• Vol. 42 No. 9, 445–450
  • 15 September 2013

Recognition and Treatment of Out-of-Hospital Cardiac Arrests by Non-Emergency Ambulance Services in Singapore



Introduction: Prompt recognition of cardiac arrest and initiation of cardiopulmonary resuscitation (CPR) and defibrillation is necessary for good outcomes from out-of-hospital cardiac arrest (OHCA). This study aims to describe the recognition and treatment of OHCA in patients conveyed by non-emergency ambulance services (EAS) in Singapore.

Materials and Methods: This is a multi-centre, retrospective chart review, of cases presenting to public emergency departments (EDs), conveyed by non-EAS and found to be in cardiac arrest upon ED arrival. The study was from October 2002 to August 2009. The following variables were examined: ability to recognise cardiac arrest, whether CPR was carried out by the ambulance crew and whether an automated external defibrillator (AED) was applied.

Results: Eighty-six patients were conveyed by non-EAS and found to be in cardiac arrest upon ED arrival. Mean age was 63 years (SD 21.8), 70.9% were males. A total of 53.5% of arrests occurred in the ambulance while 70.9% were found to be asystolic upon ED arrival. Seven patients had a known terminal illness. Survival to discharge was 3.5%. Cardiac arrest went unrecognised by the ambulance crew in 38 patients (44.2%). CPR was performed in 35 patients (40.7%) of the 86 patients and AED was applied in only 10 patients (11.6%).

Conclusion: We found inadequate recognition and delayed initiation of treatment for OHCA. Possible reasons include a lack of training in patient monitoring and detection of cardiac arrest, lack of CPR training, lack of confidence in performing CPR, lack of AEDs on ambulances and lack of training in their use.

The survival rates to hospital discharge from out-of hospital cardiac arrest (OHCA) in Singapore, which is reported to be 2.0%,1 is comparable to other large cities such as Hong Kong (1.25%), Chicago3 (2%), and New York (1.4%). However this is lower than that reported in several North American cities (16.3%). It is well-reported that survival rates from cardiac arrests that are witnessed by ambulance personnel are even higher,6-8 with local data showing 13.8% survival for OHCA witnessed by Singapore’s Emergency Ambulance Services (EAS).

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