[Pre-hospital management of acute myocardial infarction: weaknesses]
1Division des soins intensifs médicaux, département de médecine, Hôpital Riviera, site du Samaritain, Vevey.
Insights
Many acute myocardial infarction (AMI) deaths occur before hospital arrival. Utilizing emergency medical services (SMUR) significantly reduces in-hospital delays for AMI patients, improving outcomes.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Context:
- High mortality rates persist for acute myocardial infarction (AMI), with a significant proportion of deaths occurring prehospital.
- American Heart Association guidelines emphasize rapid Emergency Medical Services (EMS) activation for AMI.
- A notable number of AMI patients arrive at the hospital without utilizing specialized emergency ambulance services (SMUR).
Purpose:
- To quantify the underutilization of SMUR for AMI patients.
- To analyze transport methods, the role of primary care practitioners, and SMUR's impact on in-hospital delays.
- To identify factors contributing to suboptimal EMS use in AMI cases.
Summary:
- A retrospective study of 125 AMI cases (2000-2001) found 42 self-transported, 57 arrived via SMUR ambulance, and 26 via non-SMUR ambulance.
- Half of patients alerted an out-of-hospital doctor; SMUR utilization varied by transport method.
- Thrombolysis was administered to one-third of patients, with median prehospital and in-hospital delays of 120 and 40 minutes, respectively.
- In-hospital delays were significantly shorter when SMUR was utilized.
Impact:
- Confirms suboptimal utilization of emergency ambulance services for AMI, influenced by patient and primary care practitioner decisions.
- Highlights the need for targeted information campaigns for both the general population and primary care providers regarding appropriate AMI management and EMS activation.
- Emphasizes the critical role of timely SMUR intervention in reducing in-hospital delays for acute myocardial infarction patients.
Abstract:
The overall mortality of acute myocardial infarction (AMI) is still high, half of deaths occurring in the prehospital setting. The American Heart Association (AHA) recommendations strongly emphasize the rapid use of "Emergency Medical Services". Despite this guideline, we frequently observe patients with AMI arriving at the hospital without an emergency ambulance service (SMUR). We undertook a retrospective study to quantify this problem with special interest in the mean of transport, in the role of the primary care practitioner and in the influence of the SMUR on the in-hospital delay. We had 125 AMI in 2000 and 2001: 42 reached the hospital by self-transportation, 57 by ambulance with SMUR and 26 by ambulance without SMUR. An out-hospital doctor was first warned by half of the patients 38% of which arrived by ambulance with SMUR, 37% by ambulance without SMUR and 25% by their own means. A thrombolysis was applied in one third of the AMI: the median prehospital and in-hospital delays were 120 and 40 minutes respectively. The in-hospital delay was significantly shorter when the emergency ambulance service was used. Our results confirm a suboptimal utilisation of the emergency ambulance service for AMI, due to patient and out-hospital doctors. This encourages us to go on providing specific information to the population but also to the primary care practitioners.
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