Key result
Patient's site of call, age, and hour of EMS activation were the strongest independent predictors of pre-hospital transportation delays, though median delays remained within guideline recommendations.
Why the study?
The emergency medical service provides rapid pre-hospital care in STEMI, but the temporal and regional characteristics of EMS-related delays in a metropolitan STEMI network required assessment.
Observational (n=4,751)
Yes
p-value: p=<0.001
In a metropolitan STEMI network, EMS transportation delays were significantly but minimally influenced by patient location, age, and time of day, remaining within guideline-recommended intervals.
Call-to-door times stay guideline-compliant despite location, age, and timing predictors; leaves open whether targeted EMS interventions can shorten delays further.
OBJECTIVE: The emergency medical service (EMS) provides rapid pre-hospital diagnosis and transportation in ST-elevation myocardial infarction (STEMI) systems of care. Aim of the study was to assess temporal and regional characteristics of EMS-related delays in a metropolitan STEMI network. METHODS: Patient call-to-arrival of EMS at site (call-to-site), transportation time from site to hospital (site-to-door), call-to-door, patient's location, month, weekday, and hour of EMS activation were recorded in 4751 patients referred to a tertiary center with suspicion of STEMI. RESULTS: Median call-to-site, site-to-door, and call-to-door times were 9 (7-12), 39 (31-48), and 49 (41-59) minutes, respectively. The shortest transportation times were noted between 08:00 and 16:00 and in general on Sundays. They were significantly prolonged between midnight and 04:00, whereby the longest difference did not exceed 4 min in median. Patient's site of call had a major impact on transportation times, which were shorter in Central and Western districts as compared to Southern and Eastern districts of Vienna (p < 0.001 between-group difference for call-to-site, site-to-door, and call-to-door). After multivariable adjustment, patient's site of call was an independent predictor of call-to-site delay (p < 0.001). Moreover, age and hour of EMS activation were the strongest predictors of call-to-site, site-to-door, and call-to-door delays (p < 0.05). CONCLUSION: In our Viennese STEMI network, the strongest determinants of pre-hospital EMS-related transportation delays were patient's site of call, patient's age, and hour of EMS activation. Due to the significant but small median time delays, which are within the guideline-recommended time intervals, no impact on clinical outcome can be expected.
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Jäger et al. (2019) conducted an observational in Suspected ST-elevation myocardial infarction (STEMI) (n=4,751). Patient's site of call, hour of EMS activation, and age was evaluated on Pre-hospital EMS-related transportation delays (call-to-site, site-to-door, and call-to-door) (p=<0.001). Patient's site of call, age, and hour of EMS activation were the strongest independent predictors of pre-hospital transportation delays, though median delays remained within guideline recommendations.
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