Modeling the effectiveness and cost-effectiveness of an emergency service system

Abstract

Survival from out-of-hospital cardiac arrest is in large part determined by the time from collapse to initiation of cardiopulmonary resuscitation (CPR) and the time from collapse to initiation of definitive care. A model utilizing these two crucial times was developed to examine various prehospital emergency medical services (EMS). The effectiveness (percent survival) and cost-effectiveness (cost divided by effectiveness) of four different EMS systems were examined. Two of the systems are already operational in various parts of the country: (1) basic life support consisting of CPR as provided by emergency medical technicians (EMT's); and (2) advanced life support consisting of definitive care as provided by paramedics. Two proposed systems are: (1) rapid defibrillation by EMTs; and (2) rapid defibrillation by EMT's with paramedic backup response. Both of these proposed systems are currently under experimental study.

The four systems were examined using various parameters such as ratio of paramedic to EMT vehicles, percentage of citizens trained in CPR and response time. Compared to the basic EMT system, the paramedic system is more effective and cost-effective. The proposed system using rapid defibrillation by EMT's is less effective than the paramedic system but is the more cost-effective. The proposed system incorporating rapid defibrillation by EMT's with paramedic backup is the most effective but also the most costly. The resulting cost-effectiveness is less than with rapid defibrillation by EMT's alone. As demonstrated in this analysis, the two proposed systems offer possibilities for improved resuscitation following out-of-hospital cardiac arrest.