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The Impact of First-Responder Defibrillation-Reply

Arthur L. Kellermann, MD, MPH; Bela B. Hackman, MD; Grant Somes, MD
JAMA. 1994;271(7):504-505. doi:10.1001/jama.1994.03510310034031.
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In Reply.  —The efficacy of using an automated external defibrillator to terminate ventricular fibrillation has been clearly established.1,2 Our study was conducted to evaluate the impact, or effectiveness, of this technology in the real world of urban emergency medical services. This is why we based our analysis on intention to treat, whether or not the treatment (ie, automated defibrillation) was actually received.The devices were used less frequently than we originally anticipated because our paramedics and firefighters arrived almost simultaneously in a substantial minority of cases. When this occurred, paramedics often gave the first shock instead of firefighters. Although it may be argued in this subset of cases that paramedics could have initiated endotracheal intubation and administration of intravenous drugs a bit faster if firefighters had proceeded with defibrillation, it is unlikely that this affected subgroup survival to a significant degree.The mean paramedic response time intervals were virtually


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