title: Evaluation of attitudes and perceptions of key clinical stakeholders regarding out-of-hospital diagnosis and treatment of ST elevation myocardial infarction patients using a region-wide survey.
abstract: BACKGROUND
  In ST elevation myocardial infarction (STEMI), prehospital management (PHM) may improve clinical outcomes through a reduction in reperfusion delay. The purpose of this study was to evaluate perceptions among healthcare stakeholder groups relating to the barriers and facilitators of implementing a PHM programme.
  
  
  METHODS
  A 25-question cross-sectional survey, using a four-point Likert scale assessing barriers and facilitators of PHM, was distributed to paramedics, cardiologists, emergency physicians and emergency nurses within the Edmonton region, where prehospital STEMI treatment is established. The proportion of responses on each question was compared and differences between groups were determined using chi(2) and Fisher's exact tests.
  
  
  RESULTS
  57% (355/619) of subjects responded: 69% paramedics, 50% cardiologists, 54% emergency physicians and 45% emergency nurses. A majority believed PHM reduced treatment delays in both rural (96-100%) and urban (86-96%) areas, while decreasing patient mortality (paramedics 97%, cardiologists 74%, emergency physicians 85%, emergency nurses 88%). Regarding the capability of paramedics to deliver PHM, paramedics 25%, cardiologists 33%, emergency physicians 67%, and emergency nurses 47% stated that urban paramedics are better equipped and trained than rural paramedics. Although 81% of paramedics supported the possibility of PHM delivery without physician overview, 0% of cardiologists, 98% of emergency physicians and 95% emergency nurses agreed. A majority (71-88%) favoured mandatory signed informed consent.
  
  
  CONCLUSIONS
  While stakeholders agreed on the benefits of PHM, perceptual differences existed on paramedics' ability to deliver PHM without physician overview. Addressing real and perceived barriers through communication and educational programmes may enhance PHM within this healthcare region and facilitate the implementation of PHM programmes.
authors.affiliation: Epidemiology Coordinating and Research (EPICORE) Centre, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: N A
authors.initials: NA
authors.lastname: Rajabali
authors.forename: R T
authors.initials: RT
authors.lastname: Tsuyuki
authors.forename: S
authors.initials: S
authors.lastname: Sookram
authors.forename: S H
authors.initials: SH
authors.lastname: Simpson
authors.forename: R C
authors.initials: RC
authors.lastname: Welsh
mesh_terms: D000416:Alberta; D000488:Allied Health Personnel; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration; D004632:Emergency Medical Services / Q000458:organization & administration*; D016529:Emergency Nursing; D006801:Humans; D007258:Informed Consent; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy; D019035:Rural Health Services / Q000458:organization & administration; D019037:Urban Health Services / Q000458:organization & administration