Cheating sudden death: how to do it, and what life's like after it.

Abstract

Before the development of portable external defibrillators and the adoption of this technology by the emergency medical services, survival from out‐of‐hospital cardiac arrest was a very rare occurrence. Although CPR could be administered by ambulance crews, the delays involved in moving the victim to hospital prior to defibrillation were too great to allow many to survive. The first major advance in prehospital care occurred when Frank Pantridge addressed possible ways of reducing the high mortality rate associated with myocardial infarction. He recognized that most individuals who died did so within an hour of the onset of symptoms. Despite opposition from colleagues and the authorities, he and his resident, John Geddes, implemented the world's first mobile coronary care unit (MCCU) in Belfast in 1966. During the first 15 months of operation, the MCCU attended 10 patients who had ventricular fibrillation outside hospital, and all were successfully defibrillated.1 Soon after, MCCUs were introduced in many cities world‐wide, their main role being to transport victims of myocardial infarction quickly, and to provide defibrillation if needed. However, time was often wasted waiting for staff to arrive at the MCCUs prior to dispatch, and many cities had only a single MCCU serving a large geographic area. Response times were often slow, and those who had cardiac arrests before the MCCU arrived usually did not survive. The MCCU system was a breakthrough in prehospital care, but was limited by the concept that defibrillation had to be administered by a physician. The first move towards paramedic‐administered defibrillation occurred just 3 years after Pantridge's MCCU saved its first patient. Eugene Nagel, an emergency room physician from Miami, recognized the limitations of the MCCU system. Because of legal impediments which forbade paramedics from administering treatments other than first aid and CPR without orders from a physician, Nagel used …