Inappropriate dispatcher decision for emergency medical service users with acute myocardial infarction.
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.
Fourny
Magali
M
Grenoble University Hospital, France.
Lucas
Anne-Sophie
AS
Belle
Loïc
L
Debaty
Guillaume
G
Casez
Pierre
P
Bouvaist
Hélène
H
François
Patrice
P
Vanzetto
Gérald
G
Labarère
José
J
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