In the Journals

Delays in EMS response affect treatment, outcomes in STEMI

The length of response by emergency medical services has an impact on the treatment and outcomes of patients with STEMI, according to findings published in Heart.

Researchers also found an unexplained variation in emergency medical services (EMS) delays that reached beyond differences in system characteristics.

Ahmad Alrawashdeh, BSN, MSc, and colleagues evaluated EMS delays and their influence on time to treatment and mortality in patients with STEMI.

“Delays to treatment contribute to death and disability after STEMI. Much of the existing literature targeting treatment delays has focused on in-hospital system delays,” Alrawashdeh, a PhD candidate in the department of community emergency health and paramedic practice at Monash University in Australia and the department of allied sciences at the Jordan University of Science and Technology in Jordan, told Cardiology Today. “However, we know that a large proportion of system delays occur while in the care of emergency medical services. To date, there is little understanding of the extent of EMS delays, the factors contributing to them, the variability in delays across the world and the impact of these delays on patient outcomes. As a result, EMS systems lack appropriate benchmarks to improve performance.”

The researchers gathered data on EMS time arrivals from published studies in five databases. Time in minutes between first medical contact and hospital door arrival was the primary EMS interval, Alrawashdeh and colleagues wrote.

The length of response by emergency medical services has an impact on the treatment and outcomes of patients with STEMI, according to findings published in Heart.
Source: Adobe Stock

Secondary intervals included other components of EMS delay. Weighted means were measured using random-effects models.

The researchers analyzed data that included 100 studies from 20 countries, consisting of 125,343 patients (weighted mean age, 61 years; 74% men).

Among the 101,646 patients for whom first medical contact-to-hospital door time was available, the weighted mean was 41 minutes (95% CI, 39-43). Substantial heterogeneity was seen in each interval, possibly explained by region, urban classification, hospital distance and method of ECG interpretation, according to the researchers.

In a meta-regression analysis, each 10 minute-increase in first medical contact-to-hospital door time led to a 10.6% reduction in patients treated within 90 minutes (95% CI, 7.6-13.5), after researchers adjusted for hospital door-to-balloon time.

Among patients receiving prehospital thrombolysis, shorter EMS delays had an association with lower short-term mortality (P = .018).

Alrawashdeh told Cardiology Today that compared with hospital delay, EMS delay had lesser concerns from international guidelines, and there has been no reduction in EMS delays during the past 3 decades.

“The findings of this study clearly show the need for local or international efforts or initiatives to monitor and reduce EMS delays in STEMI,” Alrawashdeh said. “We believe that our global estimates of total EMS delay and its components may serve as or contribute to establishing benchmarks for EMS delays in STEMI and identify areas for performance improvement, which could lead to shorter delay and, thus, better patient outcome.” – by Earl Holland Jr.

Disclosures: The authors report no relevant financial disclosures.

The length of response by emergency medical services has an impact on the treatment and outcomes of patients with STEMI, according to findings published in Heart.

Researchers also found an unexplained variation in emergency medical services (EMS) delays that reached beyond differences in system characteristics.

Ahmad Alrawashdeh, BSN, MSc, and colleagues evaluated EMS delays and their influence on time to treatment and mortality in patients with STEMI.

“Delays to treatment contribute to death and disability after STEMI. Much of the existing literature targeting treatment delays has focused on in-hospital system delays,” Alrawashdeh, a PhD candidate in the department of community emergency health and paramedic practice at Monash University in Australia and the department of allied sciences at the Jordan University of Science and Technology in Jordan, told Cardiology Today. “However, we know that a large proportion of system delays occur while in the care of emergency medical services. To date, there is little understanding of the extent of EMS delays, the factors contributing to them, the variability in delays across the world and the impact of these delays on patient outcomes. As a result, EMS systems lack appropriate benchmarks to improve performance.”

The researchers gathered data on EMS time arrivals from published studies in five databases. Time in minutes between first medical contact and hospital door arrival was the primary EMS interval, Alrawashdeh and colleagues wrote.

The length of response by emergency medical services has an impact on the treatment and outcomes of patients with STEMI, according to findings published in Heart.
Source: Adobe Stock

Secondary intervals included other components of EMS delay. Weighted means were measured using random-effects models.

The researchers analyzed data that included 100 studies from 20 countries, consisting of 125,343 patients (weighted mean age, 61 years; 74% men).

Among the 101,646 patients for whom first medical contact-to-hospital door time was available, the weighted mean was 41 minutes (95% CI, 39-43). Substantial heterogeneity was seen in each interval, possibly explained by region, urban classification, hospital distance and method of ECG interpretation, according to the researchers.

In a meta-regression analysis, each 10 minute-increase in first medical contact-to-hospital door time led to a 10.6% reduction in patients treated within 90 minutes (95% CI, 7.6-13.5), after researchers adjusted for hospital door-to-balloon time.

Among patients receiving prehospital thrombolysis, shorter EMS delays had an association with lower short-term mortality (P = .018).

Alrawashdeh told Cardiology Today that compared with hospital delay, EMS delay had lesser concerns from international guidelines, and there has been no reduction in EMS delays during the past 3 decades.

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“The findings of this study clearly show the need for local or international efforts or initiatives to monitor and reduce EMS delays in STEMI,” Alrawashdeh said. “We believe that our global estimates of total EMS delay and its components may serve as or contribute to establishing benchmarks for EMS delays in STEMI and identify areas for performance improvement, which could lead to shorter delay and, thus, better patient outcome.” – by Earl Holland Jr.

Disclosures: The authors report no relevant financial disclosures.

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