Inappropriate dispatcher decision for emergency medical service users with acute myocardial infarction☆
Received 4 June 2009; received in revised form 10 July 2009; accepted 11 July 2009. published online 10 March 2010. Corrected Proof
Abstract
Objectives
Current guidelines recommend utilization of prehospital emergency medical services (EMSs) by patients with ST-elevation myocardial infarction (STEMI). The aims of this study were to estimate the percentage of inappropriate initial dispatcher decisions and determine their impact on delays in reperfusion therapy for EMS users with STEMI.
Methods
As part of a prospective regional registry of patients with STEMI, we analyzed the original data for 245 patients who called a university hospital-affiliated EMS call center in France. The primary study outcome was time to reperfusion therapy calculated from the documented date and time of the first patient call.
Results
The initial EMS dispatcher's decision was appropriate (ie, dispatching a mobile intensive care unit staffed by an emergency or critical care physician) for 171 (70%) patients and inappropriate for 74 (30%) patients. Inappropriate decisions included referring the patient to a family physician (n = 59), providing medical advice (n = 9), and dispatching an ambulance (n = 6). Inappropriate initial decisions resulted in increased median time to reperfusion for 140 patients receiving fibrinolysis (95 vs 53 minutes; P < .001) and 91 patients undergoing primary percutaneous coronary intervention (170 vs 107 minutes; P < .001). In-hospital mortality was not different between the 2 study groups (6.8% vs 9.9%; P = .42).
Conclusion
The initial dispatcher's decision is inappropriate for 30% of EMS users with STEMI and results in substantial delays in time to reperfusion therapy. Accuracy of telephone triage should be improved for patients who activate EMSs in response to symptoms suggestive of acute coronary syndrome.
aQuality of Care Unit, Grenoble University Hospital, Grenoble, France
bService d'Aide Médicale Urgente (SAMU 38), Grenoble University Hospital, Grenoble, France
cDepartment of Cardiology, Annecy General Hospital, Annecy, France
dCardiovascular and Thoracic Department, Grenoble University Hospital, Grenoble, France
eTechniques de l'Ingénierie Médicale et de la Complexité (TIMC), Unité Mixte de Recherche 5525, Centre National de la Recherche Scientifique (CNRS), Université Joseph Fourier, Grenoble, France
☆ Grant support: This study was supported by a grant from Grenoble University Hospital (Direction de la Recherche Clinique, Programme de Recherche Clinique).
ABSTRACT