Role of pre-hospital emergency medical systems in the rescue of patients with ST-elevation myocardial infarction.

BACKGROUND: Myocardial infarction (MI) is a series of clinical syndromes caused by ischemic necrosis of myocardial cells that results from severe and persistent acute ischemia of the myocardium due to a dramatic reduction or interruption of coronary blood supply. OBJECTIVE: In this study, we analyzed the role of pre-hospital emergency services in the rescue of patients suffering from ST-elevation myocardial infarction (STEMI). METHODS: We enrolled 229 patients with STEMI who were transported to the Second Hospital of Tianjin Medical University by Tianjin Emergency Center from January 2017 to June 2021. With the development of the pre-hospital emergency medical system in Tianjin (2019) as the time node, the patients were divided into three groups: A (87 cases), B (68 cases), and C (74 cases). The onset-to-call time, emergency response time, door-to-balloon (D-B) time, first medical contact to balloon dilation (FMC-B) time, symptom onset-to-balloon dilation (S-B) time, proportion of patients receiving prehospital administration of bispecific antibodies, number of days hospitalized, total hospitalization expenses, and in-hospital incidence and mortality of heart failure were compared between the three groups. RESULTS: Group C differed significantly from group A and group B in terms of emergency response time, D-B time, FMC-B time, S-B time, the proportion of patients who received prehospital administration of bispecific antibodies, and the number of days of hospitalization (P< 0.05), but there was no significant difference in the onset-to-call time (P> 0.05) and the decreasing trends in the in-hospital incidence and mortality of heart failure were not statistically significant (incidence: 9.50% vs. 13.23%, 12.64%; mortality: 4.10% vs. 5.90%, 4.60%). CONCLUSION: A reasonable pre-hospital emergency medical network layout and resource investment, as well as the strengthening of the interface between pre-hospital and in-hospital medical emergencies and pre-hospital standardized rescue, can shorten the emergency response time and the total ischemic time in patients with chest pain, which can improve patient prognosis to a certain extent.

Vulnerabilidade ao stresse em profissionais de emergência médica pré-hospitalar / Vulnerability to stress in pre-hospital medical emergency professionals / La vulnérabilité au stress chez les professionnels de cas d’urgence médicale préhospitalière / Vulnerabilidad al estrés en profesionales de emergencias médicas pre-hospitalarias

Os estudos efectuados com os profissionais de emergência médica pré-hospitalar em Portugal são ainda extremamente reduzidos, embora a problemática se encontre mais desenvolvida em países como os EUA, Canadá e Japão. Neste sentido, pelas características próprias desta profissão interessa compreender de forma mais aprofundada em que medida se encontram estes profissionais vulneráveis ao stresse, sendo este o objectivo principal deste estudo. A amostra foi constituída por 161 profissionais de emergência médica distribuídos pelo (Técnico de Ambulância de Emergências / Tripulante de Ambulância de Emergências), território nacional dos quais 42,2% possuem a categoria profissional de TAE/TAS ( 31,7% são Enfermeiros e 26,1% são médicos, tendo sido utilizada uma amostragem por clusters, seguida da técnica de amostragem aleatória. Os resultados indicam a existência de médias globais baixas de vulnerabilidade ao stresse. No que diz respeito às alterações do sono, verificou-se a existência de diferenças estatisticamente significativas nas dimensões "Perfeccionismo e intolerância à frustração", "Condições de vida adversas", "Dramatização da existência", "Subjugação", e "Deprivação de afectos e rejeição", assim como para a totalidade do instrumento de medida do stresse. Os sujeitos de estudo que não praticam exercício físico apresentam valores médios de vulnerabilidade ao stresse mais elevados. (AU)

Research with pre-hospital medical emergency professionals in Portugal is still extremely reduced, even though this matter is better developed in countries such as the USA, Canada and Japan. Therefore, the characteristics inherent to this profession produce the interest to comprehend more thoroughly the vulnerability of these professionals to stress, which was the main objective of the present study. The sample was constituted by 161 medical emergency professionals distributed throughout the national territory; 42,2% of them possess the professional category of TAE/TAS, 31,7% are nurses, and 26,1% are physicians. We used the clusters sampling method, followed by the aleatoric sampling technique.The results indicate the existence of low global averages in vulnerability to stress. “Perfectionism and intolerance to frustration”, “Adverse life conditions”, “Dramatization of existence”, and “Deprivation of affects and rejection”, as well as to the totality of the stress assessment instrument. The subjects of the study that did not practice exercises presented higher stress vulnerability average values. (AU)

Les études effectuées sur les professionnels de cas d’urgence médicale pré-hospitalière au portugal sont encore extrêmement réduites, bien que cette problématique se trouve plus développée dans certains pays comme les états-unis, Le canada et le japon. dans ce sens, par les caractéristiques propres à cette profession, il est intéressant de comprendre de manière plus approfondie en quelle mesure ces professionnels se trouvent vulnérables au stress, cela étant l’objectif principal de cette étude. L’échantillon était constitué de 161 professionnels de l’urgence médicale distribuée sur tout le territoire national, desquels 42,2 % possédaient la catégorie professionnelle de tae/tas, 31,7 % étaient infirmiers, et 26,1 % médecins ; on a utilisé un échantillonnage par partitionnement des données, suivie de la technique de l’échantillonnage aléatoire. les résultats indiquent une moyenne globale basse de vulnérabilité au stress. toutefois il existe des différences statistiquement significatives entre la vulnérabilité au stress et la catégorie professionnelle. en ce qui concerne les altérations du sommeil on vérifie l’existence de différences statistiquement significatives dans les dimensions “perfectionnisme et intolérances à la frustration”, “conditions de vie adverses”, “dramatisation de l’existence”, “subjugation”, “privation d’affects et rejet”, comme pour la totalité de l’instrument de mesure du stress. les sujets d’étude qui ne pratiquent pas d’exercice physique présentent des valeurs moyennes de vulnérabilité au stress plus élevées. (AU)

Los estudios efectuados a profesionales de emergencias médicas pre-hospitalarias en Portugal son aún extremadamente reducidos, aunque la problemática se encuentre más extendida en paises como EUA, Canadá y Japón. En este sentido y por las características propias de esta profesión, nos interesa comprender de manera más profunda en que medida se encuentran vulnerables al estrés estos profesionales, siendo éste el objetivo principal de este estudio. La muestra estuvo compuesta por 161 profesionales de emergencias médicas, distribuidos por el territorio nacional, de los cuales 42.2% poseen la categoria de TAE/TAS (Técnico de Ambulancia de Emergencias / Tripulante de Ambulancia de Emergencias), 31.7% son enfermeros y 26.1% son médicos, habiendo sido utilizada una muestra por clusters, seguida de la técnica de la muestra aleatoria. Los resultados arrojaron la existencia de promedios globales bajos de vulnerabilidad al estrés. En lo que respecta a las alteraciones del sueño, se verificó la existencia de diferencias estadísticamente significativas en las dimensiones “Perfeccionismo e intolerancia a la frustración”, “Condiciones de vida adversas”, “Dramatización de la existencia”, Subyugación” y “Privación de afectos y rechazo”, así como también para la totalidad del instrumento de medida del estrés. Los indivíduos del estudio que no realizan ejercicios físicos presentan valores promedio de vulnerabilidad al estrés más elevados. (AU)