title: Inappropriate dispatcher decision for emergency medical service users with acute myocardial infarction.
abstract: OBJECTIVE
  Current guidelines recommend utilization of prehospital emergency medical services (EMSs) by patients with ST-elevation myocardial infarction (STEMI). The aims of this study were to estimate the percentage of inappropriate initial dispatcher decisions and determine their impact on delays in reperfusion therapy for EMS users with STEMI.
  
  
  METHODS
  As part of a prospective regional registry of patients with STEMI, we analyzed the original data for 245 patients who called a university hospital-affiliated EMS call center in France. The primary study outcome was time to reperfusion therapy calculated from the documented date and time of the first patient call.
  
  
  RESULTS
  The initial EMS dispatcher's decision was appropriate (ie, dispatching a mobile intensive care unit staffed by an emergency or critical care physician) for 171 (70%) patients and inappropriate for 74 (30%) patients. Inappropriate decisions included referring the patient to a family physician (n = 59), providing medical advice (n = 9), and dispatching an ambulance (n = 6). Inappropriate initial decisions resulted in increased median time to reperfusion for 140 patients receiving fibrinolysis (95 vs 53 minutes; P < .001) and 91 patients undergoing primary percutaneous coronary intervention (170 vs 107 minutes; P < .001). In-hospital mortality was not different between the 2 study groups (6.8% vs 9.9%; P = .42).
  
  
  CONCLUSIONS
  The initial dispatcher's decision is inappropriate for 30% of EMS users with STEMI and results in substantial delays in time to reperfusion therapy. Accuracy of telephone triage should be improved for patients who activate EMSs in response to symptoms suggestive of acute coronary syndrome.
authors.affiliation: Grenoble University Hospital, France.
authors.forename: Magali
authors.initials: M
authors.lastname: Fourny
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Lucas
authors.forename: Loïc
authors.initials: L
authors.lastname: Belle
authors.forename: Guillaume
authors.initials: G
authors.lastname: Debaty
authors.forename: Pierre
authors.initials: P
authors.lastname: Casez
authors.forename: Hélène
authors.initials: H
authors.lastname: Bouvaist
authors.forename: Patrice
authors.initials: P
authors.lastname: François
authors.forename: Gérald
authors.initials: G
authors.lastname: Vanzetto
authors.forename: José
authors.initials: J
authors.lastname: Labarère
mesh_terms: D000368:Aged; D017115:Catheter Ablation / Q000592:standards / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D015425:Myocardial Reperfusion / Q000592:standards / Q000706:statistics & numerical data; D016017:Odds Ratio; D015912:Thrombolytic Therapy / Q000592:standards / Q000706:statistics & numerical data; D013997:Time Factors