The C. J. Shanaberger Lecture: The Evolution of Prehospital Cardiac Care: 1966–2006 andBeyond

Prehospital cardiac care began 40 year ago. This lecture reviews the origins and evolution of prehospital emergency care for cardiac arrest. Several national and international guidelines have defined an evolving standard of care. The most recent guidelines, published in 2005, argue for a return to the basics and emphasize the importance of CPR and defibrillation. In 40 years we have learned much about the epidemiology of cardiac arrest and the factors associated with successful resuscitation. Timely CPR and defibrillation remain the cornerstones of successful therapy. A new role for EMS personnel may help identify at-risk patients and thus prevent future cardiac arrest. A pilot program, know as SPHERE (Supporting Public Health with Emergency Responders) is underway in King County, Washington. The goal is to identify patients with risk factors of high blood pressure or high blood glucose and motivate the patient to seek follow-up care. Several intervention strategies are being tested. Since EMS providers see up to 10% of the population in any given year the chance to identify at-risk patients provides a public health opportunity.