Resuscitation from out-of-hospital cardiac arrest in an under-resourced environment

Published data on the epidemiology of out-of-hospital cardiac arrest (OHCA) come mostly from developed countries. Few studies have described the nature of OHCA in developing countries, where resources guaranteeing rapid access to cardiac arrest cases may not be available. A retrospective case series on OHCA in Johannesburg, the first study of this type in an African population, showed that response times were comparatively long, less than half of patients were resuscitated and rates of shockable rhythms and return of spontaneous circulation were lower than those reported in most other published studies. These results are most likely caused by lack of resources, in the form of emergency vehicles, in a region with a very busy emergency medical service, providing prehospital care to a large population. Other factors caused by poor emergency service management tend to complicate this picture and exacerbate the response time problem. Although paramedic learning programmes in South Africa are of a high standard and prepare qualifying practitioners to treat OHCA cases adequately, a lack of effective emergency medical service management and organization means that these human resources cannot be put to good use in improving OHCA outcomes. To improve OHCA outcomes, under-resourced emergency medical services should focus on fundamental aspects of the system to guarantee rapid access to patients, rather than more advanced scopes of practice for paramedics.

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