Journal Article

Hospital-Confirmed Acute Myocardial Infarction: Prehospital Identification Using the Medical Priority Dispatch System

Clawson, Jeff J., Broadbent, Meghan, Fivaz, Conrad, Barron, Tracey, Olola, Christopher, Gardett, Isabel, Scott, Greg

2018

Overview

Introduction Early recognition of an acute myocardial infarction (AMI) can increase the patient's likelihood of survival. As the first point of contact for patients accessing medical care through emergency services, emergency medical dispatchers (EMDs) represent the earliest potential identification point for AMIs. The objective of the study was to determine how AMI cases were coded and prioritized at the dispatch point, and also to describe the distribution of these cases by patient age and gender. Hypothesis/Problem No studies currently exist that describe the EMD's ability to correctly triage AMIs into Advanced Life Support (ALS) response tiers. The retrospective descriptive study utilized data from three sources: emergency medical dispatch, Emergency Medical Services (EMS), and emergency departments (EDs)/hospitals. The primary outcome measure was the distributions of AMI cases, as categorized by Chief Complaint Protocol, dispatch priority code and level, and patient age and gender. The EMS and ED/hospital data came from the Utah Department of Health (UDoH), Salt Lake City, Utah. Dispatch data came from two emergency communication centers covering the entirety of Salt Lake City and Salt Lake County, Utah. Overall, 89.9% of all the AMIs (n=606) were coded in one of the three highest dispatch priority levels, all of which call for ALS response (called CHARLIE, DELTA, and ECHO in the studied system). The percentage of AMIs significantly increased for patients aged 35 years and older, and varied significantly by gender, dispatch level, and chief complaint. A total of 85.7% of all deaths occurred among patients aged 55 years and older, and 88.9% of the deaths were handled in the ALS-recommended priority levels. Acute myocardial infarctions may present as a variety of clinical symptoms, and the study findings demonstrated that more than one-half were identified as having chief complaints of Chest Pain or Breathing Problems at the dispatch point, followed by Sick Person and Unconscious/Fainting. The 35-year age cutoff for assignment to higher priority levels is strongly supported. The Falls and Sick Person Protocols offer opportunities to capture atypical AMI presentations. Clawson JJ , Gardett I , Scott G , Fivaz C , Barron T , Broadbent M , Olola C . Hospital-confirmed acute myocardial infarction: prehospital identification using the Medical Priority Dispatch System. Prehosp Disaster Med. 2018;33(1):29-35.

• Publisher: Cambridge University Press,Jems Publishing Company, Inc
• Subject: Adult / Aged / Cardiovascular disease / Cohort Studies / Disasters / Early Diagnosis / Electrocardiography - methods / Emergency medical care / Emergency Medical Service Communication Systems - utilization / Emergency medical services / Emergency Medical Services - organization & administration / Emergency Service, Hospital / Family medical history / Female / Fuzzy sets / Health services / Heart attacks / Hospitals / Humans / Male / Medical prognosis / Middle Aged / Myocardial infarction / Myocardial Infarction - diagnosis / Myocardial Infarction - mortality / Myocardial Infarction - therapy / Original Research / Outcome Assessment (Health Care) / Pain / Patients / Retrospective Studies / Risk Assessment / Survival Rate / Task forces / Triage / United States