PROGRAMS THAT provide advanced life support outside the hospital have operated for more than two decades. Although cardiac arrest is encountered by paramedic teams only in a small proportion of responses, that condition is particularly important for emergency medical services (EMS) providers. First, cardiac arrest is potentially reversible if treated promptly and appropriately. A second reason for directing attention to this disorder is that survival rates are relatively easy to determine and can be used as one measure of the effectiveness of the EMS system. In paramedic-supported EMS systems, reported rates of survival to hospital discharge have typically ranged from about 11% to 33% for patients with an initial rhythm of ventricular fibrillation (VF).1 However, two recent articles2,3 describe considerably lower survival rates, even though standard procedures, training, and equipment seem to have been used. The survival rates for patients with initial rhythms of VF (or ventricular tachycardia)
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