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Disparities in Emergency Medical Services Time Intervals for Patients with Suspected Acute Coronary Syndrome: Findings from the North Carolina Prehospital Medical Information System.
J Am Heart Assoc. 2021 08 03; 10(15):e019305.JA

Abstract

Background Timely emergency medical services (EMS) response, management, and transport of patients with suspected acute coronary syndrome (ACS) significantly reduce delays to emergency treatment and improve outcomes. We evaluated EMS response, scene, and transport times and adherence to proposed time benchmarks for patients with suspected ACS in North Carolina from 2011 to 2017. Methods and Results We conducted a population-based, retrospective study with the North Carolina Prehospital Medical Information System, a statewide electronic database of all EMS patient care reports. We analyzed 2011 to 2017 data on patient demographics, incident characteristics, EMS care, and county population density for EMS-suspected patients with ACS, defined as a complaint of chest pain or suspected cardiac event and documentation of myocardial ischemia on prehospital ECG or prehospital activation of the cardiac care team. Descriptive statistics for each EMS time interval were computed. Multivariable logistic regression was used to quantify relationships between meeting response and scene time benchmarks (11 and 15 minutes, respectively) and prespecified covariates. Among 4667 patients meeting eligibility criteria, median response time (8 minutes) was shorter than median scene (16 minutes) and transport (17 minutes) time. While scene times were comparable by population density, patients in rural (versus urban) counties experienced longer response and transport times. Overall, 62% of EMS encounters met the 11-minute response time benchmark and 49% met the 15-minute scene time benchmark. In adjusted regression analyses, EMS encounters of older and female patients and obtaining a 12-lead ECG and venous access were independently associated with lower adherence to the scene time benchmark. Conclusions Our statewide study identified urban-rural differences in response and transport times for suspected ACS as well as patient demographic and EMS care characteristics related to lower adherence to scene time benchmark. Strategies to reduce EMS scene times among patients with ACS need to be developed and evaluated.

Authors+Show Affiliations

Department of Emergency Medicine School of Medicine University of North Carolina at Chapel Hill Chapel Hill NC. School of Information and Library Science University of North Carolina at Chapel Hill Chapel Hill NC.Department of Emergency Medicine School of Medicine University of North Carolina at Chapel Hill Chapel Hill NC. ESO Austin TX.School of Nursing University of North Carolina at Chapel Hill Chapel Hill NC.Department of Emergency Medicine School of Medicine University of North Carolina at Chapel Hill Chapel Hill NC. Orange County Emergency Services Hillsborough NC.Department of Biostatistics Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC.Department of Emergency Medicine School of Medicine University of North Carolina at Chapel Hill Chapel Hill NC.Division of Cardiology Department of Medicine University of North Carolina at Chapel Hill Chapel Hill NC.Department of Emergency Medicine School of Medicine University of North Carolina at Chapel Hill Chapel Hill NC.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

34323113

Citation

Cui, Eric R., et al. "Disparities in Emergency Medical Services Time Intervals for Patients With Suspected Acute Coronary Syndrome: Findings From the North Carolina Prehospital Medical Information System." Journal of the American Heart Association, vol. 10, no. 15, 2021, pp. e019305.
Cui ER, Fernandez AR, Zegre-Hemsey JK, et al. Disparities in Emergency Medical Services Time Intervals for Patients with Suspected Acute Coronary Syndrome: Findings from the North Carolina Prehospital Medical Information System. J Am Heart Assoc. 2021;10(15):e019305.
Cui, E. R., Fernandez, A. R., Zegre-Hemsey, J. K., Grover, J. M., Honvoh, G., Brice, J. H., Rossi, J. S., & Patel, M. D. (2021). Disparities in Emergency Medical Services Time Intervals for Patients with Suspected Acute Coronary Syndrome: Findings from the North Carolina Prehospital Medical Information System. Journal of the American Heart Association, 10(15), e019305. https://doi.org/10.1161/JAHA.120.019305
Cui ER, et al. Disparities in Emergency Medical Services Time Intervals for Patients With Suspected Acute Coronary Syndrome: Findings From the North Carolina Prehospital Medical Information System. J Am Heart Assoc. 2021 08 3;10(15):e019305. PubMed PMID: 34323113.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Disparities in Emergency Medical Services Time Intervals for Patients with Suspected Acute Coronary Syndrome: Findings from the North Carolina Prehospital Medical Information System. AU - Cui,Eric R, AU - Fernandez,Antonio R, AU - Zegre-Hemsey,Jessica K, AU - Grover,Joseph M, AU - Honvoh,Gilson, AU - Brice,Jane H, AU - Rossi,Joseph S, AU - Patel,Mehul D, Y1 - 2021/07/29/ PY - 2021/7/30/pubmed PY - 2021/10/30/medline PY - 2021/7/29/entrez KW - acute coronary syndrome KW - disparities KW - emergency medical services KW - prehospital delay SP - e019305 EP - e019305 JF - Journal of the American Heart Association JO - J Am Heart Assoc VL - 10 IS - 15 N2 - Background Timely emergency medical services (EMS) response, management, and transport of patients with suspected acute coronary syndrome (ACS) significantly reduce delays to emergency treatment and improve outcomes. We evaluated EMS response, scene, and transport times and adherence to proposed time benchmarks for patients with suspected ACS in North Carolina from 2011 to 2017. Methods and Results We conducted a population-based, retrospective study with the North Carolina Prehospital Medical Information System, a statewide electronic database of all EMS patient care reports. We analyzed 2011 to 2017 data on patient demographics, incident characteristics, EMS care, and county population density for EMS-suspected patients with ACS, defined as a complaint of chest pain or suspected cardiac event and documentation of myocardial ischemia on prehospital ECG or prehospital activation of the cardiac care team. Descriptive statistics for each EMS time interval were computed. Multivariable logistic regression was used to quantify relationships between meeting response and scene time benchmarks (11 and 15 minutes, respectively) and prespecified covariates. Among 4667 patients meeting eligibility criteria, median response time (8 minutes) was shorter than median scene (16 minutes) and transport (17 minutes) time. While scene times were comparable by population density, patients in rural (versus urban) counties experienced longer response and transport times. Overall, 62% of EMS encounters met the 11-minute response time benchmark and 49% met the 15-minute scene time benchmark. In adjusted regression analyses, EMS encounters of older and female patients and obtaining a 12-lead ECG and venous access were independently associated with lower adherence to the scene time benchmark. Conclusions Our statewide study identified urban-rural differences in response and transport times for suspected ACS as well as patient demographic and EMS care characteristics related to lower adherence to scene time benchmark. Strategies to reduce EMS scene times among patients with ACS need to be developed and evaluated. SN - 2047-9980 UR - https://www.unboundmedicine.com/medline/citation/34323113/Disparities_in_Emergency_Medical_Services_Time_Intervals_for_Patients_with_Suspected_Acute_Coronary_Syndrome:_Findings_from_the_North_Carolina_Prehospital_Medical_Information_System_ L2 - https://www.ahajournals.org/doi/abs/10.1161/JAHA.120.019305?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -