Refibrillation managed by EMT-Ds: incidence and outcome without paramedic back-up.

Some patients converted from ventricular fibrillation to organized rhythms by defibrillation-trained ambulance technicians (EMT-Ds) will refibrillate before hospital arrival. The authors analyzed 271 cases of ventricular fibrillation managed by EMT-Ds working without paramedic back-up. Of 111 patients initially converted to organized rhythms, 19 (17%) refibrillated, 11 (58%) of whom were reconverted to perfusing rhythms, including nine of 11 (82%) who had spontaneous pulses prior to refibrillation. Among patients initially converted to organized rhythms, hospital admission rates were lower for patients who refibrillated than for patients who did not (53% versus 76%, P = NS), although discharge rates were virtually identical (37% and 35%, respectively). Scene-to-hospital transport times were not predictively associated with either the frequency of refibrillation or patient outcome. Defibrillation-trained EMTs can effectively manage refibrillation with additional shocks and are not at a significant disadvantage when paramedic back-up is not available.