Inappropriate dispatcher decision for emergency medical service users with acute myocardial infarction.

OBJECTIVES: Current guidelines recommend utilization of prehospital emergency medical services (EMSs) by patients with ST-elevation myocardial infarction (STEMI). The aims of this study were to estimate the percentage of inappropriate initial dispatcher decisions and determine their impact on delays in reperfusion therapy for EMS users with STEMI. METHODS: As part of a prospective regional registry of patients with STEMI, we analyzed the original data for 245 patients who called a university hospital-affiliated EMS call center in France. The primary study outcome was time to reperfusion therapy calculated from the documented date and time of the first patient call. RESULTS: The initial EMS dispatcher's decision was appropriate (ie, dispatching a mobile intensive care unit staffed by an emergency or critical care physician) for 171 (70%) patients and inappropriate for 74 (30%) patients. Inappropriate decisions included referring the patient to a family physician (n = 59), providing medical advice (n = 9), and dispatching an ambulance (n = 6). Inappropriate initial decisions resulted in increased median time to reperfusion for 140 patients receiving fibrinolysis (95 vs 53 minutes; P < .001) and 91 patients undergoing primary percutaneous coronary intervention (170 vs 107 minutes; P < .001). In-hospital mortality was not different between the 2 study groups (6.8% vs 9.9%; P = .42). CONCLUSION: The initial dispatcher's decision is inappropriate for 30% of EMS users with STEMI and results in substantial delays in time to reperfusion therapy. Accuracy of telephone triage should be improved for patients who activate EMSs in response to symptoms suggestive of acute coronary syndrome.

[Factors associated with delay in calling Emergency Medical Services ("15") for patients with ST-elevation myocardial infarction in southern Isère]. / Facteurs associés au délai d'appel au centre 15 du service d'aide médicale urgente chez les patients ayant un syndrome coronaire aigu avec sus-décalage du segment ST dans le sud du département de l'Isère.

BACKGROUND: Time until revascularization is an important prognostic factor for patients with ST-elevation myocardial infarction. The objective of this study was to investigate the factors associated with patients' delay in calling for emergency medical services (SAMU, "15" in France). METHODS: We analyzed the original data of a permanent prospective register of patients receiving care from mobile intensive care units staffed by emergency physicians and dispatched by SAMU in southern Isère (France), from October 1, 2002, through December 31, 2004. RESULTS: Of the 380 patients analyzed, 71% were men and 15% had a history of coronary disease. The median age was 60 years for men and 72 for women. The median time from symptom onset to calling SAMU was 63 minutes (interquartile range, 27 to 144). In the univariate analyses, the time to the call was higher for women (90 v 58, p<0.01) and increased with age (p<0.01) and prior calls to a physician or nurse (115 v 45, p<0.001). In the multivariable analysis, factors independently associated with delay in calling SAMU included female gender, age of 55-64 years, prior calls to a physician or nurse, and onset of pain during the weekend or at night. The media call delay did not differ for patients with and without a history of coronary disease. CONCLUSION: The subpopulations of patients characterized by the factors associated with delayed calls should be the target of programs to stress the importance of calling SAMU quickly, regardless of the time of day; the effectiveness of these programs should be evaluated by randomized studies before they enter general use.