Key result
Female sex was associated with a significantly lower likelihood of meeting the 15-minute emergency medical services scene time benchmark compared to male sex (OR 0.63).
Why the study?
Timely EMS response, management, and transport reduce delays to treatment and improve outcomes in suspected ACS, motivating evaluation of EMS time intervals and adherence to proposed benchmarks.
Are patient demographics and incident characteristics associated with adherence to EMS time benchmarks for suspected acute coronary syndrome?
Observational (n=4,667)
Yes
Are patient demographics and incident characteristics associated with adherence to EMS time benchmarks for suspected acute coronary syndrome?
Odds Ratio: 0.63 (95% CI 0.55–0.73)
Absolute Event Rate: 41.2% vs 54.7%
Significant disparities exist in EMS response and scene times for suspected ACS based on sex, age, and geography, identifying key areas for prehospital process improvement.
Sex disparities in EMS scene times for suspected ACS merit review; this observational link leaves open whether interventions can improve equity.
Background Timely emergency medical services (EMS) response, management, and transport of patients with suspected acute coronary syndrome (ACS) significantly reduce delays to emergency treatment and improve outcomes. We evaluated EMS response, scene, and transport times and adherence to proposed time benchmarks for patients with suspected ACS in North Carolina from 2011 to 2017. Methods and Results We conducted a population-based, retrospective study with the North Carolina Prehospital Medical Information System, a statewide electronic database of all EMS patient care reports. We analyzed 2011 to 2017 data on patient demographics, incident characteristics, EMS care, and county population density for EMS-suspected patients with ACS, defined as a complaint of chest pain or suspected cardiac event and documentation of myocardial ischemia on prehospital ECG or prehospital activation of the cardiac care team. Descriptive statistics for each EMS time interval were computed. Multivariable logistic regression was used to quantify relationships between meeting response and scene time benchmarks (11 and 15 minutes, respectively) and prespecified covariates. Among 4667 patients meeting eligibility criteria, median response time (8 minutes) was shorter than median scene (16 minutes) and transport (17 minutes) time. While scene times were comparable by population density, patients in rural (versus urban) counties experienced longer response and transport times. Overall, 62% of EMS encounters met the 11-minute response time benchmark and 49% met the 15-minute scene time benchmark. In adjusted regression analyses, EMS encounters of older and female patients and obtaining a 12-lead ECG and venous access were independently associated with lower adherence to the scene time benchmark. Conclusions Our statewide study identified urban-rural differences in response and transport times for suspected ACS as well as patient demographic and EMS care characteristics related to lower adherence to scene time benchmark. Strategies to reduce EMS scene times among patients with ACS need to be developed and evaluated.
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Cui et al. (2021) conducted an observational in Suspected acute coronary syndrome (ACS) (n=4,667). Female sex vs. Male sex was evaluated on Adherence to 15-minute EMS scene time benchmark (OR 0.63, 95% CI 0.55-0.73). Female sex was associated with a significantly lower likelihood of meeting the 15-minute emergency medical services scene time benchmark compared to male sex (OR 0.63).
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