Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-10T05:50:25.584Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  10 December 2017

Jeff J. Clawson ,
Isabel Gardett ,
Greg Scott ,
Conrad Fivaz ,
Tracey Barron ,
Meghan Broadbent  and
Christopher Olola
Jeff J. Clawson
Affiliation:
International Academies of Emergency Dispatch, Salt Lake City, UtahUSA
Isabel Gardett*
Affiliation:
International Academies of Emergency Dispatch, Salt Lake City, UtahUSA
Greg Scott
Affiliation:
International Academies of Emergency Dispatch, Salt Lake City, UtahUSA
Conrad Fivaz
Affiliation:
International Academies of Emergency Dispatch, Salt Lake City, UtahUSA
Tracey Barron
Affiliation:
International Academies of Emergency Dispatch, Bristol, United Kingdom
Meghan Broadbent
Affiliation:
International Academies of Emergency Dispatch, Salt Lake City, UtahUSA
Christopher Olola
Affiliation:
International Academies of Emergency Dispatch, Salt Lake City, UtahUSA
*
Correspondence: Isabel Gardett, PhD International Academies of Emergency Dispatch 110 S. Regent Street, 8th Floor Salt Lake City, Utah 84111 USA E-mail: Isabel.gardett@emergencydispatch.org
Get access Rights & Permissions [Opens in a new window]

Abstract

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.

Methods

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.

Results

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.

Conclusion

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.

ClawsonJJ, GardettI, ScottG, FivazC, BarronT, BroadbentM, OlolaC. Hospital-Confirmed Acute Myocardial Infarction: Prehospital Identification Using the Medical Priority Dispatch System. Prehosp Disaster Med. 2018;33(1):29–35.

Keywords

acute myocardial infarctionemergency medical dispatchEmergency Medical Servicesheart attackmedical priority dispatch
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 33 , Issue 1 , February 2018 , pp. 29 - 35
Copyright
© World Association for Disaster and Emergency Medicine 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Conflicts of interest: Jeff J. Clawson is the inventor of the Medical Priority Dispatch Protocol System (MPDS) studied herein. The other authors declare no conflicts of interest.

References

1. CDC. Leading Causes of Death. Centers for Disease Control and Prevention Web site. www.cdc.gov/nchs/fastats/leading-causes-of-death.htm. Published October 7, 2015. Updated April 27, 2016. Accessed September 1, 2016.Google Scholar
2. WHO. The Top Ten Causes of Death. World Health Organization Web site. www.who.int/mediacentre/factsheets/fs310/en. Published 2016. Accessed September 1, 2016.Google Scholar
3. Go, AS, Mozaffarian, D, Roger, VL, et al. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28-e292.Google Scholar
4. CDC. Heart Disease Facts. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/HeartDisease/facts.htm. Published August 10, 2015. Accessed September 9, 2016.Google Scholar
5. CDC. Heart Disease Fact Sheet. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_disease.htm. Published June 16, 2016. Accessed September 9, 2016.Google Scholar
6. Bang, A, Grip, L, Herlitz, J, et al. Lower mortality after prehospital recognition and treatment followed by fast tracking to coronary care compared with admittance via emergency department in patients with ST-elevation myocardial infarction. Internal J Cardiology. 2008;129(13):325-332.Google Scholar
7. Hochman, JS, Sleeper, LA, Webb, JG, et al. Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction. JAMA. 2006;295(21):2511-2515.Google Scholar
8. Clawson, J, Olola, C, Heward, A, et al. The Medical Priority Dispatch System’s ability to predict cardiac arrest outcomes and high acuity prehospital alerts in chest pain patients presenting to 9-9-9. Resuscitation. 2008;78(3):298-306.Google Scholar
9. Sporer, K, Wilson, G. How well do emergency medical dispatch codes predict prehospital medication administration in a diverse urban community? J Emerg Med. 2013;44(2):413-422.Google Scholar
10. Myocardial Infarction Clinical Presentation. Medscape Web site. http://emedicine.medscape.com/article/155919-clinical. Published 1994. Updated March 28, 2016. Accessed September 12, 2016.Google Scholar
11. Brady, WJ. Atypical presentations of acute myocardial infarction: medical and legal consequences. AHC Media. December 1, 2000. http://www.ahcmedia.com/articles/47718-atypical-presentations-of-acute-myocardial-infarction-medical-and-legal-consequences. Accessed September 9, 2016.Google Scholar
12. Meisel, ZF, Armstrong, K, Mechem, CC, et al. Influence of sex on the out-of-hospital management of chest pain. Acad Emerg Med. 2010;17(1):80-87.Google Scholar
13. Moy, E, Barrett, M, Coffey, R, et al. Missed diagnosis of acute myocardial infarction in the emergency department: variation by patient and facility characteristics. Diagnosis. 2015;2(1):29-40.Google Scholar
14. Zadek, LA. Fuzzy sets as a basis for a theory of possibility. Fuzzy Sets and Systems. 1978;1(1):3-28.Google Scholar
15. AHA. STEMI Receiving Center Certification. American Heart Association Web site. http://www.heart.org/HEARTORG/HealthcareResearch/MissionLifelineHomePage/STEMI-ReceivingHospitals/STEMI-Receiving-Hospitals_UCM_307429_Article.jsp#.VrUqoY-cGUk. Published 2016. Accessed September 7, 2016.Google Scholar
16. Erhardt, L, Herlitz, J, Bossaert, L, et al. Task Force on the Management of Chest Pain: task force report. Eur Heart J. 2002;23:1153-1176.Google Scholar
17. Tatum, JL, Jesse, RL, Kontos, MC, et al. Comprehensive strategy for the evaluation and triage of the chest pain patient. Ann Emerg Med. 1997;29(1):116-125.Google Scholar
18. Rusnak, RA, Stair, TO, Hansen, K, Fastow, JS. Litigation against the emergency physician: common features in cases of missed myocardial infarction. Ann Emerg Med. 1989;18(10):1029-1034.Google Scholar
19. Conti, R, Bavry, AA, Peterson, JW. Silent ischemia: clinical relevance. J Am Coll Cardiol. 2012;59:435-441.Google Scholar
20. Kannel, WB, Abbot, RD. Incidence and prognosis of unrecognized myocardial infarction: an update on the Framingham study. N Engl J Med. 1984;311(18):1144-1147.Google Scholar
21. Valensi, P, Lorgis, L, Cottin, Y. Prevalence, incidence, predictive factors and prognosis of silent myocardial infarction: a review of the literature. Archives of Cardiovascular Disease. 2011;104:178-188.Google Scholar
22. Lusiana, L, Perrone, A, Pesavento, R, et al. Prevalence, clinical features, and acute course of atypical myocardial infarction. Angiology. 1994;45(1):49-55.Google Scholar
23. Tan, MP, Kenny, RA. Cardiovascular assessment of falls in older people. Clinical Interventions in Aging. 2006;1(1):57-66.Google Scholar
24. Alboni, P, Brignole, M, Menozzi, C, et al. Diagnostic value of history in patients with syncope with or without heart disease. J Am Coll Card. 2001;37(7):1921-1928.Google Scholar