{"id":7013,"date":"2015-05-01T00:00:00","date_gmt":"2015-05-01T04:00:00","guid":{"rendered":"http:\/\/news.christianacare.org\/2015\/05\/using-ems-dispatch-to-trigger-stemi-alerts-decreases-door-to-balloon-times\/"},"modified":"2015-05-01T00:00:00","modified_gmt":"2015-05-01T04:00:00","slug":"using-ems-dispatch-to-trigger-stemi-alerts-decreases-door-to-balloon-times","status":"publish","type":"post","link":"https:\/\/research.christianacare.org\/publications\/2015\/05\/01\/using-ems-dispatch-to-trigger-stemi-alerts-decreases-door-to-balloon-times\/","title":{"rendered":"Using EMS Dispatch to Trigger STEMI Alerts Decreases Door-to-Balloon Times"},"content":{"rendered":"

Stowens JC, Sonnad SS, Rosenbaum RA<\/p>\n

West J Emerg Med 2015 May;16(3):472-80<\/p>\n

PMID: 25987932<\/a><\/p>\n

Abstract<\/h2>\n

INTRODUCTION: <\/strong>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.<\/p>\n

METHODS: <\/strong>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.<\/p>\n

RESULTS: <\/strong>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 \u226460 minute DTB time. Only 64% (41\/64) met this goal in the standard communication group (p=0.0001).<\/p>\n

CONCLUSION: <\/strong>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\u226460 minutes quality metric.<\/p><\/p>\n","protected":false},"excerpt":{"rendered":"

Stowens JC, Sonnad SS, Rosenbaum RA West J Emerg Med 2015 May;16(3):472-80 PMID: 25987932 Abstract 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<\/p>\n

Continue reading Using EMS Dispatch to Trigger STEMI Alerts Decreases Door-to-Balloon Times<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[12,1],"tags":[24],"class_list":["post-7013","post","type-post","status-publish","format-standard","hentry","category-cardiovascular","category-pubs-pres","tag-heart-attack"],"acf":[],"_links":{"self":[{"href":"https:\/\/research.christianacare.org\/publications\/wp-json\/wp\/v2\/posts\/7013","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/research.christianacare.org\/publications\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/research.christianacare.org\/publications\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/research.christianacare.org\/publications\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/research.christianacare.org\/publications\/wp-json\/wp\/v2\/comments?post=7013"}],"version-history":[{"count":0,"href":"https:\/\/research.christianacare.org\/publications\/wp-json\/wp\/v2\/posts\/7013\/revisions"}],"wp:attachment":[{"href":"https:\/\/research.christianacare.org\/publications\/wp-json\/wp\/v2\/media?parent=7013"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/research.christianacare.org\/publications\/wp-json\/wp\/v2\/categories?post=7013"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/research.christianacare.org\/publications\/wp-json\/wp\/v2\/tags?post=7013"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}