Rutschman Ross, Alinier Guillaume, Scott Greg, Reimann Thomas, Sliman Bounouh Sonia, Castle Nicholas R, Olola Christopher
Priority Dispatch Corp., Inc, Salt Lake City, Utah.
Hamad Medical Corporation Ambulance Service, Doha, Qatar.
Prehosp Emerg Care. 2025;29(5):670-678. doi: 10.1080/10903127.2024.2387721. Epub 2024 Sep 4.
ST-elevation myocardial infarction (STEMI) is an Acute Myocardial Infarction (AMI) with the greatest risk of death and disability. Getting diagnosed patients rapid definitive treatment at the correct facility is crucial in improving their outcome. Using a Question-and-Answer algorithm (Medical Priority Dispatch System (MPDS)), trained Emergency Medical Dispatchers (EMDs) can help identifying STEMI at the time of dispatch. This can assist Emergency Medical Services (EMS) pre-planning transport to potential STEMI-receiving hospitals. The study aimed to determine whether hospital-confirmed STEMI cases transported by ambulance are associated with certain dispatch determinant codes and identify the treatments performed.
The retrospective study analyzed deidentified dispatch and hospital data of STEMI patients who were transported by Qatar's Ambulance Service between January 2018 and May 2021. Data analysis compared patient demographics with dispatch measures, considering chief complaint and determinant codes, and Percutaneous Coronary Intervention (PCI) treatment received.
A total of 3,724 STEMI cases with MPDS dispatch codes were retrieved. After excluding patient transfer and pandemic-related cases, a final sample of 2,607 cases was analyzed. Most STEMI patients (86.0%) were classified as high priority levels at dispatch, had chest pain as chief complaint (62.9%), and were male (90.8%). Approximately, 99.0% of the STEMI patients received PCI treatment. Distributions of STEMI cases and PCI treatment did not significantly differ by patient demographics and dispatch measures.
Qatar's STEMI patients are more likely to be male and to receive adequate acute care irrespective of any demographic factor and despite potential language issues. This study highlights that the chief complaint may be described or interpreted differently when the questioning language is not their mother tongue, or when there is a language barrier between the caller, call taker, or when using the MPDS protocols language or when self-translating questions instantly in another language. Therefore, EMDs should be made aware of the language differences and be encouraged to further clarify the chief complaint when appropriate. There may be a need for potential refinements of the MPDS questioning algorithm and EMD training with AMI symptoms reinforcement. This could help improve their early identification of STEMI cases with non-classic chest pain symptoms.
ST段抬高型心肌梗死（STEMI）是死亡和致残风险最高的急性心肌梗死（AMI）类型。在正确的医疗机构为确诊患者提供快速的确定性治疗对于改善其预后至关重要。通过使用问答算法（医疗优先调度系统（MPDS）），经过培训的急救医疗调度员（EMD）可以在调度时帮助识别STEMI。这有助于紧急医疗服务（EMS）预先规划将患者转运至可能接收STEMI患者的医院。本研究旨在确定经救护车转运的医院确诊STEMI病例是否与某些调度决定因素代码相关，并确定所实施的治疗方法。
这项回顾性研究分析了2018年1月至2021年5月期间由卡塔尔救护车服务转运的STEMI患者去识别化的调度和医院数据。数据分析将患者人口统计学信息与调度措施进行了比较，同时考虑了主要症状和决定因素代码，以及接受的经皮冠状动脉介入治疗（PCI）。
共检索到3724例有MPDS调度代码的STEMI病例。排除患者转运和与大流行相关的病例后，对最终的2607例样本进行了分析。大多数STEMI患者（86.0%）在调度时被归类为高优先级，主要症状为胸痛（62.9%），且为男性（90.8%）。大约99.0%的STEMI患者接受了PCI治疗。STEMI病例的分布和PCI治疗在患者人口统计学和调度措施方面没有显著差异。
卡塔尔的STEMI患者更可能为男性，且无论任何人口统计学因素以及存在潜在语言问题，都能获得充分的急性治疗。本研究强调，当提问语言不是患者的母语时，或者当呼叫者、接听者之间存在语言障碍时，或者使用MPDS协议语言时，或者即时用另一种语言自行翻译问题时，主要症状的描述或解释可能会有所不同。因此，应让急救医疗调度员意识到语言差异，并鼓励他们在适当的时候进一步明确主要症状。可能需要对MPDS提问算法进行潜在改进，并加强急救医疗调度员对AMI症状的培训。这有助于提高他们对具有非典型胸痛症状的STEMI病例的早期识别能力。
