EMS medical direction and prehospital practices for acute cardiovascular events.
OBJECTIVE
The purpose of this analysis was to determine whether there is an association between type of emergency medical services (EMS) medical direction and local EMS agency practices and characteristics specifically related to emergency response for acute cardiovascular events.


METHODS
We surveyed 1,292 EMS agencies in nine states. For each cardiovascular prehospital procedure or practice, we compared the proportion of agencies that employed paid (full- or part-time) medical directors with the proportion of agencies that employed volunteer medical directors. We also compared the proportion of EMS agencies who reported direct interaction between emergency medical technicians (EMTs) and their medical director within the previous four weeks with the proportion of agencies who reported no direct interaction. Chi-square tests were used to assess statistical differences in proportion of agencies with a specific procedure by medical director employment status and medical director interaction. We repeated these comparisons using t-tests to evaluate mean differences in call volume.


RESULTS
The EMS agencies with prehospital cardiovascular response policies were more likely to report employment of a paid medical director and less likely to report employment of a volunteer medical director. Similarly, agencies with prehospital cardiovascular response practices were more likely to report recent medical director interaction and less likely to report absence of recent medical director interaction. Mean call volumes for chest pain, cardiac arrest, and stroke were higher among agencies having paid medical directors (compared with agencies having volunteer medical directors) and agencies having recent medical director interaction (compared with agencies not having recent medical director interaction).


CONCLUSIONS
Our study demonstrated that EMS agencies with a paid medical director and agencies with medical director interaction with EMTs in the previous four weeks were more likely to have prehospital cardiovascular procedures in place. Given the strong relationship that both employment status and direct interaction have with the presence of these practices, agencies with limited resources to provide a paid medical director or a medical director that can be actively involved with EMTs should be supported through partnerships and other interventions to ensure that they receive the necessary levels of medical director oversight.
Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. sgreer@cdc.gov
Sophia
S
Greer
Ishmael
I
Williams
Amy L
AL
Valderrama
Patricia
P
Bolton
Davis G
DG
Patterson
Zefeng
Z
Zhang
D000208:Acute Disease; D022561:Advanced Cardiac Life Support / Q000706:statistics & numerical data*; D019985:Benchmarking; D002300:Cardiac Care Facilities / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000145:classification / Q000175:diagnosis / Q000628:therapy*; D002637:Chest Pain / Q000175:diagnosis / Q000628:therapy; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000592:standards; D004638:Emergency Treatment / Q000592:standards; D004651:Employment / Q000191:economics / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006323:Heart Arrest / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007400:Interprofessional Relations; D008486:Physician Executives / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000458:organization & administration / Q000706:statistics & numerical data; D020521:Stroke / Q000175:diagnosis / Q000628:therapy; D013997:Time Factors; D014481:United States; D019037:Urban Health Services / Q000458:organization & administration / Q000706:statistics & numerical data; D014838:Volunteers / Q000706:statistics & numerical data; D000078329:Workforce