Jeffrey W Runge

EMT Defibrillation Does Not Increase Survival From Sudden Cardiac Death in a Two-Tiered Urban-Suburban EMS System☆☆☆★★★♢

OBJECTIVEnThe use of automatic external defibrillators (AEDs) by EMS initial responders is widely advocated. Evidence supporting the use of AEDs is based largely on the experience of one metropolitan area, with effect on survival in many systems not yet proved. We conducted this study to determine whether the addition of AEDs to an EMS system with a response time of 4 minutes for first-responder emergency medical technicians (FREMTs) and 10 minutes for paramedics would affect survival from cardiac arrest.nnnMETHODSnThis prospective, controlled, crossover study (AED versus no AED) of consecutive cardiac arrests managed by 24 FREMT fire companies took place from 1992 to 1995 in Charlotte, North Carolina, a city of 455,000. Patients were stratified using the Utstein criteria. The primary endpoint was survival to hospital discharge among patients with bystander-witnessed arrests of cardiac origin.nnnRESULTSnOf the 627 patients, 243 were bystander-witnessed arrests of cardiac origin. Survival to hospital discharge was accomplished in 5 of 110 patients (4.6%; 95% confidence interval [CI] 0.6% to 8.4%) with AED compared with 7 of 133 (5.3%, 95% CI 1.5% to 9.1%) without AED (P = .8). Both groups were comparable with regard to age, gender, history of myocardial infarction, congestive heart failure or diabetes, arrest at home, bystander CPR, and whether or not ventricular fibrillation (VF) was the initial rhythm. For arrests of any cause, witnessed by bystanders or EMS personnel, with an initial rhythm of VF or ventricular tachycardia (VT), 5 of 77 (6.5%, 95% CI 1.0% to 12.0%) with AED survived compared with 8 of 105 patients (7.6%, 95% CI 2.5% to 12.7%) without AED (P = .8). Statistically significant differences were noted in race and EMS response times between the two groups, which did not affect survival.nnnCONCLUSIONnAddition of AEDs to this EMS system did not improve survival from sudden cardiac death. The data do not support routinely equipping initial responders with AEDs as an isolated enhancement, and raise further doubt about such expenditures in similar EMS systems without first optimizing bystander CPR and EMS dispatching.

Enforcement of drunken driving laws in cases involving injured intoxicated drivers.

STUDY OBJECTIVEnTo determine the frequency of driving while impaired (DWI) charges among alcohol-intoxicated drivers injured in motor vehicle crashes (MVCs) and any differences in the group of those charged compared with those not charged.nnnMETHODSnWe performed a retrospective analysis of linked data from medical and judicial sources. Our setting was an urban emergency department of a trauma center serving a population of 1 million. We studied consecutive drivers injured in MVCs over a period of 15 months who had measured serum ethanol (BAC) levels of 100 mg/dL or higher. BAC, Trauma Score (TS), demographics, and crash data were linked to court records of charges, outcome, and prior convictions. The group of individuals who were charged with DWI were compared with those who were not charged.nnnRESULTSnOne hundred eighty-seven patients were studied; 53 (28%) were charged with DWI, and 32 (17% of total) were convicted. Two (7%) of 29 patients with severe injuries, 9 (28%) of 32 with moderate injuries, and 42 (33%) of 126 with nonsevere injuries were charged (P = .004). Eighteen (16%) of 112 patients with no prior convictions were charged; 20 (56%) of 36 patients with one, 11 (52%) of 21 with two, 3 (25%) of 12 with three, and 0 of 5 with four or more prior DWI convictions were charged (P < .001). There were no significant differences in BAC, demographics, or other measures between the two groups.nnnCONCLUSIONnAlcohol-impaired drivers who require ED treatment for injuries sustained in an MVC are infrequently charged with DWI. The likelihood of a DWI charge diminishes with increasing severity of injury. Repeat offenders are charged more often, but the frequency of charges does not increase with increasing number of prior DWI convictions.

BOOSTER SEATS FOR CHILDREN: CLOSING THE GAP BETWEEN SCIENCE AND PUBLIC POLICY IN THE UNITED STATES

The Association for the Advancement of Automotive Medicine (AAAM) sponsored an international conference, April 23-24, 2001, in Washington, D.C., to promote scientifically sound public policy on child booster seats in motor vehicles. This commentary lists 12 recommendations drafted by the conference planning committee, and also includes a brief summary of relevant scientific evidence presented at the conference related to each recommendation.

Speeding and Other Unsafe Driving Actions

Abstract [National Highway Traffic Safety Administration: Speeding and other unsafe driving actions. Ann Emerg Med December 1999;34:799-800.]

Commentary: And Who Is My Neighbor?

[Runge JW: NHTSA Notes commentary: And who is my neighbor? Ann Emerg Med April 1998;31:519-520.].

Road safety and public health: a US perspective and the global challenge.

Together we can save lives and reduce sufferingnnRoad traffic crashes are not just a highway safety problem—they are a public health problem. With over a million people killed each year on the world’s roads, and tens of millions more injured, road traffic crashes are a leading cause of death and the ninth leading cause of disability adjusted life years (DALYs) lost worldwide. By 2020, road traffic injuries are projected to become the third leading cause of DALYs. This is all the more tragic because we could prevent so many of these deaths, so many of these injuries, and so much of this suffering.nnIn the United States, road traffic injuries accounted for more than 42 000 deaths in 2002 and almost three million non-fatal injuries.1 They are the leading cause of death for people ages 1–34 years and the leading cause of injury related death. The cost of motor vehicle crashes exceeded

Commentary: Antihistamines and driving performance—An underrecognized issue in traffic safety

230 billion in 2000.2 The United States has the most motor vehicles per capita of any country in the world (765 motor vehicles per 1000 population).3 Therefore, we had to begin addressing the problem of road traffic safety many …

Child Safety Seat Distribution: What Works?

Abstract [Runge JW. NHTSA Notes Commentary: Antihistamines and driving performance—an underrecognized issue in traffic safety. Ann Emerg Med. October 2000;36:389-390.]

Commentary: Cell Phones and the Multi-tasking Driver☆☆☆

Abstract National Highway Traffic Safety Administration: Child safety seat distribution: What works? Ann Emerg Med September 1999;34:403-404.]

16. First Responder Defibrillation Does Not Increase Survival from Sudden Cardiac Death in a Two-Tiered Urban-Suburban EMS System

[Runge JW: NHTSA Notes commentary: Cell phones and the multi-tasking driver. Ann Emerg Med February 1998;31:279-280.].