Coronary artery diseaseComparison of Early Mortality of Paramedic-Diagnosed ST-Segment Elevation Myocardial Infarction With Immediate Transport to a Designated Primary Percutaneous Coronary Intervention Center to That of Similar Patients Transported to the Nearest Hospital
Section snippets
Methods
The study was conducted in the City of Ottawa (Ontario, Canada) as a collaborative effort among the Ottawa Base-Hospital Program, the Ottawa Paramedic Service, the emergency departments from the 4 Ottawa hospitals, and the University of Ottawa Heart Institute. A peak load of 42 ambulance units provide emergency service throughout the city to a population of approximately 800,000 residents. The farthest point of service was 53 km. Most ambulances (70%) were staffed with ≥1 advanced-care
Results
During the paramedic-referred primary PCI period, paramedics transported 130 consecutive patients directly to the PCI center with a preliminary diagnosis of STEMI. Upon hospital arrival, STEMI on the prehospital ECG was confirmed in 108 patients by the admitting cardiologist. These patients comprise the paramedic-referred primary PCI group. During ambulance transportation, 1 patient developed ventricular fibrillation that was treated with immediate, successful defibrillation. The patient was
Discussion
This study confirms that an integrated multidisciplinary metropolitan approach in which paramedics independently triage and transport patients with STEMI to a designated center for primary PCI based on their interpretation of the prehospital ECG is safe and feasible. The very low in-hospital mortality in the paramedic-referred primary PCI group compared with the control group is likely due to 2 key factors: (1) faster reperfusion due to triage at the scene by the paramedics coupled with (2)
Acknowledgment
We thank all the front-line paramedics and management team at the Ottawa Paramedic Service for dedication and enthusiasm, who were responsible for the success of this initiative. We are also indebted to Pat Doucette, RN, and Sheila Ryan, BSc, for invaluable contribution to the paramedic-referred primary PCI protocol.
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