Powell A M, Halon J M, Nelson J
Landsbaum Center for Health Education.
Indiana University Health West Hospital.
Rural Remote Health. 2014;14:2690. Epub 2014 May 2.
Emergent care of the acute heart attack patient continues to be at the forefront of quality and cost reduction strategies throughout the healthcare industry. Although the average cardiac door-to-balloon (D2B) times have decreased substantially over the past few years, there are still vast disparities found in D2B times in populations that reside in rural areas. Such disparities are mostly related to prolonged travel time and subsequent delays in cardiac catherization lab team activation. Urban ambulance companies that are routinely staffed with paramedic level providers have been successful in the implementation of pre-hospital 12-lead electrocardiogram (ECG) protocols as a strategy to reduce D2B times.
The authors sought to evaluate the evidence related to the risk and benefits associated with the replication of an ECG transmission protocol in a small rural emergency medical service. The latter is staffed with emergency medical technician-basics (EMT-B), emergency medical technician-advanced (EMT-A), and emergency medical technician-intermediate (EMT-I) level.
The evidence reviewed was limited to studies with relevant data regarding the challenges and complexities of the ECG transmission process, the difficulties associated with ECG transmission in rural settings, and ECG transmission outcomes by provider level.
The evidence supports additional research to further evaluate the feasibility of ECG transmission at the non-paramedic level. Multiple variables must be investigated including equipment cost, utilization, and rural transmission capabilities. Clearly, pre-hospital ECG transmission and early activation of the cardiac catheterization laboratory are critical components to successfully decreasing D2B times.
急性心脏病发作患者的紧急护理一直是整个医疗行业质量和成本降低策略的重点。尽管在过去几年中心脏病平均门球时间（D2B）大幅下降，但在农村地区居民中，D2B时间仍存在巨大差异。这种差异主要与较长的运输时间以及随后心脏导管实验室团队启动的延迟有关。配备护理人员级别的提供者的城市救护车公司已成功实施院前12导联心电图（ECG）方案，作为减少D2B时间的策略。
作者试图评估与在小型农村紧急医疗服务中复制心电图传输方案相关的风险和益处的证据。后者配备了基础急救医疗技术员（EMT-B）、高级急救医疗技术员（EMT-A）和中级急救医疗技术员（EMT-I）级别。
审查的证据仅限于有关心电图传输过程的挑战和复杂性、农村环境中心电图传输的困难以及按提供者级别划分的心电图传输结果的相关数据的研究。
证据支持进一步研究，以进一步评估非护理人员级别心电图传输的可行性。必须研究多个变量，包括设备成本、利用率和农村传输能力。显然，院前心电图传输和心脏导管实验室的早期启动是成功缩短D2B时间的关键组成部分。
