Early access to defibrillation is a key to survival

EDITOR—We wish to comment on some of the strategies suggested by Norris et al to reduce mortality from acute coronary attacks.1 Recently we reviewed outcomes for all cardiac arrests in adults presenting to the emergency department at the Norfolk and Norwich Hospital during 1991 and 1996. The region served by this hospital is semirural, with a single tier response ambulance service. Between 1991 and 1996 several changes were made to the organisation and delivery of prehospital care. Foremost was the amalgamation of the three ambulance services covering East Anglia. The proportion of calls answered by a paramedic crew also changed, increasing from 70% to 100%. Ninety five per cent of calls were answered within 16 minutes in 1991 and within 22 minutes in 1996. Despite these changes there was no significant difference in outcome. …