Paramedics as decision makers on the activation of the catheterization laboratory in the presence of acute ST-elevation myocardial infarction.
METHODS
To minimize delays in time to reperfusion in an urban-suburban North Carolina County, Guilford County Emergency Medical Services (EMS) and Moses Cone Hospital, Greensboro, NC, have collaborated to use the acquisition of 12-lead electrocardiographs and their paramedic interpretation to initiate the catheterization laboratory team and cardiologist; independent of over read by a physician. The study population of 91 patients was divided into the catheterization laboratory activation by EMS and catheterization laboratory activation by the emergency department physician (ED-MD) groups, and also by EMS and self-transported groups.


RESULTS
The EMS group had shorter median time intervals from hospital door to percutaneous coronary intervention (PCI) with balloon inflation than those patients who self-transported to the hospital. Also, patients who were treated during the EMS activation of the catheterization laboratory phase had shorter median hospital door to PCI times than those who were treated during ED-MD activation of the catheterization laboratory.


CONCLUSIONS
The time from hospital arrival to PCI with balloon inflation was significantly shorter during the period in which EMS activated the catheterization laboratory than during the period the laboratory was activated by hospital staff. Thus, paramedics with quality electrocardiogram interpretation training and education can identify patients with acute ST-elevation myocardial infarction and properly activate the catheterization laboratory.
Young
Dwayne R
DR
Guilford County Emergency Medical Services, 1002 Meadowood Street, Greensboro, NC 27409, USA. dwayne.young@guilford-es.com
Murinson
Marc
M
Wilson
Charles
C
Hammond
Belinda
B
Welch
Mary
M
Block
Vicki
V
Booth
Sheryl
S
Tedder
William
W
Dolby
Karen
K
Roh
Jackie
J
Beaton
Robert
R
Edmunds
John
J
Young
Mark
M
Rice
Vermell
V
Somers
Cheryl
C
Edwards
Robin
R
Maynard
Charles
C
Wagner
Galen S
GS
D006328:Cardiac Catheterization / Q000706:statistics & numerical data*; D003657:Decision Making; D004562:Electrocardiography / Q000706:statistics & numerical data*; D004634:Emergency Medical Technicians / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy*; D009657:North Carolina; D013996:Time and Motion Studies; D014218:Triage / Q000379:methods* / Q000706:statistics & numerical data*