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Paramedic versus physician-staffed ambulances and prehospital delays in the management of patients with ST-segment elevation myocardial infarction
Affiliations- Voivodeship Rescue Service in Katowice, Katowice, Poland
- Department of Emergency Medicine, Medical University of Bialystok, Bialystok
- University of Strategic Planning in Dabrowa Gornicza, Poland
- 3rd Department of Cardiology, Silesian Center for Heart Disease, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Sil
- Department of Science, Biostatistics and New Technologies, Silesian Center for Heart Disease, Zabrze, Poland.
- Department of Cardiovascular Disease Prevention, School of Public Health in Bytom, Medical University of Silesia
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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.
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.
Keywords
acute myocardial infarction, paramedic-only staffed ambulances, physician-staffed ambulances, time delays
About this articleTitle
Paramedic versus physician-staffed ambulances and prehospital delays in the management of patients with ST-segment elevation myocardial infarction
Journal
Issue
Article type
Original Article
Pages
110-117
Published online
2019-07-15
Page views
2035
Article views/downloads
1682
DOI
Pubmed
Bibliographic record
Cardiol J 2021;28(1):110-117.
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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