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Prehospital Emergency Care Volume 14, 2010 - Issue 3
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Education and Practice

Delayed Prehospital Implementation of the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care

Blair L. Bigham From Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital (BLB, LJM), University of Toronto, Toronto, Ontario, Canada; the University of Washington (KK, JP), Seattle, Washington; Axio Research (KK), Seattle, Washington; the Medical College of Wisconsin (TPA), Milwaukee, Wisconsin; the University of California San Diego (DPD), San Diego, California; British Columbia Ambulance Service (SD), Vancouver, British Columbia, Canada; the University of Pittsburgh (BS), Pittsburgh, Pennsylvania; the University of Alabama at Birmingham (SN), Birmingham, Alabama; Gresham Fire and Emergency Services (JS), Gresham, Oregon; and the University of Texas Southwestern (AI), Dallas, Texas. Revision received January 27, 2010; accepted for publication February 17, 2010.Correspondence[email protected]
, MSc ACPf,
Kent Koprowicz From Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital (BLB, LJM), University of Toronto, Toronto, Ontario, Canada; the University of Washington (KK, JP), Seattle, Washington; Axio Research (KK), Seattle, Washington; the Medical College of Wisconsin (TPA), Milwaukee, Wisconsin; the University of California San Diego (DPD), San Diego, California; British Columbia Ambulance Service (SD), Vancouver, British Columbia, Canada; the University of Pittsburgh (BS), Pittsburgh, Pennsylvania; the University of Alabama at Birmingham (SN), Birmingham, Alabama; Gresham Fire and Emergency Services (JS), Gresham, Oregon; and the University of Texas Southwestern (AI), Dallas, Texas. Revision received January 27, 2010; accepted for publication February 17, 2010.
, PhD(c),
Tom P. Aufderheide From Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital (BLB, LJM), University of Toronto, Toronto, Ontario, Canada; the University of Washington (KK, JP), Seattle, Washington; Axio Research (KK), Seattle, Washington; the Medical College of Wisconsin (TPA), Milwaukee, Wisconsin; the University of California San Diego (DPD), San Diego, California; British Columbia Ambulance Service (SD), Vancouver, British Columbia, Canada; the University of Pittsburgh (BS), Pittsburgh, Pennsylvania; the University of Alabama at Birmingham (SN), Birmingham, Alabama; Gresham Fire and Emergency Services (JS), Gresham, Oregon; and the University of Texas Southwestern (AI), Dallas, Texas. Revision received January 27, 2010; accepted for publication February 17, 2010.
, MD,
Daniel P. Davis From Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital (BLB, LJM), University of Toronto, Toronto, Ontario, Canada; the University of Washington (KK, JP), Seattle, Washington; Axio Research (KK), Seattle, Washington; the Medical College of Wisconsin (TPA), Milwaukee, Wisconsin; the University of California San Diego (DPD), San Diego, California; British Columbia Ambulance Service (SD), Vancouver, British Columbia, Canada; the University of Pittsburgh (BS), Pittsburgh, Pennsylvania; the University of Alabama at Birmingham (SN), Birmingham, Alabama; Gresham Fire and Emergency Services (JS), Gresham, Oregon; and the University of Texas Southwestern (AI), Dallas, Texas. Revision received January 27, 2010; accepted for publication February 17, 2010.
, MD,
Stuart Donn From Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital (BLB, LJM), University of Toronto, Toronto, Ontario, Canada; the University of Washington (KK, JP), Seattle, Washington; Axio Research (KK), Seattle, Washington; the Medical College of Wisconsin (TPA), Milwaukee, Wisconsin; the University of California San Diego (DPD), San Diego, California; British Columbia Ambulance Service (SD), Vancouver, British Columbia, Canada; the University of Pittsburgh (BS), Pittsburgh, Pennsylvania; the University of Alabama at Birmingham (SN), Birmingham, Alabama; Gresham Fire and Emergency Services (JS), Gresham, Oregon; and the University of Texas Southwestern (AI), Dallas, Texas. Revision received January 27, 2010; accepted for publication February 17, 2010.
, PhD,
Judy Powell From Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital (BLB, LJM), University of Toronto, Toronto, Ontario, Canada; the University of Washington (KK, JP), Seattle, Washington; Axio Research (KK), Seattle, Washington; the Medical College of Wisconsin (TPA), Milwaukee, Wisconsin; the University of California San Diego (DPD), San Diego, California; British Columbia Ambulance Service (SD), Vancouver, British Columbia, Canada; the University of Pittsburgh (BS), Pittsburgh, Pennsylvania; the University of Alabama at Birmingham (SN), Birmingham, Alabama; Gresham Fire and Emergency Services (JS), Gresham, Oregon; and the University of Texas Southwestern (AI), Dallas, Texas. Revision received January 27, 2010; accepted for publication February 17, 2010.
, BSN,
Brian Suffoletto From Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital (BLB, LJM), University of Toronto, Toronto, Ontario, Canada; the University of Washington (KK, JP), Seattle, Washington; Axio Research (KK), Seattle, Washington; the Medical College of Wisconsin (TPA), Milwaukee, Wisconsin; the University of California San Diego (DPD), San Diego, California; British Columbia Ambulance Service (SD), Vancouver, British Columbia, Canada; the University of Pittsburgh (BS), Pittsburgh, Pennsylvania; the University of Alabama at Birmingham (SN), Birmingham, Alabama; Gresham Fire and Emergency Services (JS), Gresham, Oregon; and the University of Texas Southwestern (AI), Dallas, Texas. Revision received January 27, 2010; accepted for publication February 17, 2010.
, MD,
Sarah Nafziger From Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital (BLB, LJM), University of Toronto, Toronto, Ontario, Canada; the University of Washington (KK, JP), Seattle, Washington; Axio Research (KK), Seattle, Washington; the Medical College of Wisconsin (TPA), Milwaukee, Wisconsin; the University of California San Diego (DPD), San Diego, California; British Columbia Ambulance Service (SD), Vancouver, British Columbia, Canada; the University of Pittsburgh (BS), Pittsburgh, Pennsylvania; the University of Alabama at Birmingham (SN), Birmingham, Alabama; Gresham Fire and Emergency Services (JS), Gresham, Oregon; and the University of Texas Southwestern (AI), Dallas, Texas. Revision received January 27, 2010; accepted for publication February 17, 2010.
, MD,
John Stouffer From Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital (BLB, LJM), University of Toronto, Toronto, Ontario, Canada; the University of Washington (KK, JP), Seattle, Washington; Axio Research (KK), Seattle, Washington; the Medical College of Wisconsin (TPA), Milwaukee, Wisconsin; the University of California San Diego (DPD), San Diego, California; British Columbia Ambulance Service (SD), Vancouver, British Columbia, Canada; the University of Pittsburgh (BS), Pittsburgh, Pennsylvania; the University of Alabama at Birmingham (SN), Birmingham, Alabama; Gresham Fire and Emergency Services (JS), Gresham, Oregon; and the University of Texas Southwestern (AI), Dallas, Texas. Revision received January 27, 2010; accepted for publication February 17, 2010.
, EMT-P,
Ahamed Idris From Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital (BLB, LJM), University of Toronto, Toronto, Ontario, Canada; the University of Washington (KK, JP), Seattle, Washington; Axio Research (KK), Seattle, Washington; the Medical College of Wisconsin (TPA), Milwaukee, Wisconsin; the University of California San Diego (DPD), San Diego, California; British Columbia Ambulance Service (SD), Vancouver, British Columbia, Canada; the University of Pittsburgh (BS), Pittsburgh, Pennsylvania; the University of Alabama at Birmingham (SN), Birmingham, Alabama; Gresham Fire and Emergency Services (JS), Gresham, Oregon; and the University of Texas Southwestern (AI), Dallas, Texas. Revision received January 27, 2010; accepted for publication February 17, 2010.
, MD &
Laurie J. Morrison From Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital (BLB, LJM), University of Toronto, Toronto, Ontario, Canada; the University of Washington (KK, JP), Seattle, Washington; Axio Research (KK), Seattle, Washington; the Medical College of Wisconsin (TPA), Milwaukee, Wisconsin; the University of California San Diego (DPD), San Diego, California; British Columbia Ambulance Service (SD), Vancouver, British Columbia, Canada; the University of Pittsburgh (BS), Pittsburgh, Pennsylvania; the University of Alabama at Birmingham (SN), Birmingham, Alabama; Gresham Fire and Emergency Services (JS), Gresham, Oregon; and the University of Texas Southwestern (AI), Dallas, Texas. Revision received January 27, 2010; accepted for publication February 17, 2010.
, MSc, MD show all
Pages 355-360 | Received 05 Nov 2009, Published online: 13 Apr 2010
 
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Abstract

Introduction. In 2005, the American Heart Association (AHA) released guidelines to improve survival rates from out-of-hospital cardiac arrest (OHCA). Objective. To determine if, and when, emergency medical services (EMS) agencies participating in the Resuscitation Outcomes Consortium (ROC) implemented these guidelines. Methods. We contacted 178 EMS agencies and completed structured telephone interviews with 176 agencies. The survey collected data on specific treatment protocols before and after implementation of the 2005 guidelines as well as the date of implementation crossover (the “crossover date”). The crossover date was then linked to a database describing the size, type, and structure of each agency. Descriptive statistics and regression were used to examine patterns in time to crossover. Results. The 2005 guidelines were implemented by 174 agencies (99%). The number of days from guideline release to implementation was as follows: mean 416 (standard deviation 172), median 415 (range 49–750). There was no difference in time to implementation in fire-based agencies (mean 432), nonfire municipal agencies (mean 365), and private agencies (mean 389, p = 0.31). Agencies not providing transport took longer to implement than agencies that transported patients (463 vs. 384 days, p = 0.004). Agencies providing only basic life support (BLS) care took longer to implement than agencies who provided advanced life support (ALS) care (mean 462 vs. 397 days, p = 0.03). Larger agencies (>10 vehicles) were able to implement the guidelines more quickly than smaller agencies (mean 386 vs. 442 days, p = 0.03). On average, it took 8.9 fewer days to implement the guidelines for every 50% increase in EMS-treated runs/year to which an agency responded. Conclusion. ROC EMS agencies required an average of 416 days to implement the 2005 AHA guidelines for OHCA. Small EMS agencies, BLS-only agencies, and nontransport agencies took longer than large agencies, agencies providing ALS care, and transport agencies, respectively, to implement the guidelines. Causes of delays to guideline implementation and effective methods for rapid EMS knowledge translation deserve investigation.

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