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Original Research

Open Access

The optimal location and time for paramedics to wear personal protective equipment that minimize delay in dispatch to cardiac arrest patients

  • Hyung Il Kim1,†
  • Tae Hun Lee2,*,†,

1Department of Emergency Medicine, Dankook University Hospital, College of Medicine, Dankook University, 31116 Cheonan, Republic of Korea

2Department of Emergency Medicine, Chuncheon Sacred Heart Hospital, 24253 Chuncheon, Republic of Korea

DOI: 10.22514/sv.2024.003 Vol.20,Issue 1,January 2024 pp.63-70

Submitted: 13 March 2023 Accepted: 13 April 2023

Published: 08 January 2024

*Corresponding Author(s): Tae Hun Lee E-mail:

† These authors contributed equally.


Wearing level D personal protective equipment (PPE) after the first outbreak of coronavirus disease 2019 (COVID-19) has become mandatory in Korea. However, PPE use worsened paramedics’ on-scene dispatch. A delayed response to patients experiencing cardiac arrests, could cost them their lives. This study was therefore conducted to determine not only whether PPE wearing affects the dispatch time but also the time difference between wearing PPE inside the ambulance while en route to the scene and wearing PPE outside the ambulance before departure to ascertain the optimal location for paramedics to wear PPE. The response times of paramedics for reaching the cardiac arrest patients before (pre-PPE group) and after (post-PPE group) PPE wearing became mandatory were compared. Forty-five paramedics participated in a PPE-wearing simulation. The total amount of time spent by them wearing PPE was measured outside the ambulance, in the passenger seat, and in the patient care compartment. The median response time for the post-PPE group was 1–1.5 min longer than that for the pre-PPE group for dispatches within 10 km. The average time for PPE suit-up was the shortest outside the ambulance (140.53 s). It was 178.47 s in the passenger seat, whereas it was 151.22 s in the patient care compartment. The response time increased after wearing PPE. PPE suit-up time was shortest outside the ambulance. Considering the wearing time, prognosis, safety of the paramedics, the location at which PPE are worn should be appropriately determined.


Disasters; Out-of-hospital cardiac arrest; Emergency medical services; Pandemics; Personal protective equipment

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Hyung Il Kim,Tae Hun Lee. The optimal location and time for paramedics to wear personal protective equipment that minimize delay in dispatch to cardiac arrest patients. Signa Vitae. 2024. 20(1);63-70.


[1] Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020; 395: 497–506.

[2] Kim JY, Choe PG, Oh Y, Oh KJ, Kim J, Park SJ, et al. The first case of 2019 novel coronavirus pneumonia imported into Korea from Wuhan, China: implication for infection prevention and control measures. Journal of Korean Medical Science. 2020; 35: e61.

[3] World Health Organization. COVID-19 significantly impacts health services for noncommunicable diseases. 2022. Available at: (Accessed: 02 August 2022).

[4] Nolan JP, Monsieurs KG, Bossaert L, Böttiger BW, Greif R, Lott C, et al. European resuscitation council COVID-19 guidelines executive summary. Resuscitation. 2020; 153: 45–55.

[5] Larsen MP, Eisenberg MS, Cummins RO, Hallstrom AP. Predicting survival from out-of-hospital cardiac arrest: a graphic model. Annals of Emergency Medicine. 1993; 22: 1652–1658.

[6] Holmberg M, Holmberg S, Herlitz J. Incidence, duration and survival of ventricular fibrillation in out-of-hospital cardiac arrest patients in Sweden. Resuscitation. 2000; 44: 7–17.

[7] Chung H, Namgung M, Lee DH, Choi YH, Bae SJ. Effect of delayed transport on clinical outcomes among patients with cardiac arrest during the coronavirus disease 2019 pandemic. Australasian Emergency Care. 2022; 25: 241–246.

[8] Jost D, Derkenne C, Kedzierewicz R, Briche F, Frattini B, Bertho K, et al. The need to adapt the rescue chain for out-of-hospital cardiac arrest during the COVID-19 pandemic: experience from the paris fire brigade basic life support and advanced life support teams. Resuscitation. 2020; 153: 56–7.

[9] Baldi E, Sechi GM, Mare C, Canevari F, Brancaglione A, Primi R, et al. Out-of-hospital cardiac arrest during the COVID-19 outbreak in Italy. New England Journal of Medicine. 2020; 383: 496–8.

[10] Marijon E, Karam N, Jost D, Perrot D, Frattini B, Derkenne C, et al. Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study. The Lancet Public Health. 2020; 5: e437–443.

[11] Lai PH, Lancet EA, Weiden MD, Webber MP, Zeig-Owens R, Hall CB, et al. Characteristics associated with out-of-hospital cardiac arrests and resuscitations during the novel coronavirus disease 2019 pandemic in New York city. JAMA Cardiology. 2020; 5: 1154–1163.

[12] Lim D, Park SY, Choi B, Kim SH, Ryu JH, Kim YH, et al. The comparison of emergency medical service responses to and outcomes of out-of-hospital cardiac arrest before and during the COVID-19 pandemic in an area of Korea. Journal of Korean Medical Science. 2021; 36: e255.

[13] Korean Disease Control and Prevention Agency. Cardiac arrest survey. 2006–2019. Available at: (Accessed: 02 August 2022).

[14] Ong J, Pourmand A, O’Connell F. An international perspective of out-of-hospital cardiac arrest and cardiopulmonary resuscitation during the COVID-19 pandemic. The American Journal of Emergency Medicine. 2021; 48: 340–341.

[15] Christian MD, Loutfy M, McDonald LC, Martinez KF, Ofner M, Wong T, et al. Possible SARS coronavirus transmission during cardiopulmonary resuscitation. Emerging Infectious Diseases. 2004; 10: 287–293.

[16] Kim WY, Choi W, Park SW, Wang EB, Lee WJ, Jee Y, et al. Nosocomial transmission of severe fever with thrombocytopenia syndrome in Korea. Clinical Infectious Diseases. 2015; 60: 1681–1683.

[17] Nam HS, Yeon MY, Park JW, Hong JY, Son JW. Healthcare worker infected with middle east respiratory syndrome during cardiopulmonary resuscitation in Korea, 2015. Epidemiology and Health. 2017; 39: e2017052.

[18] Craig S, Cubitt M, Jaison A, Troupakis S, Hood N, Fong C, et al. Management of adult cardiac arrest in the COVID-19 era: consensus statement from the Australasian college for emergency medicine. The Medical Journal of Australia. 2020; 213: 126–33.

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