Moving Care Forward

Abstract

In 1967, the modern era of prehospital emergency cardiac care began with Dr Frank Pantridge's publication of “A mobile intensive-care unit in the management of myocardial infarction.”1 Recognizing that myocardial infarction mortality could be reduced by interventions prior to hospital arrival, Dr Pantridge developed a specialized ambulance system in Belfast, Ireland to stabilize and transport patients with suspected acute myocardial infarction to the Royal Victoria Hospital. Within 3 years, Dr Pantridge's system was being replicated in the United States, first in Haywood County, NC and subsequently in Pittsburgh, Pa, Seattle, Wash, Miami, Fla, and Los Angeles, Calif. Dr Pantridge recognized the importance of collecting performance data and setting time standards, including a goal of 15 minutes from dispatch to patient arrival. His initial publication documented an improvement in the percentage of calls meeting this goal from 20% to 78%. Article see p 1464 Over 40 years later, prehospital emergency cardiac care has expanded in scope to provide rapid coronary artery reperfusion for ST-segment elevation myocardial infarction (STEMI). The essential elements include prehospital diagnosis and in-the-field catheterization laboratory activation. In the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) registry, the 27% of patients with a prehospital ECG underwent faster coronary reperfusion (median time to primary percutaneous coronary intervention [PCI]: 61 minutes versus 75 minutes, P <0.0001; fibrinolysis:19 minutes versus 29 minutes, P =0.003) and had a trend toward lower mortality (adjusted odds ratio: 0.80, 95% confidence interval: 0.63 to 1.01).2 When the prehospital ECG is used to activate catheterization laboratories, treatment times are remarkably fast. Rokos and colleagues highlighted 10 regional STEMI systems that combined paramedic diagnosis with hospital activation resulting in half of patients undergoing coronary intervention within 60 minutes of hospital arrival.3 Recognizing the importance of prehospital care, both US and European guidelines establish primary …