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[The patterns of admission for patients with suspected acute myocardial infarction]
T E Knudsen1, A C Johannessen, G F Fly
1Silkeborg Centralsygehus, medicinsk afdeling.
Insights
Delays in emergency care for acute myocardial infarction patients are significant. Improving prehospital treatment and ambulance staffing is crucial for better patient outcomes.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Context:
- Investigated hospital admission patterns for 161 acute myocardial infarction (AMI) patients between February and September 1988.
- Analyzed patient pathways, including doctor contact, direct ambulance calls, and self-arrival at facilities.
- Examined delays in prehospital care and their impact on patient condition.
Purpose:
- To assess the timeliness and effectiveness of prehospital care for suspected acute myocardial infarction.
- To identify critical points of delay in the patient journey from symptom onset to hospital admission.
- To evaluate the composition of ambulance staffing during emergency responses.
Summary:
- 59% of AMI patients contacted their doctor first, with a median doctor delay of 15 minutes; only 7% were escorted to the hospital.
- Doctors did not accompany patients in 40% of cases, leading to 44% arriving in poor condition and 33% mortality.
- Adequately staffed ambulances (3 trained personnel) were present in only 5% of initial doctor-contact cases versus 41% of emergency ambulance calls.
Impact:
- Highlights significant deficiencies in prehospital management of AMI patients.
- Underscores the need for enhanced emergency medical services protocols and training.
- Suggests improvements in doctor-patient interaction and ambulance response to reduce mortality and morbidity.
Abstract:
The patterns of admission to hospital for 161 patients with suspected acute myocardial infarction during the period 1.2.1988-30.9.1988 were investigated. This revealed that 59% called their doctor, 20% called the ambulance directly, 11% arrived at the doctor's office or casualty department and 7% were admitted with cardiac arrest. The durations of delay were investigated. The median duration of delay by the doctor was 15 minutes but only 7% of the cases were escorted to hospital by the doctor. In 53% of the cases, the doctors waited for the ambulance without escorting the patient. In 40% of the cases, the doctors did not wait for the ambulance. 44% of the patients with acute myocardial infarction referred to hospital by doctors who did not accompany them were in poor condition on arrival (one patient died in the ambulance). 33% of these patients died in hospital. The ambulances were staffed by three persons with paramedical training in only 5% of the cases when the patient first called the doctor and in 41% of the cases when the ambulance was called as an emergency. The study reveals that prehospital treatment of cardiac patients should be improved.