Carpenter Rob, McWhorter Rochell, Donaldson Shirl, Silberman Dave, Maffei Steve
The University of Texas at Tyler, Tyler, TX, USA.
Boston University, Boston, MA, USA.
Health Serv Insights. 2021 Aug 4;14:11786329211037521. doi: 10.1177/11786329211037521. eCollection 2021.
Residents in rural communities have a higher incidence of cardiac death and risk factors associated with cardiac disease. Living in a rural region can add precious time that amplifies cardiac death during an ST-elevated myocardial infarction (STEMI) episode. The consensus is that improved efficiencies can increase myocardial salvage and decrease STEMI mortality rates. This article identifies issues that may impact pre-hospital STEMI triage of patients in a rural region of the United States (U.S.). A qualitative research design was chosen to gain insight into emergency personnel perceptions of pre-hospital STEMI triage. The participants (n = 18) were obtained from a convenience sample in rural Northeast Texas, U.S. Data were gathered by individual and group semi-structured interviews. Themes were identified, synthesized, and oriented to offer a basis for understanding opportunities to improve the delivery of rural STEMI care. This study demonstrated that quality improvement initiatives aimed at achieving pre-hospital STEMI triage efficiencies have dependencies on teamwork, technology, and training in the context of 3 stages (a) pre-transport, (b) door-to-door, and (c) post-transport. A pre-hospital STEMI triage model is offered based on the findings. By incorporating this model, emergency medical coordinators in rural communities have a better opportunity to facilitate timely reperfusion therapy for this high-risk population.
农村社区居民的心脏性死亡发生率以及与心脏病相关的危险因素较高。生活在农村地区可能会增加宝贵的时间，这会在ST段抬高型心肌梗死（STEMI）发作期间加大心脏性死亡的风险。人们的共识是，提高效率可以增加心肌挽救率并降低STEMI死亡率。本文确定了可能影响美国农村地区患者院前STEMI分诊的问题。我们选择了定性研究设计，以深入了解急救人员对院前STEMI分诊的看法。参与者（n = 18）来自美国得克萨斯州东北部农村地区的便利样本。数据通过个人和小组半结构化访谈收集。确定、综合并梳理了主题，以便为理解改善农村STEMI护理服务提供的机会奠定基础。这项研究表明，旨在实现院前STEMI分诊效率的质量改进举措在三个阶段（a）转运前、（b）门到门以及（c）转运后依赖于团队合作、技术和培训。基于研究结果，我们提供了一个院前STEMI分诊模型。通过采用该模型，农村社区的紧急医疗协调员有更好的机会为这一高危人群提供及时的再灌注治疗。
