Inappropriate dispatcher decision for emergency medical service users with acute myocardial infarction

• Published in: The American journal of emergency medicine 2011, Vol.29 (1), p.37-42
• Main Authors: Fourny, Magali, MSc, Lucas, Anne-Sophie, MD, Belle, Loïc, MD, Debaty, Guillaume, MD, Casez, Pierre, MSc, Bouvaist, Hélène, MD, François, Patrice, MD, PhD, Vanzetto, Gérald, MD, PhD, Labarère, José, MD
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiovascular disease; Catheter Ablation; Catheter Ablation - standards; Catheter Ablation - statistics & numerical data; Emergency; Emergency and intensive care: techniques, logistics; Emergency medical care; Emergency Medical Services; Emergency Medical Services - standards; Emergency Medical Services - statistics & numerical data; Female; Health services; Heart attacks; Hospital Mortality; Hospitals; Humans; Intensive care medicine; Intensive care unit. Emergency transport systems. Emergency, hospital ward; Life Sciences; Male; Medical sciences; Middle Aged; Mortality; Myocardial Infarction; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Myocardial Reperfusion; Myocardial Reperfusion - standards; Myocardial Reperfusion - statistics & numerical data; Odds Ratio; Santé publique et épidémiologie; Thrombolytic Therapy; Thrombolytic Therapy - standards; Thrombolytic Therapy - statistics & numerical data; Time Factors
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2009.07.008

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.