title: Pre-hospital electrocardiography by emergency medical personnel: effects on scene and transport times for chest pain and ST-segment elevation myocardial infarction patients.
abstract: OBJECTIVE
  This study sought to measure the impact of pre-hospital (PH) electrocardiography (ECG) on scene-to-hospital time for patients with chest pain of cardiac origin and those with ST-segment elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  Pre-hospital ECG decreases door-to balloon (D2B) time for STEMI patients. However, obtaining a PH ECG might prolong scene time. We investigated the impact of obtaining a PH ECG on both scene and transport times for patients with chest pain suspected of cardiac origin.
  
  
  METHODS
  City of San Diego Emergency Medical System runsheets of patients with chest pain from January 2003 to April 2008 were analyzed. The scene times and transport times were compared before (from January 2003 to December 2005) and after (from January 2006 to April 2008) implementation of the PH ECG. Among patients with a PH ECG, median scene times and transport times were compared in patients with and without STEMI.
  
  
  RESULTS
  There were 21,742 patients evaluated for chest pain during the study period. Implementation of PH ECG resulted in minimal increases in median scene time (19 min, 10 s vs. 19 min, 28 s, p = 0.002) and transport time (13 min, 16 s vs. 13 min, 28 s, p = 0.007). However, compared with chest pain patients, in STEMI patients (n = 303), shorter median scene time (17 min, 51 s vs. 19 min, 31 s, p < 0.001), transport time (12 min, 34 s vs. 13 min, 31 s, p = 0.006), and scene-to-hospital time was observed (30 min, 45 s vs. 33 min, 29 s, p < 0.001).
  
  
  CONCLUSIONS
  Obtaining a PH ECG for patients with chest pain minimally prolongs scene and transport times. Further, for STEMI patients, both scene times and transport times are actually reduced leading to a potential reduction in total ischemic time.
authors: Division of Cardiovascular Medicine, University of California, San Diego, CA, USA.
authors: Mitul
authors: M
authors: Patel
authors: James V
authors: JV
authors: Dunford
authors: Steve
authors: S
authors: Aguilar
authors: Edward
authors: E
authors: Castillo
authors: Ekta
authors: E
authors: Patel
authors: Roger
authors: R
authors: Fisher
authors: Ginger
authors: G
authors: Ochs
authors: Ehtisham
authors: E
authors: Mahmud
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D004562:Electrocardiography / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004634:Emergency Medical Technicians; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis*; D013997:Time Factors