title: Regional implementation of the NWC guideline on ST-elevation myocardial infarction: Report from the Task Force Prehospital Triage Zuidoost Brabant (PHT ZoB).
abstract: BACKGROUND
  The NVVC guideline on ST-elevation myocardial infarction forms the basis for the regional prehospital triage (PHT) project in Zuidoost Brabant. In this project diagnosis and treatment strategies are determined in the ambulance.
  
  
  OBJECTIVE
  To summarise quality assessment and clinical results after one year.
  
  
  METHODS
  We evaluated the protocol and patient record form, the patient's call, assignment of tasks, diagnosis, treatment, time intervals, information to hospitals, cooperation and data transmission. Time delays were compared with time delays in a regional dry run before the start of the project and with time delays reported in the literature.
  
  
  RESULTS
  Patients still wait over one hour before seeking medical attention. The GP received the majority (65%) of patient calls. In half of all cases (51%), GPs call the ambulance centre only after they have seen the patient. When the patient calls the ambulance centre (35%), information to the GP is either prompt or absent. In 77% of calls to 112 it remains unclear whether the GP was informed at all. The treatment strategy was correct in 97% of cases. Time between symptoms and call decreased in comparison with our local preliminary investigation. Quality assessment after one year shows protocol deviations that are either logical procedural improvements or correctable flaws with no substantial negative influence.
  
  
  CONCLUSIONS
  Short-term clinical results are good, but structured follow-up is needed to reduce mortality in the long term, especially after thrombolysis. A guideline is a snapshot of a dynamic process. The PHT project allows rapid adaptations to be made to new paradigms.
authors.forename: H
authors.initials: H
authors.lastname: van Bavel
authors.forename: V
authors.initials: V
authors.lastname: Brenninkmeijer
authors.forename: W
authors.initials: W
authors.lastname: van Ekelen
authors.forename: D
authors.initials: D
authors.lastname: Hendriks
authors.forename: F
authors.initials: F
authors.lastname: Hersbach
authors.forename: M
authors.initials: M
authors.lastname: Klomp
authors.forename: R
authors.initials: R
authors.lastname: Michels
authors.forename: H
authors.initials: H
authors.lastname: Olthof
authors.forename: M
authors.initials: M
authors.lastname: Sanders
authors.forename: E
authors.initials: E
authors.lastname: Thijssen
keywords: STEMI; prehospital thrombolysis; primary PCI