographical coordinates of incident locations were identified and co-ordinates were then classified as 'urban' or 'rural' according to the Irish Central Statistics Office (CSO) definition.
1798 OHCA incidents were recorded which were attended by statutory Emergency Medical Services (EMS) and where resuscitation was attempted. There was a higher percentage of male patients in rural settings (71% vs. 65%; p = 0.009) but the incidence of male patients did not differ significantly between urban and rural settings (26 vs. 25 males/100,000 population/year p = 0.353). A higher proportion of rural patients received bystander cardiopulmonary resuscitation (B-CPR) 70% vs. 55% (p ≤ 0.001), and had defibrillation attempted before statutory EMS arrival (7% vs. 4% (p = 0.019), respectively). Urban patients were more likely to receive a statutory EMS response in 8 min or less (33% vs. 9%; p ≤ 0.001). Urban patients were also more likely to be discharged alive from hospital (6% vs. 3%; p = 0.006) (incidence 2.5 vs. 1.1/100,000 population/year; p ≤ 0.001). Multivariable analysis of survival showed that the main variable of interest i.e. urban vs. rural setting was also independently associated with discharge from hospital alive (OR 3.23 (95% CI 1.43-7.31)).
There are significant disparities in the incidence of resuscitation attempts in urban and rural areas. There are challenges in the provision of services and subsequent outcomes from OHCA that occur outside of urban areas requiring novel and innovative solutions. An integrated community response system is necessary to improve metrics around OHCA response and outcomes in rural areas.
爱尔兰超过三分之一的人口居住在农村地区，这些地区被定义为居住在人口少于 1500 人的所有地区之外的地区。这对提供有效的院前复苏服务提出了挑战。2012 年，爱尔兰成为拥有全国范围院外心脏骤停（OHCA）登记覆盖的三个欧洲国家之一。OHCA 登记册提供了监测爱尔兰社区获得救生服务的质量和公平性的能力。
利用全国 OHCA 数据的第一年，评估尝试复苏和有法定紧急医疗服务（EMS）参与的农村和城市环境中 OHCA 发生率、发病率和结局的差异。
确定事件地点的地理坐标，然后根据爱尔兰中央统计局（CSO）的定义，将坐标分类为“城市”或“农村”。
记录了 1798 例 OHCA 事件，这些事件均由法定 EMS 处理，并尝试了复苏。农村地区的男性患者比例较高（71%比 65%；p = 0.009），但城乡地区的男性患者发病率差异无统计学意义（26 比 25 男性/每 10 万人口/年，p = 0.353）。农村患者接受旁观者心肺复苏术（B-CPR）的比例较高（70%比 55%；p ≤ 0.001），并且在法定 EMS 到达之前接受电除颤的比例也较高（7%比 4%；p = 0.019）。城市患者更有可能在 8 分钟或更短时间内获得法定 EMS 响应（33%比 9%；p ≤ 0.001）。城市患者也更有可能从医院出院时存活（6%比 3%；p = 0.006）（发病率为 2.5 比 1.1/每 10 万人口/年；p ≤ 0.001）。对生存的多变量分析表明，感兴趣的主要变量，即城市与农村环境，也与从医院出院存活独立相关（OR 3.23（95%CI 1.43-7.31））。
在城市和农村地区，复苏尝试的发生率存在显著差异。在城市地区以外发生的 OHCA 服务提供和随后的结果存在挑战，需要新颖和创新的解决方案。需要建立一个综合的社区应对系统，以改善农村地区 OHCA 应对和结果的指标。
