Reduction in treatment delay by paramedic ECG diagnosis of myocardial infarction with direct CCU admission

Abstract

Objectives: To establish the feasibility of training paramedics of diagnose acute myocardial infarction by ECG before hospital admission and whether direct paramedic coronary care admission, arranged by very high frequency (VHF) radio communication with the coronary care unit (CCU), would reduce delay of thrombolysis treatment.

Design: Prospective controlled study.

Setting: District general hospital CCU and a local district ambulance paramedic service.

Patients: 124 patients with ECG evidence of myocardial infarction or ischaemia admitted directly to the CCU by the paramedic service were compared with 123 patients admitted by the emergency department and subsequently transferred to the CCU.

Main outcome measures: ECG diagnostic accuracy by paramedics, and interval durations for CCU admission and thrombolysis.

Results: ECG diagnostic accuracy by the paramedics was 87.5% in the training phase and 92% in admission. The total call to thrombolysis interval was reduced from 154 to 93 minutes and the "door to needle" interval was reduced from 97 to 37 minutes.

Conclusions: Trained paramedics can reliably diagnose myocardial infarction by ECG. The use of a direct admission procedure, by a VHF radio link to the CCU, substantially reduces the time interval for thrombolytic treatment after acute myocardial infarction.

Figure 1

Distribution and management of patients in phase I.

Figure 2

Distribution and management of patients in phase II.

Figure 3

Comparison of mean delay times between phases I and II.

Figure 4

Time from call to emergency services to arrival in the coronary care unit.

Figure 5

Door to needle time.