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- Title
Hospital-Confirmed Acute Myocardial Infarction: Prehospital Identification Using the Medical Priority Dispatch System.
- Authors
Clawson, Jeff J.; Gardett, Isabel; Scott, Greg; Fivaz, Conrad; Barron, Tracey; Broadbent, Meghan; Olola, Christopher
- Abstract
Introduction Early recognition of an acute myocardial infarction (AMI) can increase the patient's likelihood of survival. As the first point of contact for patients accessing medical care through emergency services, emergency medical dispatchers (EMDs) represent the earliest potential identification point for AMIs. The objective of the study was to determine how AMI cases were coded and prioritized at the dispatch point, and also to describe the distribution of these cases by patient age and gender. Hypothesis/Problem No studies currently exist that describe the EMD's ability to correctly triage AMIs into Advanced Life Support (ALS) response tiers.<bold>Methods: </bold>The retrospective descriptive study utilized data from three sources: emergency medical dispatch, Emergency Medical Services (EMS), and emergency departments (EDs)/hospitals. The primary outcome measure was the distributions of AMI cases, as categorized by Chief Complaint Protocol, dispatch priority code and level, and patient age and gender. The EMS and ED/hospital data came from the Utah Department of Health (UDoH), Salt Lake City, Utah. Dispatch data came from two emergency communication centers covering the entirety of Salt Lake City and Salt Lake County, Utah.<bold>Results: </bold>Overall, 89.9% of all the AMIs (n=606) were coded in one of the three highest dispatch priority levels, all of which call for ALS response (called CHARLIE, DELTA, and ECHO in the studied system). The percentage of AMIs significantly increased for patients aged 35 years and older, and varied significantly by gender, dispatch level, and chief complaint. A total of 85.7% of all deaths occurred among patients aged 55 years and older, and 88.9% of the deaths were handled in the ALS-recommended priority levels.<bold>Conclusion: </bold>Acute myocardial infarctions may present as a variety of clinical symptoms, and the study findings demonstrated that more than one-half were identified as having chief complaints of Chest Pain or Breathing Problems at the dispatch point, followed by Sick Person and Unconscious/Fainting. The 35-year age cutoff for assignment to higher priority levels is strongly supported. The Falls and Sick Person Protocols offer opportunities to capture atypical AMI presentations. Clawson JJ , Gardett I , Scott G , Fivaz C , Barron T , Broadbent M , Olola C . Hospital-confirmed acute myocardial infarction: prehospital identification using the Medical Priority Dispatch System. Prehosp Disaster Med. 2018;33(1):29-35.
- Subjects
UNITED States; EMERGENCY medical services; MYOCARDIAL infarction diagnosis; LIFE support systems in critical care; HEALTH services administration; NAUSEA treatment; EQUIPMENT &; supplies; MYOCARDIAL infarction-related mortality; MYOCARDIAL infarction treatment; ELECTROCARDIOGRAPHY; EMERGENCY medical services communication systems; HOSPITAL emergency services; LONGITUDINAL method; HEALTH outcome assessment; RISK assessment; SURVIVAL; MEDICAL triage; RETROSPECTIVE studies; EARLY diagnosis
- Publication
California English, 2018, Vol 23, Issue 3, p29
- ISSN
0008-1035
- Publication type
journal article
- DOI
10.1017/S1049023X1700704X