To the Editor.
—In their article,1 Kellermann and associates outline the EMS system of the Memphis Fire Department and the procedure they follow for responding to out-of-hospital cardiac arrests. Included in the system are automated external defibrillators on half of the first-responder units of the Memphis Fire Department engine companies. The addition of the automated external defibrillators to the Memphis Fire Department completes the recommended links of the American Heart Association's "chain of survival."2The study results describe the outcomes of patients who had received various levels of care and the effect of many variables such as response times of first-responder, ACLS, and initial rhythm. From that, recommendations were made that adults who "fail to respond to an adequate trial of prehospital ACLS" should not be transported and that "physicians should authorize paramedics to cease efforts in the field."1 There are a number of other researchers who
McCoy ML. Out-of-Hospital CPR. JAMA. 1994;271(10):748. doi:10.1001/jama.1994.03510340037027