Sudden cardiac death (SCD) continues unabated. Coronary care units, while effective in lowering hospital mortality, cannot significantly reduce SCD which occurs primarily outside the hospital and accounts for the majority of deaths from coronary heart disease (CHD). In view of the frequent precipitous nature of SCD, only a program which identifies and protects the victim prior to the event can hope to be successful in preventing the majority of SCD. Since it is likely that SCD is due to an arrhythmia, drug prophylaxis might prove effective. In view of the toxicity of currently available agents, it is mandatory to preselect a population at highest risk before embarking on a drug trial. Ventricular premature beats (VPB) may identify subjects susceptible to SCD. Epidemiologic and physiologic information on VPB is reviewed, and proposals are made for studies designed to establish the usefulness of VPB as a risk factor for SCD.

Approaches to Sudden Death from Coronary Heart Disease

In order to better understand the problem of prehospital sudden cardiac death (SCD) two groups of individuals were studied. One group was monitored by rescue squads during attempted rescue. These subjects were defibrillated from prehospital ventricular fibrillation (VF) and hospitalized if they survived or autopsied if they could not be resuscitated. The second group were SCDs which were witnessed and described by observers. Detailed past histories of both groups were collected, and either clinical or autopsy diagnoses were obtained. On the day of death or VF, one quarter reported new symptoms (primarily chest pain and dyspnea) preceding collapse by more than 30 minutes, one quarter reported symptoms lasting from 1 to 30 minutes, and one half collapsed instantaneously or within 1 minute of acute symptoms. A history of old myocardial infarction (MI) was present in 41% and of angina pectoris in 54%, and 27% reported new or changing symptoms within four weeks. In defibrillated survivors, "would-be SCDs," ele...

Pathophysiologic Observations in Prehospital Ventricular Fibrillation and Sudden Cardiac Death

In 51 months, 234 patients with out-of-hospital ventricular fibrillation (VF) were successfully resuscitated, hospitalized, and discharged home. Patients surviving an episode of primary ventricular fibrillation, that is, VF not associated with acute myocardial infarction, showed a 2-year mortality rate greater than three times that of survivors from VF associated with acute transmural infarction. Recurrent out-of-hospital VF was common, and a pattern of early recurrence was noted, with a median interval of 17 weeks in 34 documented cases. Ten patients were counted as long-term survivors from second episodes of out-of-hospital VF, one of whom survived a third episode. Coronary anatomy and ventricular function were studied in 29 survivors of primary VF. Of the 29 patients, 23 had coronary disease, considered "operable" in 17. Exercise testing and left ventricular function studies were normal or minimally abnormal in approximately half of these patients. There is an obvious need to develop effective measures to prevent primary VF, which commonly presents almost instantaneously, without prodromal symptoms.

Resuscitation from out-of-hospital ventricular fibrillation: 4 years follow-up.

How can we meet the special needs of children for emergency medical services (EMS) when today's EMS systems are often unprepared for the challenge? This comprehensive overview of EMS for children (EMS-C) provides an answer by presenting a vision for tomorrow's EMS-C system and practical recommendations for attaining it. Drawing on many studies and examples, the volume explores why emergency care for children--from infants through adolescents--must differ from that for adults and describes what seriously ill or injured children generally experience in today's EMS systems. The book points the way to integrating EMS-C into current emergency programs and into broader aspects of health care for children. It gives recommendations for ensuring access to emergency care through the 9-1-1 system; training health professionals, from paramedics to physicians; educating the public; providing proper equipment, protocols, and referral systems; improving communications among EMS-C providers; enhancing data resources and expanding research efforts; and stimulating and supporting leadership in EMS-C at the federal and state levels. For those already deeply involved in EMS efforts, this volume is a convenient, up-to-date, and comprehensive source of information and ideas. More importantly, for anyone interested in improving the emergency services available to children--emergency care professionals from emergency medical technicians to nurses to physicians, hospital and EMS administrators, public officials, health educators, children's advocacy groups, concerned parents and other responsible adults--this timely volume provides a realistic plan for action to link EMS-C system components into a workable structure that will better serve all of the nation's children.

Emergency medical services for children

https://www.amjmed.com/article/0002-9343(75)90564-1/pdf

Reduction of prehospital, ambulance and community coronary death rates by the community-wide emergency cardiac care system.

By means of a telemetry-medical command system, a program based on cooperation between in-hospital physicians and mobile paramedical rescue crews, 146 consecutive victims were monitored remotely by telemetered electrocardiogram over a 24-month period. Of those successfully monitored, ventricular fibrillation or standstill was found in 15% while bradyrhythmias were found in 6%. Response time by rescue vehicle was four minutes or less in 80% of the cases. This mobile emergency care system offers advantages over new and special physician-staffed systems in that it has very fast response times, uses highly trained paramedics, possesses immediate availability, entails lower costs, permits higher utilization by applying to a greater variety of emergency conditions, and commands general community acceptance. Defibrillation of a victim outside the hospital was monitored by radio.

https://jamanetwork.com/journals/JAMA/articlepdf/357109/jama_214_2_009.pdf

David Rankin

Papers

Telemetry-medical command in coronary and other mobile emergency care systems.