Use of Emergency Medical Service Transport Among Patients With ST-Segment–Elevation Myocardial Infarction

Abstract

Background-Activation of emergency medical services (EMS) is critical for the early triage and treatment of patients experiencing ST-segment-elevation myocardial infarction, yet data regarding EMS use and its association with subsequent clinical care are limited. Methods and Results-We performed an observational analysis of 37 634 ST-segment-elevation myocardial infarction patients treated at 372 US hospitals participating in the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines between January 2007 and September 2009, and examined independent patient factors associated with EMS transportation versus patient self-transportation. We found that EMS transport was used in only 60% of ST-segment-elevation myocardial infarction patients. Older patients, those living farther from the hospital, and those with hemodynamic compromise were more likely to use EMS transport. In contrast, race, income, and education level did not appear to be associated with the mode of transport.

Impact of Sex and Contact‐to‐Device Time on Clinical Outcomes in Acute ST‐Segment Elevation Myocardial Infarction—Findings From the National Cardiovascular Data Registry

“…Given that EMS is accessible to >98% of the US population, only 61.5% of the patients in this cohort utilized EMS as a mode of transportation for STEMI 1. This aligns with prior studies showing that 60% of STEMI patients use EMS 25. Results of this analysis show that more female patients were transported to emergency facilities by EMS than male patients.…”

Emergency Department Bypass for ST-Segment–Elevation Myocardial Infarction Patients Identified With a Prehospital Electrocardiogram

“…Factors associated with the low use of EMS for STEMI patients in the US have been investigated, but creative approaches are needed to further increase the use of EMS services for patients with ischemic symptoms and the use of prehospital ECGs among EMS providers. 18 Second, given the concerns regarding false activation of the catheterization laboratory for suspected STEMI patients, highly trained paramedics and better infrastructure to support the transmission of prehospital ECGs are needed. 19,20 Third, reliable triage protocols are needed to guide EMS providers to accurately identify patients who should be triaged for initial ED evaluation and stabilization such as those with prehospital cardiac arrest, cardiogenic shock, severe heart failure, or respiratory failure.…”

Impact of Door-to-Balloon Time in Patients With ST-Elevation Myocardial Infarction Who Arrived by Self-Transport ― Acute Myocardial Infarction-Kyoto Multi-Center Risk Study Group ―

“…From the reports of a large observational study in the United States, patients who arrived at hospitals using selftransport were on average younger, males, with a relatively lower risk, or hemodynamically stable on presentation. 10, 12 In our study, 31% patients were in the self-transport group, and 69% were in the EMS group. The finding that there was a larger number of older patients in the EMS group with a higher Killip classification is consistent with past reports.…”