Purpose: The aim of this study was to investigate the relationship between the quantitative and qualitative contents of education for EMS providers and resuscitation practices among countries participating the Pan-Asian-Resuscitation-Outcomes-Study (PAROS).

Study design: A multination of questionnaire survey combined with retrospective, population-based observational study.

Methods: An on-line survey for quality and quantity and education for EMS providers was conducted focusing on the highest and second-levels of EMS providers in the PAROS countries (Japan, Singapore, South Korea, Taiwan, Malaysia, Philippines, Dubai, Indonesia, China, and Thailand).We defined the qualification levels of emergency medical technician (EMT) according to the WHO definitions EMT-Advanced (EMT-A) and EMTBasic (EMT-B). Performance of EMS practice was analyzed according to the following factors: The time required from EMS arrived to start of cardio pulmonary resuscitation (CPR) (AC time) and the time required from EMS arrived to start of first defibrillation shock (AS time) and frequencies of various clinical procedures for patients of out-of-hospital cardiac arrest (OHCA). The data were obtained from the PAROS-Clinical Research Network (PAROS-CNR). A total of 66780 OHCA cases were analyzed. We excluded cases of non-EMS transfer and those less than 18 years old or more than 90 years old.

Results: Among 10 PAROS participating countries examined in this study, Japan South Korea, Taiwan and Singapore adopt fire-based EMS and other countries adopt hospital-based EMS. The longest education length for an EMT-A was 4740 hours for a paramedic in the Philippines, and the shortest EMT-A education time was 850 hours for a paramedic in Japan (Fire academy model). There was no EMT-Bs in hospital-based EMS countries. EMT-Bs in fire-based EMS had about 300 hours training which is about 10 times shorter than EMT-A. Significant positive correlation was found between clinical training length and frequency of advanced life support (ALS) procedures for OHCA patients. Positive correlations were found in clinical training length and frequency of drug administration (r=0.91) and advanced-airway (r=0.83). Negative correlation was found in didactic hours with drug administration (r=-0.74) and advanced airway (r=-0.59). Fields ROSC were 19.0% for Taiwan, 15.7% for Japan, 10.6% for South Korea, and 9.0% for Singapore, respectively. There is weak correlation between Fields ROSC and clinical training time (r=0.28).

hospital-based EMS countries was a longer response time than in fire-based EMS countries. Therefore, increasing the number of trained EMT-Bs will be necessary in hospital-based EMS countries. In the fire-based EMS countries, better EMS practice was related to the education time length, that of clinical education. However, the data also indicated that quality of EMS was not only factor to influence OHCA outcome.

Conclusion: For fire-based EMS countries, improving of the quality of continuous EMS education will be necessary. For hospital-based EMS countries, introducing of EMT-B education will be desired. In order to improve the quality of EMS in Asian countries, developing and implementing of clinical ladder for EMS education should be made.