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November 23, 1994

Emergency Medical Services: Factors Associated With Poor Survival-Reply

Author Affiliations

Bronx Municipal Hospital Bronx, NY

JAMA. 1994;272(20):1573-1574. doi:10.1001/jama.1994.03520200029017

In Reply.  —Dr Bickell's conjecture that specially trained physician directors of EMS systems positively influence out-of-hospital cardiac arrest survival rates has not been supported by the New York City experience.New York City was the first municipality in the United States to employ a full-time specially trained physician director of EMS and had continued to do so since 1981. Despite the influence of these individuals, New York City EMS was unable to achieve the impressive survival rates of the smaller systems cited by Bickell. At the time of our study, New York City EMS coordinated the deployment of 583 ambulance tours daily, staffed by 650 paramedics and 1700 emergency medical technician/defibrillators who respond to 1 million calls annually. The impact of any one person on such a vast system is likely to be substantially less than in the Houston experience. During the period of our study, in Houston there were

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