Study objective: To examine the success of rural emergency medical technician-defibrillation (EMT-D) programs in relation to community population size.
Design and setting: The four major studies addressing EMT-Ds in communities of fewer than 40,000 persons were reviewed. Additional, unpublished data on community size and neurologic condition of survivors were obtained from the authors. Survivors with prearrest neurologic status in communities with more than 15,000 persons were compared with those in communities of fewer than 15,000 persons.
Results: With the exception of the initial rural EMT-D study from Iowa, large communities had a higher rate of prearrest-level neurologic survival than small communities. Control communities appeared to have a slightly lower survival rate than small rural communities.
Conclusion: Small rural communities cannot expect statistics for prearrest neurologic survival after cardiac arrest to be similar to those from large rural communities. Many emergency medical system factors, such as delay to system access, lack of first-responder CPR, and absence of full-time EMTs, may prevent EMT-D programs in small rural communities from experiencing comparable cardiac arrest survival.