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More than 20 years ago, about two-thirds of all deaths from a heart attack occurred outside the hospital. Because of this, several cities outfitted ambulances as mobile coronary care units.

This proved so successful that the city of Seattle now has 30 percent of the population with some training in cardiopulmonary resuscitation (CPR) and mobile coronary care units. It is reported that the death rate of heart attack victims during transportation to a hospital is reduced from 22 percent to about 9 percent.Delay

Promptness of CPR results in survival and recovery of cardiac arrest (heart attack) victims. If a victim in cardiac arrest is to survive, three types of delays must be avoided: (1) delay in calling for help; (2) delay by emergency medical services dispatcher; and (3) delay in transporting the victim to the hospital.

Delay in calling. Chances of survival are greatly improved when a call for emergency services is made as soon as a heart attack is suspected and before the victim collapses.

Those with previous heart attack(s), angina, and other types of chest pain must learn that speed is essential if help is to be effective. Those knowing they are overweight, smoke cigarettes, have hypertension, have high blood cholesterol or have a family history of coronary artery disease should take precautions by learning to identify the signs and symptoms of a heart attack and informing family members and coworkers what to do in the event of a heart attack.

Delay by dispatcher. The time from receiving a telephone request for assistance to the arrival of an ambulance needs to be quick. Ideally, the time from a victim's collapse to defibrillation should be less than six minutes. A University of Iowa expert says that the response time of the dispatcher should be no more than 30 seconds.

Delay transporting. The essential action is to keep the victim alive long enough to reach the best treatment facility.

CPR and defibrillation

CPR "buys" a little time for the heart attack victim who is in cardiac arrest. All adults should be trained in how to perform CPR. Two well-known organizations, the American Red Cross and the American Heart Association, have training courses offered in most communities. Nevertheless, the cardiac arrested victim usually must receive defribrillation.

Cardiac arrest is usually produced by ventricular fibrillation, which ordinarily can be quickly terminated by electroshock from a defibrillator.

Richard Cummins suggests that survival rates increase by 7 percent for every minute saved in getting the defibrillator to the victim. Therefore, some experts suggest that a lone rescuer first telephone for emergency help rather than attempt even one minute of CPR before calling for help.

Automatic external defibrillators can be made available to senior care centers and homes of high-risk victims. Several communities are equipping their police units with defibrillation equipment since they are often the first to arrive on the scene of heart attacks.