1 Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts USA.
2 Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina USA.
Prehosp Disaster Med. 2014 Feb;29(1):50-3. doi: 10.1017/S1049023X14000016. Epub 2014 Jan 22.
The time interval from diagnosis to reperfusion therapy for patients experiencing ST-segment elevation myocardial infarction (STEMI) has a significant impact on morbidity and mortality.
It is hypothesized that the time required for interfacility patient transfers from a community hospital to a regional percutaneous coronary intervention (PCI) center using an Advanced Life Support (ALS) transfer ambulance service is no different than utilizing the "911" ALS ambulance.
Quality assurance data collected by a tertiary care center cardiac catheterization program were reviewed retrospectively. Data were collected on all patients with STEMI requiring interfacility transfer from a local community hospital to the tertiary care center's PCI suite, approximately 16 miles away by ground, 12 miles by air. In 2009, transfers of patients with STEMI were redirected to the municipal ALS ambulance service, instead of the hospital's contracted ALS transfer service. Data were collected from January 2007 through May 2013. Temporal data were compared between transports initiated through the contracted ALS ambulance service and the municipal ALS service. Data points included time of initial transport request and time of ambulance arrival to the sending facility and the receiving PCI suite.
During the 4-year study period, 63 patients diagnosed with STEMI and transferred to the receiving hospital's PCI suite were included in this study. Mean times from the transport request to arrival of the ambulance at the sending hospital's emergency department were six minutes (95% CI, 4-7 minutes) via municipal ALS and 13 minutes (95% CI, 9-16 minutes) for the ALS transfer service. The mean times from the ground transport request to arrival at the receiving hospital's PCI suite when utilizing the municipal ALS ambulance and hospital contracted ALS ambulance services were 48 minutes (95% CI, 33-64 minutes) and 56 minutes (95% CI 52-59 minutes), respectively. This eight-minute period represented a 14% (P = .001) reduction in the mean transfer time to the PCI suite for patients transported via the municipal ALS ambulance.
In the appropriate setting, the use of the municipal "911" ALS ambulance service for the interfacility transport of patients with STEMI appears advantageous in reducing door-to-catheterization times.
ST 段抬高型心肌梗死（STEMI）患者从诊断到再灌注治疗的时间间隔对发病率和死亡率有重大影响。
假设使用高级生命支持（ALS）转运救护车将患者从社区医院转运到区域经皮冠状动脉介入（PCI）中心所需的时间与使用“911”ALS 救护车不同。
回顾性审查由三级护理中心心脏导管插入程序收集的质量保证数据。收集了所有需要从当地社区医院转运到三级护理中心 PCI 套房的 STEMI 患者的数据，地面距离约 16 英里，空中距离 12 英里。2009 年，STEMI 患者的转运被重新定向到市 ALS 救护车服务，而不是医院的合同 ALS 转运服务。数据收集时间为 2007 年 1 月至 2013 年 5 月。将通过合同 ALS 救护车服务和市 ALS 服务启动的转运的时间数据进行比较。数据点包括初始转运请求的时间和救护车到达转运医院和接收 PCI 套房的时间。
在 4 年的研究期间，纳入了 63 名诊断为 STEMI 并转至接收医院 PCI 套房的患者。通过市 ALS，从转运请求到救护车到达转运医院急诊室的平均时间为 6 分钟（95%CI，4-7 分钟），而通过 ALS 转运服务的平均时间为 13 分钟（95%CI，9-16 分钟）。利用市 ALS 救护车和医院合同 ALS 救护车服务，从地面转运请求到到达接收医院 PCI 套房的平均时间分别为 48 分钟（95%CI，33-64 分钟）和 56 分钟（95%CI，52-59 分钟）。这段 8 分钟的时间代表了通过市 ALS 救护车转运的患者到 PCI 套房的平均转运时间缩短了 14%（P =.001）。
在适当的情况下，使用市“911”ALS 救护车服务进行 STEMI 患者的院际转运，在缩短门到导管时间方面具有优势。
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