Influence of medical direction on the management of prehospital myocardial infarction

Abstract

Prehospital management of myocardial infarction was evaluated in two differently structured Emergency Medical Service (EMS) systems in Southern Finland: a physician directed EMS with on-site physician involvement (physician EMS) and an EMS without operational physician involvement with paramedics only (non-physician EMS). The management of 641 consecutive acute ST-elevation myocardial infarction (STEMI) patients between 1997 and 1999 (263 patients in the physician EMS group and 378 patients in non-physician EMS group) were studied. Patients treated in the physician EMS received all necessary medical care including thrombolytic therapy at the scene whereas patients in the non-physician EMS were transported to hospital for definitive treatment after initial care. There were no differences in the demographics of the patients. The delays from onset of pain to initiation of thrombolysis were shorter in the physician EMS-group (124+/-101 min (25-723) versus 196+/-150 min (12-835), p<0.001). In 2% of the patients in the physician EMS group the pain to therapy-time was unknown compared to 27% in the non-physician EMS group (p<0.001). Fifty-two patients (20%) in the physician EMS received thrombolytic therapy after cardiopulmonary resuscitation compared to two patients in the non-physician EMS (p<0.001). Of the resuscitated patients in the physician directed EMS group 60% were discharged from the hospital, and 44% of these had a good neurological recovery. We conclude that a physician directed EMS is able to reduce the pain to therapy delays significantly in STEMI patients and may offer thrombolytic therapy to a wider patient group compared to an EMS without operational medical involvement.