Reduction in STEMI transfer times utilizing a municipal "911" ambulance service.
BACKGROUND
The time interval from diagnosis to reperfusion therapy for patients experiencing ST-segment elevation myocardial infarction (STEMI) has a significant impact on morbidity and mortality.


OBJECTIVE
It is hypothesized that the time required for interfacility patient transfers from a community hospital to a regional percutaneous coronary intervention (PCI) center using an Advanced Life Support (ALS) transfer ambulance service is no different than utilizing the "911" ALS ambulance.


METHODS
Quality assurance data collected by a tertiary care center cardiac catheterization program were reviewed retrospectively. Data were collected on all patients with STEMI requiring interfacility transfer from a local community hospital to the tertiary care center's PCI suite, approximately 16 miles away by ground, 12 miles by air. In 2009, transfers of patients with STEMI were redirected to the municipal ALS ambulance service, instead of the hospital's contracted ALS transfer service. Data were collected from January 2007 through May 2013. Temporal data were compared between transports initiated through the contracted ALS ambulance service and the municipal ALS service. Data points included time of initial transport request and time of ambulance arrival to the sending facility and the receiving PCI suite.


RESULTS
During the 4-year study period, 63 patients diagnosed with STEMI and transferred to the receiving hospital's PCI suite were included in this study. Mean times from the transport request to arrival of the ambulance at the sending hospital's emergency department were six minutes (95% CI, 4-7 minutes) via municipal ALS and 13 minutes (95% CI, 9-16 minutes) for the ALS transfer service. The mean times from the ground transport request to arrival at the receiving hospital's PCI suite when utilizing the municipal ALS ambulance and hospital contracted ALS ambulance services were 48 minutes (95% CI, 33-64 minutes) and 56 minutes (95% CI 52-59 minutes), respectively. This eight-minute period represented a 14% (P = .001) reduction in the mean transfer time to the PCI suite for patients transported via the municipal ALS ambulance.


CONCLUSIONS
In the appropriate setting, the use of the municipal "911" ALS ambulance service for the interfacility transport of patients with STEMI appears advantageous in reducing door-to-catheterization times.
1 Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts USA.
Joseph C
JC
Tennyson
2 Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina USA.
Mark R
MR
Quale
D000552:Ambulances; D004631:Emergency Medical Service Communication Systems; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy*; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D013997:Time Factors