• Aspirin administration by emergency medical dispatchers using a protocol-driven aspirin diagnostic and instruction tool

      Barron, Tracey; Clawson, Jeff; Scott, Greg; Patterson, Brett; Shiner, Ronald; Robinson, Donald; Wrigley, Fenella; Gummett, James; Olola, Christopher H.O. (2013-07)
      Background The American College of Cardiology and the American Heart Association recommend early aspirin administration to patients with symptoms of acute coronary syndrome (ACS)/acute myocardial infarction (AMI). The primary objective of this study was to determine if Emergency Medical Dispatchers (EMD) can provide chest pain/heart attack patients with standardised instructions effectively, using an aspirin diagnostic and instruction tool (ADxT) within the Medical Priority Dispatch System (MPDS) before arrival of an emergency response crew. Methods This retrospective study involved three dispatch centres in the UK and USA. We analysed 6 months of data involving chest pain/heart attack symptoms taken using the MPDS chest pain and heart problems/automated internal cardiac defibrillator protocols. Results The EMDs successfully completed the ADxT on 69.8% of the 44 141 cases analysed. The patient's mean age was higher when the ADxT was completed, than when it was not (mean±SD: 53.9±19.9 and 49.9±20.2; p<0.001, respectively). The ADxT completion rate was higher for second-party than first-party calls (70.3% and 69.0%; p=0.024, respectively). A higher percentage of male than female patients took aspirin (91.3% and 88.9%; p=0.001, respectively). Patients who took aspirin were significantly younger than those who did not (mean±SD: 61.8±17.5 and 64.7±17.9, respectively). Unavailability of aspirin was the major reason (44.4%) why eligible patients did not take aspirin when advised. Conclusions EMDs, using a standardised protocol, can enable early aspirin therapy to treat potential ACS/AMI prior to responders' arrival. Further research is required to assess reasons for not using the protocol, and the significance of the various associations discovered. https://emj.bmj.com/content/emermed/30/7/572.full.pdf URL This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/emermed-2012-201339
    • High-risk non-ST elevation acute coronary syndromes (NSTEACS) for paramedics

      Reed, Ashley (2012-08)
      Abstract published with permission. Pre-hospital clinicians frequently encounter patients suffering acute coronary syndromes (ACS) and they form an integral part in recognising and conveying the ST-elevation myocardial infraction (STEMI) patient to the most appropriate destination, namely the heart attack centre (HAC). The emphasis has been upon the recognition and subsequent management of the STEMI patient. The non-ST elevation acute coronary syndrome (NSTEACS) patient has a similar mortality and morbidity yet does not receive the same pathways as STEMI. This article aims to provide an understanding based on a case study around NSTEACS with supporting evidence relating to risk stratification, clinical trials and clinical guidelines of what needs to be developed to enhance the care we provide to the NSTEAC patient in the pre-hospital arena.
    • Impact of Early (≤24 H) Versus Delayed (>24 H) Intervention in Patients With non-ST Segment Elevation Myocardial Infarction: An Observational Study of 20,882 Patients From the London Heart Attack Group

      Panoulas, Vasileios; Rathod, Krishnaraj S.; Jain, Ajay K.; Firoozi, Sam; Nevett, Joanne; Kalra, Sundeep Singh; Malik, Iqbal S.; Mathur, Anthony; Redwood, Simon; MacCarthy, Philip A.; et al. (2020-06-03)
    • Reducing time to angiography and hospital stay for patients with high-risk non-ST-elevation acute coronary syndrome: retrospective analysis of a paramedic-activated direct access pathway

      Koganti, Sudheer; Patel, N.; Seraphim, A.; Kotecha, T.; Whitbread, Mark; Rakhit, Roby D. (2016-06)
      Objective: To assess whether a novel ‘direct access pathway’ (DAP) for the management of high-risk nonST-elevation acute coronary syndromes (NSTEACS) is safe, results in ‘shorter time to intervention and shorter admission times’. This pathway was developed locally to enable London Ambulance Service to rapidly transfer suspected high-risk NSTEACS from the community to our regional heart attack centre for consideration of early angiography. Methods: This is a retrospective case–control analysis of 289 patients comparing patients with high-risk NSTEACS admitted via DAP with age-matched controls from the standard pan-London high-risk ACS pathway (PLP) and the conventional pathway (CP). The primary end point of the study was time from admission to coronary angiography/intervention. Secondary end point was total length of hospital stay. Results: Over a period of 43 months, 101 patients were admitted by DAP, 109 matched patients by PLP and 79 matched patients through CP. Median times from admission to coronary angiography for DAP, PLP and CP were 2.8 (1.5–9), 16.6 (6–50) and 60 (33–116) hours, respectively ( p<0.001). Median length of hospital stay for DAP and PLP was similar at 3.0 (2.0–5.0) days in comparison to 5 (3–7) days for CP ( p<0.001). Conclusions: DAP resulted in a significant reduction in time to angiography for patients with high-risk NSTEACS when compared to existing pathways. https://bmjopen.bmj.com/content/bmjopen/6/6/e010428.full.pdf This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/bmjopen-2015-010428
    • TCT-241 Drug-eluting stents are superior to bare metal stents in reducing mortality in cardiogenic shock complicating ST-elevation myocardial infarction

      Iqbal, M. Bilal; Hadjiloizou, Nearchos; Kabir, Tito; Archbold, Andrew; Crake, Tom; Firoozi, Sam; Kalra, Sundeep S.; Knight, Charles; Lim, Pitt; Malik, Iqbal S.; et al. (2013-10)