Ornato J P, Craren E J, Gonzalez E R, Garnett A R, McClung B K, Newman M M
Department of Internal Medicine, Medical College of Virginia, Richmond 23298.
Am J Emerg Med. 1988 Mar;6(2):108-12. doi: 10.1016/0735-6757(88)90045-9.
Effective emergency systems using emergency medical technicians (EMTs) trained to defibrillate or paramedics can save more lives from out-of-hospital cardiac arrest due to ventricular fibrillation than can emergency systems staffed with basic EMTs who cannot defibrillate. This article focuses on the cost-effectiveness of systems staffed with each type of EMT. Data were collected from all 50 states and from the District of Columbia to determine the number of hours and estimated cost of initial training for the three types of EMTs in the United States in 1986. The median initial training hours for basic EMTs, EMTs trained in defibrillation, and paramedics were 110, 129, and 700, respectively. Median costs for initial training at each EMT level were +123, +150, and +1580/student. According to published survival data for emergency medical systems staffed with EMTs at each level, the total initial training personnel and equipment cost per life saved from ventricular fibrillation was +7687, +2126, and +2289 for systems staffed by the respective EMTs. The initial cost per life saved from ventricular fibrillation is more than three times greater in systems staffed by basic EMTs than in systems staffed by EMTs trained in defibrillation or paramedics. From a medical and a cost-effective standpoint, all communities served by basic EMTs should consider upgrading them to at least the defibrillation-trained EMT level.
使用经过除颤培训的急救医疗技术员（EMT）或护理人员的高效急救系统，相较于配备无除颤能力的基础EMT的急救系统，能挽救更多因心室颤动导致的院外心脏骤停患者的生命。本文聚焦于配备各类EMT的系统的成本效益。数据收集自美国所有50个州及哥伦比亚特区，以确定1986年美国三种类型EMT的初始培训时长及估计成本。基础EMT、接受除颤培训的EMT和护理人员的初始培训时长中位数分别为110小时、129小时和700小时。每个EMT级别初始培训的成本中位数分别为每位学生123美元、150美元和1580美元。根据已公布的各级别配备EMT的急救医疗系统的生存数据，因心室颤动每挽救一条生命，由相应EMT配备的系统的初始培训人员和设备总成本分别为7687美元、2126美元和2289美元。基础EMT配备的系统中，因心室颤动每挽救一条生命的初始成本，比接受除颤培训的EMT或护理人员配备的系统高出三倍多。从医学和成本效益的角度来看，所有由基础EMT服务的社区都应考虑将其升级到至少接受除颤培训的EMT级别。
