Prehospital Actions And Reducing Treatment Delays

Several prehospital strategies related to transport and care can affect patient outcomes.

Ambulance Transport

How patients with acute MI symptoms get to the hospital has ramifications on how quickly they are evaluated and treated at the hospital. Surprisingly, calling an ambulance for heart attack symptoms is not frequently done. The Atherosclerosis Risk in Communities study reported that the percentage of MI patients arriving at the hospital by ambulance changed little from 1987 to 1998, going from 36 to 40% (41). The REACT research program revealed that the average rate of EMS use was only 33% in both the 10 intervention and 10 control communities at the study's baseline assessment (42). The NRMI-2 compared the baseline characteristics and initial management for 772,586 patients from April 1994 to March 1998 presenting by ambulance vs self-transport (excluding those in cardiogenic shock, over 6 h from symptom onset to hospital arrival, or who were transferred in). Only one of two patients with MI was transported to the hospital by ambulance (43).

Use of the EMS system by calling 9-1-1 or the equivalent local emergency number (which dispatches an ambulance) is associated with significantly faster delivery of acute reperfusion therapies. In the aforementioned NRMI-2 study, the mean door-to-throm-bolytic time was 54.7 min in those who were brought to the hospital by ambulance vs 66.9 min in those who self-transported. The mean door-to-balloon time was 141.7 min vs 173 min for those who arrived by ambulance vs those who self-transported, respectively (43).

REACT investigators reported a significant association of early reperfusion therapy with ambulance use. Of 3013 selected study patients who received reperfusion treatment, 1195 (40%) were transported via EMS personnel. The adjusted rate of reperfusion within 6 h of symptom onset was significantly greater for acute MI patients transported via EMS personnel (36 vs 24%) (44).

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