Effect of reducing ambulance response times on deaths from out of hospital cardiac arrest: cohort study

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Abstract
Objectives: To determine the association between ambulance response time and survival from out of hospital cardiopulmonary arrest and to estimate the effect of reducing response times. Design: Cohort study. Setting: Scottish Ambulance Service. Subjects: All out of hospital cardiopulmonary arrests due to cardiac disease attended by the Scottish Ambulance Service during May 1991 to March 1998. Main outcome measures: Survival rate to hospital discharge and potential improvement from reducing response times. Results: Of 13 822 arrests not witnessed by ambulance crews but attended by them within 15 minutes, complete data were available for 10 554 (76%). Of these patients, 653 (6%) survived to hospital discharge. After other significant covariates were adjusted for, shorter response time was significantly associated with increased probability of receiving defibrillation and survival to discharge among those defibrillated. Reducing the 90th centile for response time to 8 minutes increased the predicted survival to 8%, and reducing it to 5 minutes increased survival to 10-11% (depending on the model used). Conclusions: Reducing ambulance response times to 5 minutes could almost double the survival rate for cardiac arrests not witnessed by ambulance crews. What is already known on this topic Three quarters of all deaths from myocardial infarction occur after cardiac arrest in the community Survival after out of hospital arrest is much lower in the United Kingdom than the United States What this study adds Ambulance response times are independently associated with defibrillation and survival Decreasing the target for response to 90% of calls from 14 minutes to 8 minutes would increase survival from 6% to 8% A response time of 5 minutes would increase survival to 10-11%

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