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Objectives. A 10-month direct mail campaign was implemented to increase use of emergency medical services via 911 calls and to reduce prehospital delay for individuals experiencing acute myocardial infarction symptoms. Methods. This prospective, randomized, controlled trial involved three intervention groups (receiving brochures with informational, emotional, or social messages) and a control group. Results. Intervention effects were not observed except for individuals who had a history of acute myocardial infarction and who were discharged with a diagnosis of acute myocardial infarction; their 911 use was meaningfully higher in each intervention group than in the control group. Conclusions. The mailings affected only the individuals at greatest risk. (Am J Public Health. 1997;87:1705-1709)

Transcutaneous pacemakers may not improve survival in patients who go into cardiac arrest outside a hospital. Transcutaneous pacemakers stimulate the heart through electrodes placed on the chest. Some doctors believe that these pacemakers should be carried on all ambulances. Emergency medical technicians (EMTs) in 16 fire districts were taught to use transcutaneous pacemakers on people in cardiac arrest (the intervention group) and EMTs in 23 other fire districts were taught to give the usual treatment (the control group). During the study, 506 cardiac arrests occurred in the intervention group and 550 in the control group. Only 158 patients in the intervention group received the pacemaker, but their survival rates were no better than those in the control group. This was true even though the average time from collapse to the start of pacing was only nine minutes. It seems premature to recommend that every ambulance carry a transcutaneous pacemaker. Each pacemaker costs $4,000 to $7,000.

Objectives. A 10-month direct mail campaign was implemented to increase use of emergency medical services via 911 calls and to reduce prehospital delay for individuals experiencing acute myocardial infarction symptoms. Methods. This prospective, randomized, controlled trial involved three intervention groups (receiving brochures with informational, emotional, or social messages) and a control group. Results. Intervention effects were not observed except for individuals who had a history of acute myocardial infarction and who were discharged with a diagnosis of acute myocardial infarction; their 911 use was meaningfully higher in each intervention group than in the control group. Conclusions. The mailings affected only the individuals at greatest risk. [ABSTRACT FROM AUTHOR]