5% [O.R. 2.54 (95% CI 0.91–7.1; p > 0.05] and Richmond: 7.0% [O.R. 4.79 (95% CI 2.69–8.54; p < 0.0001], respectively). In Richmond the admission rate increased after the introduction and implementation of a “LDB chest compression device” overall and in the subgroups (all: 9.2% vs. 21.7%; VF: 17.7% vs. 33.3%; PEA/Asystole: 7% vs.

18.1%). In Bonn EMS system, the admission rate with ROSC was 5.4-fold higher before (O.R. 5.47 (95% CI 3.46–8.64; p < 0.01) and still 2-fold higher (O.R. 1.99 (95% CI 1.28–3.1; p < 0.05) after the introduction of LDB in Richmond. To our knowledge this study is the first which compares four separate EMS systems in four countries on two continents, concerning structure, processes and quality of treatment including outcome after OHCA. More than 6200 patients

were included, when they suffered from chest pain, severe dyspnoea or OHCA and were treated by the ALS-units of one of the participating EMS systems. PR-171 clinical trial http://www.selleckchem.com/products/INCB18424.html The study revealed as a secondary finding a remarkable difference in the rate of “highest priority responses” in the four systems (Table 1), which can be explained by differences in the incidence of the disease and the utilization and demand of the EMS system by the population. This indicator was defined first by the EED-group but it needs further investigations for better understanding.4 As a main result we found an exceptionally high level of EMS organisation in the four regions. Dispatch centres in Cantabria, Coventry and Richmond used computer aided dispatch and digital radio systems which allowed GPS vehicle tracking, caller identification and mapping and routeing of responder vehicles. These systems used Advanced Medical Priority Dispatch System (AMPDS)

for clinical evaluation of the emergency calls, prioritisation and dispatching. In the three cities the dispatch staffs were supported by an emergency demand prediction analysis; which in the Richmond system was used to place the ALS units close to predicted emergency scenes. almost These arrangements led to the result that 88% of all emergencies in Richmond were reached by an ALS unit within 480 s compared to 66% in Cantabria. But it has to be noted that in Cantabria a mix of urban, suburban and rural areas had to be served. The lack of computer aided dispatch technique in Bonn was partly compensated by the dispatchers’ excellent local knowledge and therefore 85.4% of ALS units were on scene within 480 s. To date there have been no studies performed, which analysed sensitivity, specificity, positive and negative predictive value comparing AMPDS with the use of highly skilled dispatchers.10, 11 and 12 From our experience in comparing different systems there is evidence, that AMPDS will enable dispatch centres to deploy their resources on a rational and efficient basis but there is a lack in accuracy which must be improved.