title: Paramedic transtelephonic communication to cardiologist of clinical and electrocardiographic assessment for rapid reperfusion of ST-elevation myocardial infarction.
abstract: OBJECTIVE
  We tested the hypothesis that paramedic recognition of ST-elevation myocardial infarction (STEMI) and cardiologist activation of the cardiac catheterization laboratory without transmission of the electrocardiogram reduces door-to-balloon times.
  
  
  METHODS
  We studied a consecutive series of patients suspected to have STEMI who were taken to the cardiac catheterization laboratory in the 6-month period before hotline implementation (historical controls) and during the first year of hotline use (intervention group, hotline; emergency medical service patients without hotline, concurrent controls).
  
  
  RESULTS
  Emergency medical services activated the hotline 47 times, and 25 patients were subsequently taken to the catheterization laboratory. Patients who received PCI involving hotline use (n = 20) had significantly shorter door-to-balloon times (58 minutes; 25th-75th percentile, 52-73 minutes) than historical controls (n = 15) (112 minutes; 25th-75th percentile, 81-137; P < .0001) and concurrent controls (n = 15) (92 minutes; 25th-75th percentile, 76-112; P = .019).
  
  
  CONCLUSIONS
  Paramedic transtelephonic communication to cardiologist of clinical and electrocardiogram assessment resulted in a 54-minute reduction in door-to-balloon time for patients with STEMI.
authors.affiliation: School of Medicine, Duke University, Durham, NC, USA. david.strauss@duke.edu
authors.forename: David G
authors.initials: DG
authors.lastname: Strauss
authors.forename: Paula Quintal
authors.initials: PQ
authors.lastname: Sprague
authors.forename: Kevin
authors.initials: K
authors.lastname: Underhill
authors.forename: Charles
authors.initials: C
authors.lastname: Maynard
authors.forename: George L
authors.initials: GL
authors.lastname: Adams
authors.forename: Amy
authors.initials: A
authors.lastname: Kessenich
authors.forename: Michael H
authors.initials: MH
authors.lastname: Sketch
authors.forename: Peter B
authors.initials: PB
authors.lastname: Berger
authors.forename: David
authors.initials: D
authors.lastname: Marcozzi
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
authors.forename: Galen S
authors.initials: GS
authors.lastname: Wagner
mesh_terms: D002309:Cardiology / Q000379:methods; D040421:Cell Phone; D001026:Coronary Artery Bypass / Q000379:methods; D004562:Electrocardiography / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000601:surgery*; D015425:Myocardial Reperfusion / Q000379:methods*; D009657:North Carolina; D011785:Quality Assurance, Health Care / Q000379:methods; D019114:Remote Consultation / Q000379:methods*; D017216:Telemedicine / Q000379:methods*; D013997:Time Factors; D013996:Time and Motion Studies; D016896:Treatment Outcome