A lthough out-of-hospital cardiac arrest (OHCA) is a major public health problem, 1 individual paramedics are rarely exposed to these cases. [2][3][4][5][6][7] Survival to hospital discharge from OHCA is infrequent (<10%) 8 and dependent on the quality and timing of treatment provided by paramedics. [9][10][11][12][13][14][15] Given that resuscitation skills decay over time 16 and OHCA treatment often falls short of the recommended standard, 9-14 the number of OHCAs that paramedics are exposed to may be contributing to low survival rates.The limited literature available indicates that exposure to OHCA for individual paramedics is rare 2-7 and declining. 2,3 For example, in our region, we found that on average paramedics and first responders only treat 1.4 OHCAs a year. 2Such low exposure may impact on the paramedics' ability to perform resuscitation skills according to the guidelines, which is vital to patient survival. However, data exploring the association between OHCA exposure and survival is lacking, with a recent systematic review 17 finding only one previous study involving prehospital physicans 18 and no studies involving paramedics.Therefore, in this study, we aimed to examine the association between paramedic exposure to OHCA resuscitation and patient survival to hospital discharge. We also examined the paramedics' decision to initiate resuscitation in OHCA and 2 other exposure variables: (1) paramedic career experience and (2) time since previous paramedic exposure to OHCA resuscitation. MethodsWe conducted a retrospective cohort study using 10 years of data from the Victorian Ambulance Cardiac Arrest Registry (VACAR) and the Ambulance Victoria (AV) employment database to measure the association between paramedic exposure to OHCA resuscitation and OHCA patient survival. This study was approved by the Monash University Human Research Ethics Committee (project number: CF13/971-2013000471). The need for patient consent was waived Background-Although out-of-hospital cardiac arrest (OHCA) is a major public health problem, individual paramedics are rarely exposed to these cases. In this study, we examined whether previous paramedic exposure to OHCA resuscitation is associated with patient survival. Methods and Results-For the period 2003 to 2012, we linked data from the Victorian Ambulance Cardiac Arrest Registry to Ambulance Victoria's employment data set. We defined exposure as the number of times a paramedic attended an OHCA where resuscitation was attempted in the 3 years preceding each case. Using a multivariable model adjusting for known predictors of survival, we measured the association between paramedic OHCA exposure and patient survival to hospital discharge. During the study period, there were 4151 paramedics employed and 48 291 OHCAs (44% with resuscitation attempted). The median exposure of all paramedics was 2 (interquartile range 1-3) OHCAs/year. Eleven percent of paramedics were not exposed to any OHCA cases. Increased paramedic exposure was associated with reduced odds of attempted resuscit...

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