Strategies to improve the outcome of pre-hospital cardiac arrest in Leicestershire

Despite the increasing complexity of pre-hospital care systems, the outcome from cardiac arrest (CA) remains extremely poor. The major objective of this thesis was to explore the ways in which outcome could be improved within a defined Emergency Medical Service (EMS) system in the UK. The four studies were designed to investigate certain structures and processes of care involved in achieving a successful outcome.;The first study provides a detailed descriptive account of the incidence, processes of care and outcomes for adults suffering a pre-hospital CA in a defined EMS system with a predominant single tiered ALS response. Results are compared with other relevant work. In the second study, I evaluated the resource implications of additional single paramedic units with a priority dispatch system and their impact on the short term outcome of pre-hospital CA. Prioritised response and introduction of single paramedic units had no significant impact on the number of lives saved from pre-hospital CA. Significantly increased NHS costs were incurred per life year gained. The third study was a double blind placebo controlled trial using empirical intravenous magnesium sulphate as a therapeutic intervention. My hypothesis was that given early in the resuscitation phase for patients in refractory or recurring VF, outcome could be significantly improved. However, the results showed no significant improvement in outcome. Finally, I designed and carried out a study to develop consensus opinion on future design characteristics of EMS systems in the UK using senior expert staff from Ambulance Trusts in the UK. Consensus confirmed the need for multi-tiered systems, fully implemented priority dispatch and increasing use of 'first responders'. Opinion was significantly different from the present EMS model recommended by the Department of Health.;This work has shown that despite a number of strategies to improve the outcome of pre-hospital CA in the Leicestershire EMS, no significant improvement could be produced. A more radical re-configuration of system design is suggested by experts in the field of EMS which could have a more significant impact on outcome. The thesis has also provided robust data which can be used locally in Leicestershire as well as providing avenues for future research.