| Popis: |
Background: Out-of-hospital cardiac arrest (OHCA) accounts for more than 25,000 deaths per year in Australia. The early application and use of a defibrillator, combined with early cardio-pulmonary resuscitation represents the best chance of survival. The Tasmanian Early Access to Defibrillation Program (EADP) was designed to determine whether more lives could be saved through the intervention and improve survival rates from OHCA. Objectives: This research sought primarily to answer whether more lives could be saved by reducing the barriers to early access to defibrillation. Secondary outcomes were to identify those human factors that could be modified in people to reduce the time to early access to defibrillation. Methods: The thesis describes the rationale, design and methods for a retrospective observational cohort study and a prospective observational cohort study. Sections include undertaking a base line study to determine historical outcomes, using a linked data set of five years of OHCA data to determine base line survival rates in Tasmania, including identifying any independent predictors of increased probability of survival. Outcomes were assessed using probabilistically linked computer-aided dispatch records, emergency medical services patient care records, emergency department data and inpatient data for the retrospective study. Additionally a mixed methods study, which identified the human factors that could be barriers to early defibrillation was conducted. A mix of qualitative and quantitative research methods were used to identify the human factors. Results: Independent predictors of increased chance of survival were identified in the retrospective cohort study as being decreasing age, whether the attack was witnessed, a shockable cardiac rhythm, and the cardiac arrest being of cardiac origin. In the mixed methods study human factors such as training, experience, competence and leadership were all determined to be positive factors. Conclusion: The study provided base line overall survival rates for Tasmania over five years and identified the key human factors that may reduce the barriers to early access to defibrillation by community members. This work may provide the foundation for conducting a longitudinal study to assess outcomes of OHCA when only traditional emergency medical services (EMS) defibrillation is provided, compared to defibrillation provided by community members in advance of EMS attendance. |
