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Ground emergency medical services requests for helicopter transfer of ST-segment elevation myocardial infarction
Jason T McMullan1, William Hinckley, Jared Bentley
1Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA.
Insights
Directly requesting helicopter emergency medical services (HEMS) for ST-segment elevation myocardial infarction (STEMI) patients can significantly reduce time to treatment. However, most STEMI patients may still not reach the critical 90-minute goal.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Services Research
Background:
- ST-segment elevation myocardial infarction (STEMI) requires time-critical intervention.
- Interhospital transfer via helicopter emergency medical services (HEMS) is often necessary for percutaneous coronary intervention (PCI) when patients initially arrive at non-PCI-capable hospitals.
- Ground emergency medical services (EMS) typically initiate these transfers after initial hospital arrival.
Purpose of the Study:
- To model the potential time savings of direct HEMS activation by ground EMS for STEMI patients requiring interhospital transfer.
- To compare direct-to-scene HEMS response versus a hospital rendezvous scenario for STEMI transfers.
- To evaluate the impact of these strategies on medical contact to balloon (MCTB) times.
Main Methods:
- Retrospective chart review of STEMI patients transferred for primary PCI by a HEMS agency.
- Modeling of MCTB times for two scenarios: direct-to-scene HEMS response and hospital rendezvous after ground EMS initiation.
- Analysis of data from 36 interhospital transfers over 12 months.
Main Results:
- The median MCTB time for hospital-initiated transfers was 160 minutes.
- Direct-to-scene HEMS response was estimated to reduce median MCTB time by 48 minutes (to 112 minutes).
- Hospital rendezvous scenarios also showed a median reduction of 47 minutes (to 113 minutes), with a small percentage of patients potentially reaching the <90-minute goal.
Conclusions:
- Ground EMS initiation of HEMS transfers for STEMI patients can potentially reduce critical treatment times.
- Despite potential time savings, most STEMI patients in this model did not achieve the target MCTB time of less than 90 minutes.
- Optimizing HEMS activation protocols for STEMI transfers warrants further investigation to improve patient outcomes.
Objectives:
ST-segment elevation myocardial infarction (STEMI) care is time-dependent. Many STEMI patients require interhospital helicopter transfer for percutaneous coronary intervention (PCI) if ground emergency medical services (EMS) initially transport the patient to a non-PCI center. This investigation models potential time savings of ground EMS requests for helicopter EMS (HEMS) transport of a STEMI patient directly to a PCI center, rather than usual transport to a local hospital with subsequent transfer.
Methods:
Data from a multicenter retrospective chart review of STEMI patients transferred for primary PCI by a single HEMS agency over 12 months were used to model medical contact to balloon times (MCTB) for two scenarios: a direct-to-scene HEMS response and hospital rendezvous after ground EMS initiation of transfer.
Results:
Actual MCTB median time for 36 hospital-initiated transfers was 160 minutes (range = 116 to 321 minutes). Scene response MCTB median time was estimated as 112 minutes (range = 69 to 187 minutes). The difference in medians was 48 minutes (95% confidence interval [CI] = 33 to 62 minutes). Hospital rendezvous MCTB median time was estimated as 113 minutes (range = 74 to 187 minutes). The difference in medians was 47 minutes (95% CI = 32 to 62 minutes). No patient had an actual MCTB time of less than 90 minutes; in the scene response and hospital rendezvous scenarios, 2 of 36 (6%) and 3 of 36 (8%), respectively, would have had MCTB times under 90 minutes.
Conclusions:
In this setting, ground EMS initiation of HEMS transfers for STEMI patients has the potential to reduce MCTB time, but most patients will still not achieve MCTB time of less than 90 minutes.
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