Advanced cardiac life support in the prehospital setting: the Reykjavik experience

Abstract

Since 1982 a mobile emergency care unit (emergency ambulance) manned by a physician has been operated in Reykjavik. During 1982-1986 there was 138 attempted resuscitations in sudden cardiorespiratory arrest from cardiac causes. Twenty-four patients (17%) were discharged home, all but one without mental impairment. Seventy-three patients presented with ventricular fibrillation, 21 (29%) of which were discharged. The mean ambulance response time was 5 min. Bystanders initiated cardiopulmonary resuscitation (CPR) in 40 cases (29%) which significantly improved the outcome. In witnessed arrests, 19 of 36 patients (53%) with bystander-initiated CPR were discharged compared to 5 of 62 patients (8%) where CPR awaited the arrival of the ambulance team. These results are comparable to those obtained in larger metropolitan areas. In small urban areas the size of Reykjavik (population of 110,000), an advanced and efficient prehospital care can be organized as an extension of the emergency departments role.