Stults K R, Brown D D
Circulation. 1986 Dec;74(6 Pt 2):IV13-7.
Defibrillation by minimally trained ambulance technicians can significantly improve survival after out-of-hospital cardiac arrest in communities of all sizes. However, special consideration must be given to the development of such services in small communities, chiefly because of problems associated with the low volume of true emergency calls. Communities considering implementing programs by which defibrillation is performed by the emergency medical technician (EMT-D) must first evaluate their ambulance response times and, if inadequate, alter their system of ambulance response. After implementation of such a program, a permanent, formal skill maintenance program must be established. Defibrillation protocols must allow for the fact that many patients will refibrillate after successful conversion, yet no advanced care beyond the defibrillator will generally be available. Finally, every community instituting an EMT-D program must maintain a system of monitoring EMT performance and patient outcome that documents acceptable survival-to-discharge rates as well as the safety of the program. For smaller communities a regional or statewide evaluation system may be preferable to individual community programs.
由训练程度较低的救护车急救人员进行除颤，可显著提高各类规模社区院外心脏骤停后的生存率。然而，在小社区开展此类服务时必须给予特别考虑，主要是因为与真正紧急呼叫数量少相关的问题。考虑实施由急救医疗技术员（EMT-D）进行除颤项目的社区，必须首先评估其救护车响应时间，若响应时间不足，则需改变其救护车响应系统。实施此类项目后，必须建立一个永久性的、正规的技能维护项目。除颤方案必须考虑到许多患者在成功复律后会再次发生室颤，但除颤器之外通常不会有进一步的高级护理。最后，每个开展EMT-D项目的社区必须维持一个监测急救人员表现和患者结果的系统，该系统要记录可接受的出院生存率以及项目的安全性。对于较小的社区，区域或全州范围的评估系统可能比单个社区项目更可取。
