title: Use of emergency medical service transport among patients with ST-segment-elevation myocardial infarction: findings from the National Cardiovascular Data Registry Acute Coronary Treatment Intervention Outcomes Network Registry-Get With The Guidelines.
abstract: BACKGROUND
  Activation of emergency medical services (EMS) is critical for the early triage and treatment of patients experiencing ST-segment-elevation myocardial infarction, yet data regarding EMS use and its association with subsequent clinical care are limited.
  
  
  RESULTS
  We performed an observational analysis of 37 634 ST-segment-elevation myocardial infarction patients treated at 372 US hospitals participating in the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines between January 2007 and September 2009, and examined independent patient factors associated with EMS transportation versus patient self-transportation. We found that EMS transport was used in only 60% of ST-segment-elevation myocardial infarction patients. Older patients, those living farther from the hospital, and those with hemodynamic compromise were more likely to use EMS transport. In contrast, race, income, and education level did not appear to be associated with the mode of transport. Compared with self-transported patients, EMS-transported patients had significantly shorter delays in both symptom-onset-to-arrival time (median, 89 versus 120 minutes; P<0.0001) and door-to-reperfusion time (median door-to-balloon time, 63 versus 76 minutes; P<0.0001; median door-to-needle time, 23 versus 29 minutes; P<0.0001).
  
  
  CONCLUSIONS
  Emergency medical services transportation to the hospital is underused among contemporary ST-segment-elevation myocardial infarction patients. Nevertheless, use of EMS transportation is associated with substantial reductions in ischemic time and treatment delays. Community education efforts are needed to improve the use of emergency transport as part of system-wide strategies to improve ST-segment-elevation myocardial infarction reperfusion care.
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt St, Durham, NC 27705, USA. robin.mathews@duke.edu
authors.forename: Robin
authors.initials: R
authors.lastname: Mathews
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Shuang
authors.initials: S
authors.lastname: Li
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
authors.forename: Seth W
authors.initials: SW
authors.lastname: Glickman
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Wiviott
authors.forename: Jorge F
authors.initials: JF
authors.lastname: Saucedo
authors.forename: Elliott M
authors.initials: EM
authors.lastname: Antman
authors.forename: Alice K
authors.initials: AK
authors.lastname: Jacobs
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D014187:Transportation of Patients / Q000592:standards / Q000706:statistics & numerical data*; D014481:United States