Physicians provide prehospital ACLS by staffing specially equipped ambulances in many countries (e.g., western Europe, Scandinavia, and Canada). In the United States, "intermediate"-level EMTs or paramedics provide most prehospital ACLS intervention (e.g., defibrillation or synchronized cardioversion, endotracheal intubation, intravenous fluid therapy, or drug administration). Intermediate EMTs (often called cardiac technicians) typically receive several hundred hours of training; paramedics usually receive 1000 or more hours. Adding field ACLS capability appears to affect survival from out-of-hospital cardiac arrest favorably, although the degree of benefit is relatively minimal compared to the powerful effect of early defibrillation. 8
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