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Using EMS Dispatch to Trigger STEMI Alerts Decreases Door-to-Balloon Times
INTRODUCTION: We sought to determine the potential reduction in door-to-balloon time (DTB) by allowing paramedics to perform prehospital ST-Elevation Myocardial Infarction (STEMI) notification using brief communications via emergency medical services (EMS) 9-1-1 dispatchers as soon as they saw a STE...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Department of Emergency Medicine, University of California, Irvine School of Medicine
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4427229/ https://www.ncbi.nlm.nih.gov/pubmed/25987932 http://dx.doi.org/10.5811/westjem.2015.4.24248 |
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author | Stowens, Justin C. Sonnad, Seema S. Rosenbaum, Robert A. |
author_facet | Stowens, Justin C. Sonnad, Seema S. Rosenbaum, Robert A. |
author_sort | Stowens, Justin C. |
collection | PubMed |
description | INTRODUCTION: We sought to determine the potential reduction in door-to-balloon time (DTB) by allowing paramedics to perform prehospital ST-Elevation Myocardial Infarction (STEMI) notification using brief communications via emergency medical services (EMS) 9-1-1 dispatchers as soon as they saw a STEMI on 12-lead electrocardiogram (EKG). Our hypothesis was that earlier cardiac catheterization lab (CCL) activation would improve overall DTB and avoid delays arising from on-scene issues or the time required to deliver a full report. METHODS: The study setting was a single suburban community teaching hospital, which is a regional percutaneous coronary intervention (PCI) center with more than 120,000 Emergency Department (ED) visits/year and is serviced by a single tiered-response, advanced life support (ALS) paramedic-level agency. STEMI notifications from July 2009 to July 2012 occurred by either standard direct EMS-to-physician notification or by immediate 9-1-1 dispatch notification. In the 9-1-1 dispatcher-aided notification method, paramedics were asked to provide a brief one-sentence report using their lapel microphones upon immediate realization of a diagnostic EKG (usually within 1–2 minutes of patient contact). This report to the 9-1-1 dispatcher included the patient’s sex, age, and cardiologist (if known). The dispatcher then called the emergency department attending and informed them that a STEMI was being transported and that CCL activation was needed. We used retrospective chart review of a consecutive sample of patients from an existing STEMI registry to determine whether there was a statistically significant difference in DTB between the groups. RESULTS: Eight hundred fifty-six total STEMI alert patients arrived by EMS during the study. We excluded 730 notifications due to events such as cardiac arrest, arrhythmia, death, resolution of EKG changes and/or symptoms, cardiologist decision not to perform PCI, arrival as a transfer after prior stabilization at a referring facility or arriving by an EMS agency other than New Castle County EMS (NCC*EMS). Sixty-four (64) sequential patients from each group comprised the study sample. The average DTB (SD) for the standard communication method was 57.6 minutes (17.9), while that for dispatcher-aided communication was 46.1 minutes (12.8), (mean difference 57.6-46.1 minutes=11.5 minutes with a 95% CI [6.06,16.94]) p=0.0001. In the dispatcher-aided group, 92% of patients (59/64) met standards of ≤60 minute DTB time. Only 64% (41/64) met this goal in the standard communication group (p=0.0001). CONCLUSION: Brief, early notification of STEMI by paramedics through 9-1-1 dispatchers achieves earlier CCL activation in a hospital system already using EMS-directed CCL activation. This practice significantly decreased DTB and yielded a higher percentage of patients meeting the DTB≤60 minutes quality metric. |
format | Online Article Text |
id | pubmed-4427229 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Department of Emergency Medicine, University of California, Irvine School of Medicine |
record_format | MEDLINE/PubMed |
spelling | pubmed-44272292015-05-18 Using EMS Dispatch to Trigger STEMI Alerts Decreases Door-to-Balloon Times Stowens, Justin C. Sonnad, Seema S. Rosenbaum, Robert A. West J Emerg Med Prehospital Care INTRODUCTION: We sought to determine the potential reduction in door-to-balloon time (DTB) by allowing paramedics to perform prehospital ST-Elevation Myocardial Infarction (STEMI) notification using brief communications via emergency medical services (EMS) 9-1-1 dispatchers as soon as they saw a STEMI on 12-lead electrocardiogram (EKG). Our hypothesis was that earlier cardiac catheterization lab (CCL) activation would improve overall DTB and avoid delays arising from on-scene issues or the time required to deliver a full report. METHODS: The study setting was a single suburban community teaching hospital, which is a regional percutaneous coronary intervention (PCI) center with more than 120,000 Emergency Department (ED) visits/year and is serviced by a single tiered-response, advanced life support (ALS) paramedic-level agency. STEMI notifications from July 2009 to July 2012 occurred by either standard direct EMS-to-physician notification or by immediate 9-1-1 dispatch notification. In the 9-1-1 dispatcher-aided notification method, paramedics were asked to provide a brief one-sentence report using their lapel microphones upon immediate realization of a diagnostic EKG (usually within 1–2 minutes of patient contact). This report to the 9-1-1 dispatcher included the patient’s sex, age, and cardiologist (if known). The dispatcher then called the emergency department attending and informed them that a STEMI was being transported and that CCL activation was needed. We used retrospective chart review of a consecutive sample of patients from an existing STEMI registry to determine whether there was a statistically significant difference in DTB between the groups. RESULTS: Eight hundred fifty-six total STEMI alert patients arrived by EMS during the study. We excluded 730 notifications due to events such as cardiac arrest, arrhythmia, death, resolution of EKG changes and/or symptoms, cardiologist decision not to perform PCI, arrival as a transfer after prior stabilization at a referring facility or arriving by an EMS agency other than New Castle County EMS (NCC*EMS). Sixty-four (64) sequential patients from each group comprised the study sample. The average DTB (SD) for the standard communication method was 57.6 minutes (17.9), while that for dispatcher-aided communication was 46.1 minutes (12.8), (mean difference 57.6-46.1 minutes=11.5 minutes with a 95% CI [6.06,16.94]) p=0.0001. In the dispatcher-aided group, 92% of patients (59/64) met standards of ≤60 minute DTB time. Only 64% (41/64) met this goal in the standard communication group (p=0.0001). CONCLUSION: Brief, early notification of STEMI by paramedics through 9-1-1 dispatchers achieves earlier CCL activation in a hospital system already using EMS-directed CCL activation. This practice significantly decreased DTB and yielded a higher percentage of patients meeting the DTB≤60 minutes quality metric. Department of Emergency Medicine, University of California, Irvine School of Medicine 2015-05 2015-04-21 /pmc/articles/PMC4427229/ /pubmed/25987932 http://dx.doi.org/10.5811/westjem.2015.4.24248 Text en Copyright © 2015 the authors. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Prehospital Care Stowens, Justin C. Sonnad, Seema S. Rosenbaum, Robert A. Using EMS Dispatch to Trigger STEMI Alerts Decreases Door-to-Balloon Times |
title | Using EMS Dispatch to Trigger STEMI Alerts Decreases Door-to-Balloon Times |
title_full | Using EMS Dispatch to Trigger STEMI Alerts Decreases Door-to-Balloon Times |
title_fullStr | Using EMS Dispatch to Trigger STEMI Alerts Decreases Door-to-Balloon Times |
title_full_unstemmed | Using EMS Dispatch to Trigger STEMI Alerts Decreases Door-to-Balloon Times |
title_short | Using EMS Dispatch to Trigger STEMI Alerts Decreases Door-to-Balloon Times |
title_sort | using ems dispatch to trigger stemi alerts decreases door-to-balloon times |
topic | Prehospital Care |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4427229/ https://www.ncbi.nlm.nih.gov/pubmed/25987932 http://dx.doi.org/10.5811/westjem.2015.4.24248 |
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