Raun Loren, Pederson John, Campos Laura, Ensor Katherine, Persse David
Department of Statistics, Rice University, Houston, Texas (Drs Raun and Ensor, Mr Pederson, and Ms Campos); City of Houston Health Department, 7411 Park Place Blvd, Houston, TX 77087, USA (Dr Raun); Emergency Medical Services, City of Houston, Houston, Texas (Dr Persse); and Baylor College of Medicine, Houston, Texas (Dr Persse).
J Public Health Manag Pract. 2019 Sep/Oct;25(5):E13-E21. doi: 10.1097/PHH.0000000000000836.
Houston policy is to dual dispatch medically trained firefighters, in addition to emergency medical services (EMS) units to out-of-hospital cardiac arrest (OHCA) cases. While believed to improve public health outcomes, no research exists supporting the policy that when firefighters respond before a better-equipped EMS unit, they increase the probability of survival.
To inform EMS policy decisions regarding the effectiveness of dual dispatch by determining the impact of medically trained firefighter dispatch on return of spontaneous circulation (ROSC), a measure of survivability, in OHCA 911 calls while controlling for the subsequent arrival of an EMS unit.
This retrospective study uses logistic regression to determine the association between ROSC and response time for fire apparatus first responders controlling for arrival of the EMS unit.
Out-of-hospital cardiac arrest cases in Houston between May 2008 and April 2013 when dual dispatch was used.
A total of 6961 OHCA cases with the complete data needed for the analysis.
Logistic regression of the dependence of OHCA survival using the indicator ROSC, as related to the fire first responder response times controlling for subsequent arrival of the EMS.
Fire apparatus arrived first in 46.7% of cases, a median value of 1.5 minutes before an EMS unit. Controlling for subsequent arrival time of EMS has no effect on ROSC achieved by the fire first responder. If the firefighters had not responded, the resulting 1.5-minute increase in response time equates to a decrease in probability of attaining ROSC of 20.1% for cases regardless of presenting heart rhythm and a 47.7% decrease for ventricular fibrillation cases in which bystander cardiopulmonary resuscitation was initiated.
The firefighter first responder not only improved response time but also greatly increased survivability independent of the arrival time of the better-equipped EMS unit, validating the public health benefit of the dual dispatch policy in Houston.
休斯顿的政策是，除了紧急医疗服务（EMS）单位外，还要向院外心脏骤停（OHCA）病例双重派遣经过医学培训的消防员。虽然人们认为这会改善公众健康结果，但尚无研究支持以下政策：当消防员在装备更精良的EMS单位之前做出响应时，会增加患者存活的概率。
通过确定在控制EMS单位后续到达时间的同时，经过医学培训的消防员派遣对院外心脏骤停911呼叫中自主循环恢复（ROSC，一种生存能力指标）的影响，为有关双重派遣有效性的EMS政策决策提供依据。
这项回顾性研究使用逻辑回归来确定消防设备第一响应者的ROSC与响应时间之间的关联，并控制EMS单位的到达情况。
2008年5月至2013年4月休斯顿使用双重派遣时的院外心脏骤停病例。
共有6961例OHCA病例具备分析所需的完整数据。
使用ROSC指标对OHCA存活依赖性进行逻辑回归，该指标与控制EMS后续到达情况的消防第一响应者响应时间相关。
在46.7%的病例中，消防设备最先到达，比EMS单位早中位数1.5分钟。控制EMS的后续到达时间对消防第一响应者实现的ROSC没有影响。如果消防员没有做出响应，响应时间增加1.5分钟相当于无论初始心律如何，病例实现ROSC的概率降低20.1%，对于开始进行旁观者心肺复苏的心室颤动病例，概率降低47.7%。
消防第一响应者不仅缩短了响应时间，还在不考虑装备更精良的EMS单位到达时间的情况下极大地提高了生存能力，证实了休斯顿双重派遣政策对公众健康的益处。
