Using EMS Dispatch to Trigger STEMI Alerts Decreases Door-to-Balloon Times.

Area of Science:

• Cardiology
• Emergency Medical Services
• Health Systems Science

Background:

• ST-Elevation Myocardial Infarction (STEMI) requires rapid treatment to minimize heart damage.
• Door-to-balloon (DTB) time is a critical metric for STEMI care.
• Current prehospital notification methods may introduce delays.

Purpose of the Study:

• To evaluate the impact of brief, prehospital STEMI notification via 9-1-1 dispatchers on DTB times.
• To determine if this method improves activation of the cardiac catheterization lab (CCL).
• To assess if earlier CCL activation reduces delays associated with on-scene issues or lengthy reports.

Main Methods:

• Retrospective chart review of STEMI patients from July 2009 to July 2012.
• Comparison of two notification methods: standard direct EMS-to-physician vs. dispatcher-aided 9-1-1 notification.
• In the dispatcher-aided group, paramedics provided brief EKG reports to 9-1-1 dispatchers for immediate relay to the ED.

Main Results:

• The dispatcher-aided notification group had an average DTB of 46.1 minutes, compared to 57.6 minutes in the standard group (p=0.0001).
• This represents an 11.5-minute reduction in DTB time.
• 92% of patients in the dispatcher-aided group met the ≤60 minute DTB goal, versus 64% in the standard group.

Conclusions:

• Brief STEMI notification by paramedics through 9-1-1 dispatchers leads to earlier CCL activation.
• This practice significantly decreases DTB times.
• The dispatcher-aided method increases the percentage of patients meeting the quality metric for timely STEMI care.