Comparison of the effectiveness of care provided by a physician staffed and a non-physician staffed pre-hospital response teams in patients with acute coronary syndromes with ST segment elevation
Abstract
The appropriate pre-hospital care provided to patients suffering from ST segment elevation acute myocardial infarction (STEMI) can reduce time to percutaneous coronary intervention (PCI) and minimize complications. However, there is a medical personnel with different level of education and competences involved in pre-hospital care in the Czech Republic.
Objective: The aim of the study was to compare effectiveness of pre-hospital care provided by a physician staffed and a non-physician staffed response teams in patients with STEMI. Methods: Retrospective analysis of consecutive patients treated pre-hospitally with STEMI during 2011-2013.
Direct transports for PCI, therapeutic interventions and survival rates until hospital admission in case of out-of-hospital cardiac arrest (OHCA) were evaluated as quality indicators. Results: In total, 625 STEMI patients were treated by pre-hospital system, of which 385 (61,0 %) were treated by a physician staffed response teams and 240 (38.4 %) by a non-physician staffed teams.
In a physician treated group, 354 (92.0 %) patients were triaged directly for PCI and 373 (96.9 %) received antiplatelet and antithrombotic treatment. In a non-physician treated group, 217 (90.4 %, P = 0.507) were triaged for PCI and 225 (93.8 %, P = 0.061) received antiplatelet and antithrombotic drugs.
Among 575 patients referred directly to PCI, 19 (3.3 %) developed OHCA. 11 of 14 patients resuscitated by physicians survived until hospital admission compared to 4 of 5 resuscitated in a non-physician treated group. Conclusion: In evaluated endpoints of pre-hospital treatment of STEMI we did not prove lower quality of care provided by a non-physician staffed emergency medical service.