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Factors associated with emergency medical service delays in suspected ST‐elevation myocardial infarction in Victoria, Australia: A retrospective study
Author(s) -
Alrawashdeh Ahmad,
Nehme Ziad,
Williams Brett,
Smith Karen,
Stephenson Michael,
Bernard Stephen,
Cameron Peter,
Stub Dion
Publication year - 2020
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/1742-6723.13512
Subject(s) - medicine , interquartile range , chest pain , confidence interval , myocardial infarction , emergency department , retrospective cohort study , emergency medicine , emergency medical services , observational study , ambulance service , medical record , medical emergency , psychiatry
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.