title: Prehospital system delay in patients with ST-segment elevation myocardial infarction in Singapore.
abstract: BACKGROUND
  Timely reperfusion in ST-segment elevation myocardial infarction (STEMI) improves outcomes. System delay is that between first medical contact and reperfusion therapy, comprising prehospital and hospital components. This study aimed to characterize prehospital system delay in Singapore.
  
  
  METHODS
  A retrospective chart review was performed for 462 consecutive STEMI patients presenting to a tertiary hospital from December 2006 to April 2008. Patients with cardiac arrest secondarily presented were excluded. For those who received emergency medical services (EMS), ambulance records were reviewed. Time intervals in the hospital were collected prospectively. The patients were divided into two equal groups of high/low prehospital system delay using visual binning technique.
  
  
  RESULTS
  Of 462 patients, 76 received EMS and 52 of the 76 patients were analyzed. The median system delay was 125.5 minutes and the median prehospital system delay was 33.5 minutes (interquartile range [IQR]=27.0, 42.0). Delay between call-received-by-ambulance and ambulance-dispatched was 2.48 minutes (IQR=1.47, 16.55); between ambulance-dispatch and arrival-at-patient-location was 8.07 minutes (IQR=1.30, 22.13); between arrival-at- and departure-from-patient-location was 13.12 minutes (IQR=3.12, 32.2); and between leaving-patient-location to ED-registration was 9.90 minutes (IQR=1.62, 32.92). Comparing patients with prehospital system delay of less than 35.5 minutes versus more showed that the median delay between ambulance-dispatch and arrival-at-patient-location was shorter (5.75 vs. 9.37 minutes, P<0.01). The median delay between arrival-at-patient-location and leaving-patient-location was also shorter (10.78 vs. 14.37 minutes, P<0.01).
  
  
  CONCLUSIONS
  Prehospital system delay in our patients was suboptimal. This is the first attempt at characterizing prehospital system delay in Singapore and forms the basis for improving efficiency of STEMI care.
authors.affiliation: Singhealth Emergency Medicine Residency Program, Singapore Health Services, Singapore.
authors.forename: Andrew Fu Wah
authors.initials: AF
authors.lastname: Ho
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore.
authors.forename: Pin Pin
authors.initials: PP
authors.lastname: Pek
authors.affiliation: Division of Research, Singapore General Hospital, Singapore.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Fook-Chong
authors.affiliation: Department of General Surgery, Singapore General Hospital, Singapore.
authors.forename: Ting Hway
authors.initials: TH
authors.lastname: Wong
authors.affiliation: Medical Department, Singapore Civil Defence Force, Singapore.
authors.forename: Yih Yng
authors.initials: YY
authors.lastname: Ng
authors.affiliation: Department of Cardiology, National Heart Centre, Singapore.
authors.forename: Aaron Sung Lung
authors.initials: AS
authors.lastname: Wong
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore.
authors.forename: Marcus Eng Hock
authors.initials: ME
authors.lastname: Ong
keywords: Delay; Door to balloon; Emergency medical services; First medical contact; Myocardial infarction