Rapid Triage and Transport of Patients With ST-Elevation Myocardial Infarction for Percutaneous Coronary Intervention in a Rural Health System

• Published in: The American journal of cardiology Vol. 100; no. 6; pp. 944 - 948
• Main Authors: Blankenship, James C., MD, Haldis, Thomas A., DO, Wood, G. Craig, MS, Skelding, Kimberly A., MD, Scott, Thomas, MD, Menapace, Francis J., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15.09.2007; Elsevier; Elsevier Limited
• Subjects: Aged; Air Ambulances; Angioplasty; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Clinical Protocols; Coronary heart disease; Coronary vessels; Diseases of the cardiovascular system; Efficiency, Organizational; Female; Heart; Heart attacks; Hospitals, Community - organization & administration; Hospitals, Community - standards; Hospitals, Rural - organization & administration; Hospitals, Rural - standards; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - therapy; Myocarditis. Cardiomyopathies; Patient admissions; Patient Transfer - standards; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Regional Medical Programs; Rural health care; Rural Health Services - organization & administration; Rural Health Services - standards; Time and Motion Studies; Triage; Human; Myocardial infarction; Health system; Rural environment; Angioplasty; Coronary artery; Instrumentation therapy; Cardiovascular disease; Patient; Myocardial disease; Coronary heart disease; Phlebology; Stent; Sorting; ST elevation; Rural area; Circulatory system; Emergency; Cardiology; Transport
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2007.04.031

This study was conducted to evaluate door-to-treatment times before and after the implementation of a rapid triage and transfer system for patients with ST-elevation myocardial infarction transferred from community hospitals to a rural angioplasty center for primary percutaneous coronary intervention (PCI). The system was developed in late 2004 and implemented at a rural percutaneous coronary intervention center in early 2005. Helicopter transport was available for 97% of requests for transfer from community hospitals. All patients with ST-elevation myocardial infarction transferred during 2004 and 2005 (n = 226) were evaluated with respect to presentation and treatment times. Time from community hospital presentation to wire crossing decreased during the study from 205 to 105 minutes (p = 0.0001). One fourth of patients were treated <90 minutes after presentation, and 2/3 were treated in <120 minutes. In conclusion, the implementation of a rapid triage, transfer, and treatment protocol can achieve a significant shortening of presentation-to-treatment times. Efficient community hospitals working with an efficient angioplasty center can achieve presentation–to–wire crossing times of <90 minutes for some patients.