Key result
Lower dispatch priority and non-12-lead ECG capable ambulances were associated with longer call-to-hospital times in suspected STEMI.
Why the study?
The authors sought to assess the effect of patient and system characteristics on emergency medical service delays prior to hospital arrival in suspected STEMI.
What patient and system characteristics are associated with emergency medical service delays prior to hospital arrival in suspected STEMI?
Observational (n=1,739)
What patient and system characteristics are associated with emergency medical service delays prior to hospital arrival in suspected STEMI?
Optimizing dispatch prioritization and ensuring widespread availability of prehospital 12-lead ECGs could substantially reduce time to treatment for STEMI patients.
Answers are grounded in this paper and cite their sources.
Patient and system factors linked to EMS delays in STEMI; hypothesis-generating and requires prospective validation before practice change.
OBJECTIVE: To assess the effect of patient and system characteristics on emergency medical service (EMS) delays prior to arrival at hospital in suspected ST-elevation myocardial infarction (STEMI). METHODS: This was a retrospective observational study of 1739 patients who presented with suspected STEMI to the EMS in Melbourne, Australia between October 2011 and January 2014. Our primary outcome measure was call-to-hospital time, defined as the time in minutes from emergency call to hospital arrival. We examined the association of patient and system characteristics on call-to-hospital time using multivariable linear regression. RESULTS: The mean call-to-hospital time was 60.1 min (standard deviation 20.5) and the median travel distance was 13.0 km (interquartile range 7.2-23.1). In the multivariable model, patient characteristics associated with longer call-to-hospital time were age ≥75 years (2.3 min; 95% confidence interval [CI] 0.6-4.0), female sex (1.9 min; 95% CI 0.3-3.4), pre-existing mental health disorder (4.0 min; 95% CI 1.9-6.1) or musculoskeletal disease (2.7 min; 95% CI 1.0-4.4), absence of chest pain (3.0 min; 95% CI 1.1-4.8), and presentation with clinical complications. System factors associated with call-to-hospital time include lower dispatch priority (12.7 min; 95% CI 9.0-16.5) and non-12-lead electrocardiography (ECG) capable ambulance first on scene (4.5 min; 95% CI 3.1-5.8). Patients who were not initially attended by a 12-lead capable ambulance were less likely to receive a 12-lead ECG within 10 min (18.5% vs 71.0%, P < 0.001). CONCLUSION: A range of patient and system factors may influence EMS delays in STEMI. However, optimising dispatch prioritisation and widespread availability of prehospital 12-lead ECG could lead to substantial reduction in time to treatment.
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Alrawashdeh et al. (2020) conducted an observational in suspected ST-elevation myocardial infarction (STEMI) (n=1,739). Lower dispatch priority vs. Higher dispatch priority was evaluated on call-to-hospital time, defined as the time in minutes from emergency call to hospital arrival (MD 12.7, 95% CI 9.0-16.5). Lower dispatch priority and non-12-lead ECG capable ambulances were associated with longer call-to-hospital times in suspected STEMI.
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