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Positive Association Between Ambulance Double-Crewing and OHCA Outcomes: A New Zealand Observational Study

Dicker, B; Govender, K; Howie, G; Swain, A; Todd, VF
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http://hdl.handle.net/10292/14796
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Abstract
Background and objectives

New Zealand emergency medical service (EMS) crewing configurations generally place one (single) or two (double) crew on each responding ambulance unit. Recent studies demonstrated that double-crewing was associated with improved survival from out-of-hospital cardiac arrest (OHCA), therefore single-crewed ambulances have been phased out. We aimed to determine the association between this crewing policy change and OHCA outcomes in New Zealand.

Methods

This is a retrospective observational study using data from the St John OHCA Registry on patients treated during two different time periods: the Pre-Period (1 October 2013–30 June 2015), when single-crewed ambulances were in use by EMS, and the Post-Period (1 July 2016–30 June 2018) when single-crewed ambulances were being phased out. Geographic areas identified as having low levels of double crewing during the Pre-Period were selected for investigation. The outcome of survival to thirty-days post-OHCA was investigated using logistic regression analysis.

Results

The proportion of double-crewed ambulances arriving at OHCA events increased in the Post-Period (81.8%) compared to the Pre-Period (67.5%) (p ≤ 0.001). Response times decreased by two minutes (Pre-Period: median 8 min, IQR [6–11], Post-Period: median 6 min, IQR [4–9]; p ≤ 0.001). Thirty-day survival was significantly improved in the Post-Period (OR 1.63, 95%CI (1.04–2.55), p = 0.03).

Conclusions

An association between improved OHCA survival following increased responses by double-crewed ambulances was demonstrated. This study suggests that improvements in resourcing are associated with improved OHCA outcomes.
Keywords
Resuscitation; Crew configuration; Double crewing; Survival; ROSC; EMS; New Zealand; OHCA; Cardiac Arrest; Out-of Hospital; Pre-Hospital; Paramedic; Ambulance
Date
December 2021
Source
Resuscitation Plus, Volume 8, December 2021, 100187.
Item Type
Journal Article
Publisher
Elsevier BV
DOI
10.1016/j.resplu.2021.100187
Publisher's Version
https://www.sciencedirect.com/science/article/pii/S2666520421001120
Rights Statement
(C) 2021 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons. org/licenses/by-nc-nd/4.0/)

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