Air versus ground transport of patients with acute myocardial infarction: experience in a rural-based helicopter medical service.

AIMS

Primary prehospital Helicopter Emergency Medical Service (HEMS) interventions may play a role in timely reperfusion therapy for patients with ST-segment elevation myocardial infarction (STEMI). We designed a prospective study involving patients with acute myocardial infarction aimed at the evaluation of the potential benefit of such primary HEMS interventions as compared with classical Emergency Medical Services ground transport.

METHODS AND RESULTS

This prospective study was conducted from 1 July 2007 to 15 June 2012. Successive patients with STEMI eligible for percutaneous coronary intervention were included. Simulated ground-based access times were computed using a digital cartographic program, allowing the estimation of healthcare system delay from call to admission to the catheterization laboratory.During the study period, 4485 patients benefited from HEMS activations. Of these patients, 342 (8%) suffering from STEMI were transferred for primary percutaneous coronary intervention. The median primary response time was 11 min (interquartile range: 8-14 min) using the helicopter and 32 min (25-44 min) using road transport. The median transport time was 12 min (9-15 min) using HEMS and 50 min (36-56 min) by road. The median system delay using HEMS was 52 min (45-60 min), whereas this time was 110 min (95-126 min) by road. Finally, the system delay median gain was 60 min (47-72 min).

CONCLUSION

Using HEMS in a rural region allows STEMI patients to benefit from appropriate rescue care with delays similar to those seen in urban settings.