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Original Article
Published online: 2019-07-15
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Paramedic versus physician-staffed ambulances and prehospital delays in the management of patients with ST-segment elevation myocardial infarction

Artur Borowicz, Klaudiusz Nadolny, Kamil Bujak, Daniel Cieśla, Mariusz Gąsior, Bartosz Hudzik
DOI: 10.5603/CJ.a2019.0072
·
Pubmed: 31313273

open access

Ahead of print
Original articles
Published online: 2019-07-15

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: The was 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 (physician-staffed vs. paramedic/nurse-only staffed ambulance) was adjusted for ECG transmission, sex had no impact on in-hospital mortality (OR 1.41; 95% 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.

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: The was 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 (physician-staffed vs. paramedic/nurse-only staffed ambulance) was adjusted for ECG transmission, sex had no impact on in-hospital mortality (OR 1.41; 95% 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.

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Keywords

acute myocardial infarction, paramedic-only staffed ambulances, physician-staffed ambulances, time delays

About this article
Title

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

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2019-07-15

DOI

10.5603/CJ.a2019.0072

Pubmed

31313273

Keywords

acute myocardial infarction
paramedic-only staffed ambulances
physician-staffed ambulances
time delays

Authors

Artur Borowicz
Klaudiusz Nadolny
Kamil Bujak
Daniel Cieśla
Mariusz Gąsior
Bartosz Hudzik

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