A physician-staffed ground emergency medical service does not significantly shorten door-to-balloon time in patients with STEMI: an observational study in a single emergency center in Japan

Yuki Yoshioka; Ryota Teshima; Mina Gamo; Ryuhei Yoneda; Naoki Matsunaga; Tadaaki Takada; Yasushi Fukuta; Koichi Kishi

doi:10.1002/ams2.542

A physician-staffed ground emergency medical service does not significantly shorten door-to-balloon time in patients with STEMI: an observational study in a single emergency center in Japan

Acute Med Surg. 2020 Jul 15;7(1):e542. doi: 10.1002/ams2.542. eCollection 2020 Jan-Dec.

Authors

Yuki Yoshioka¹, Ryota Teshima¹, Mina Gamo¹, Ryuhei Yoneda¹, Naoki Matsunaga¹, Tadaaki Takada¹, Yasushi Fukuta¹, Koichi Kishi²

Affiliations

¹ Department of Emergency and Critical Care Medicine Tokushima Red Cross Hospital Komatsushima City Japan.
² Department of Cardiology Tokushima Red Cross Hospital Komatsushima City Japan.

Abstract

Aim: Current guidelines recommend a door-to-balloon time (DTBT) of <90 min for reperfusion treatment of patients with ST-segment elevation myocardial infarction (STEMI). A physician-staffed ground emergency medical service (GEMS) using a rapid response car (RRC) system was implemented at our hospital in April 2015. The medical team, including a physician and nurse, is dispatched to assess the patient and expedite the start of treatment by emergency physicians and cardiologists after arrival at the hospital. The study aimed to determine whether the RRC system shortened the DTBT.

Methods: This retrospective observational study was carried out in a tertiary emergency center in Japan. Those STEMI patients with primary percutaneous intervention between January 2016 and December 2018 were evaluated. The DTBTs of patients transported by the RRC system, the emergency medical service (EMS), and transferred from other hospitals after STEMI diagnosis (TRANS group) were compared.

Results: A total of 121 patients were included, 33 in the RCC, 20 in the EMS, and 68 in the TRANS groups. The median DTBT was 51 min (interquartile range [IQR], 43-67) in the RRC, 61 min (IQR, 52-85) in the EMS, and 59 min (IQR, 48-72) in the TRANS groups (P = 0.13). The DTBT was not significantly shorter in the RRC than in the other groups.

Conclusion: An RRC physician-staffed GEMS did not significantly shorten the DTBT of patients with STEMI compared with other transport systems.

Keywords: STEMI; doctor car; door‐to‐balloon time (DTBT); physician‐staffed ground emergency medical service (GEMS); rapid response car.