Paramedic versus physician-staffed ambulances and prehospital delays in the management of patients with ST-segment elevation myocardial infarction

Abstract

Background: Time delays to reperfusion therapy in ST-segment elevation myocardial infarction (STEMI) still remain a considerable drawback in many healthcare systems. Emergency medical service (EMS) has a critical role in the early management of STEMI. Under investigation herein, was whether the use of physician-staffed ambulances leads to shorter pre-hospital delays in STEMI patients. Methods: This was an observational and retrospective study, using data from the registry of the Silesian regional EMS system in Katowice, Poland and the Polish Registry on Acute Coronary Syndromes (PL-ACS) for a study period of January 1, 2013 to December 31, 2016. The study population (n = 717) was divided into two groups: group 1 (n = 546 patients)-physician-staffed ambulances and group 2 (n = 171 patients)-paramedic-staffed ambulances. Results: Responses during the day and night shifts were similar. Paramedic-led ambulances more often transmitted 12-lead electrocardiogram (ECG) to the percutaneous coronary intervention centers. All EMS time intervals were similar in both groups. The type of EMS dispatched to patients (physicianstaffed vs. paramedic/nurse-only staffed ambulance) was adjusted for ECG transmission, sex had no impact on in-hospital mortality (odds ratio [OR] 1.41; 95% confidence interval [CI] 0.79-1.95; p = 0.4). However, service time exceeding 42 min was an independent predictor of in-hospital mortality (OR 4.19; 95% CI 1.27-13.89; p = 0.019). In-hospital mortality rate was higher in the two upper quartiles of service time in the entire study population. Conclusions: These findings suggest that both physician-led and paramedic-led ambulances meet the criteria set out by the Polish and European authorities. All EMS time intervals are similar regardless of the type of EMS unit dispatched. A physician being present on board did not have a prognostic impact on outcomes.

Does the presence of physician-staffed emergency medical services improve the prognosis in out-of-hospital cardiac arrest? A propensity score matching analysis

“…Emergency medical service systems' organization differs between countries, which may partially be the reason for Abbreviations: CRT-D, cardiac resynchronization therapy defibrillator; ECG, electrocardiogram; IO, intraosseous; IV, intravenous; UFH, unfractionated heparin; other -see Tables 1 and 2 690 Abbreviations: see Table 1 and 2 the variability of OHCA outcomes worldwide [10,20]. One of these differences refers to the utilization of physician-led EMS or paramedic-led EMS [21]. Both models are being used in developed countries, and limited data support the advantage of one of these options [9,21].…”

“…One of these differences refers to the utilization of physician-led EMS or paramedic-led EMS [21]. Both models are being used in developed countries, and limited data support the advantage of one of these options [9,21]. However, the physician-led EMS model is associated with increased costs [10].…”

Stepwise relationship between delay in percutaneous coronary intervention and long-term mortality in patients with non-ST-segment elevation myocardial infarction

“…We analyzed the data of patients admitted to the hospital for NSTEMI between July 2007 and July 2019, included in a nationwide, prospective registry of acute coronary syndromes (Polish Registry of Acute Coronary Syndromes; PL-ACS). More details regarding PL-ACS have been described previously [6][7][8][9][10]. Briefly, PL-ACS is a clinical registry established in 2003, which was a joint effort of the Silesian Center for Heart Diseases in Zabrze and the Polish Ministry of Health.…”

Pre-hospital treatment of patients with acute coronary syndrome: Recommendations for medical emergency teams. Expert position update 2022

“…Emergency medical teams are responsible for early diagnosis, triage, transport and treatment of ACS patients [1][2][3][4][5][6]. In order to improve the quality of care and decrease adequate treatment delay, an early working diagnosis of ACS and risk stratification should be conducted at the earliest possible moment.…”