Effect of Use of Ambulance as Emergency Medical Service in Patients of ST-Elevation Myocardial Infarction

  • Majid Bashir Nishtar Medical University and Hospital, Multan
  • Kubra Maryam Nishtar Medical University and Hospital, Multan
  • Nazeer Ahmed Nishtar Medical University and Hospital, Multan
  • Tariq Mehmood Ch. Pervaiz Elahi Institute of Cardiology (CPEIC), Multan
  • Adnan Aslam Bahauddin Zakariya University, Multan
Keywords: Ambulance System, Emergency Services, STEMI.

Abstract

Objective: To study the frequency of ambulance utilization by the St-elevation Myocardial Infarction patients to
reach hospital, perception of ambulance users about the facilities available in the ambulance, and evaluate the
clinical outcomes of STEMI between ambulance users and non-users.
Study Design: Cross-section survey-based study.
Place and Duration of Study: The study was carried out in the Department of Cardiology at Chaudry Pervaiz
th th Elahi Institute of Cardiology (CPEIC) Multan from 14 April 2020 to 14 September 2020.
Materials and Methods: Patients with the diagnosis of STEMI were included in the study and were classified
into two groups' ambulance and non-ambulance users, to reach the facility. Patients' demographics, initial
presenting symptoms, availability of ambulance, and time to reach the hospital were recorded. Moreover, they
were followed for complication during their stay and base line laboratory indicators. Ambulance users were
also evaluated for their perception about availability of medical services in the ambulance. The data collected
from both of the groups were compared through student's t-test and chi-square test. Statistical value less than
0.05 was considered as significant.
Results: Out of 300 patients, 32.6% were ambulance users while 67.4% were non-ambulance user. No
significant difference was found in age, gender, underlying comorbidity, and initial presenting symptoms
between two groups. Majority of ambulance users (74%) arrived in less than 45minutes. Different
complications were recorded but no significant difference was found between two groups. Majority of
ambulance users 31.5% were neutral about the level of satisfaction for ambulance facilities.
Conclusion: Frequency of ambulance utilization by STEMI patients is not only low in Pakistan, but ambulance
system is also not successful in producing significant change in clinical outcomes. Therefore an awareness
campaign along with ambulance improvement campaigns should be launched to bring a meaningful change.

References

Callachan EL, Alsheikh-Ali AA, Bruijns S, Wallis LA. Physician perceptions and recommendations about pre-hospital emergency medical services for patients with ST-elevation acute myocardial infarction in Abu Dhabi. Journal of the Saudi Heart Association. 2016; 28: 7-14.

Liaquat A, Javed Q. current trends of cardiovascular risk determinants in Pakistan. Cureus. 2018; 10: e3409.

Canto JG, Rogers WJ, Chandra NC, French WJ, Barron HV, Frederick PD, et al. The association of sex and payer status on management and subsequent survival in acute myocardial infarction. Archives of internal medicine. 2002; 162: 587-93.

Rebeiz A, Sasso R, Bachir R, Mneimneh Z, Jabbour R, El Sayed M. Emergency Medical Services Utilization and

Outcomes of Patients with ST-Elevation Myocardial Infarction in Lebanon. The Journal of Emergency Medicine.

; 55: 827-35.

Kobusingye OC, Hyder AA, Bishai D, Hicks ER, Mock C, Joshipura M. Emergency medical systems in low-and

middle-income countries: recommendations for action. Bulletin of the World Health Organization. 2005; 83: 626-

Zia N, Shahzad H, Baqir SM, Shaukat S, Ahmad H, Robinson C, et al. Ambulance use in Pakistan: an analysis of

surveillance data from emergency departments in Pakistan. BMC Emergency Medicine. 2015; 15: S9.

Snooks HA, Anthony R, Chatters R, Dale J, Fothergill R, Gaze S, et al. Support and Assessment for Fall Emergency Referrals (SAFER) 2: a cluster randomised trial and systematic review of clinical effectiveness and cost effectiveness of new protocols for emergency ambulance paramedics to assess older people following a fall with

referral to community-based care when appropriate. Health technology assessment. 2017; 21: 1-218.

Lindskou TA, Mikkelsen S, Christensen EF, Hansen PA, Jørgensen G, Hendriksen OM, et al. The Danish pre hospital emergency healthcare system and research possibilities. Scandinavian journal of trauma, resuscitation and emergency medicine. 2019; 27: 1-7.

Kobayashi A, Misumida N, Aoi S, Steinberg E, Kearney K, Fox JT, et al. STEMI notification by EMS predicts shorter door-toballoon time and smaller infarct size. The American Journal of Emergency Medicine. 2016; 34: 1610-3.

Bray JE, Stub D, Ngu P, Cartledge S, Straney L, Stewart M, et al. Mass Media Campaigns Influence on Pre hospital Behavior for Acute Coronary Syndromes: An Evaluation of the Australian Heart Foundation's Warning Signs Campaign. Journal of the American Heart Association. 2015; 4: e001927.

AlHabib KF, Sulaiman K, Al Suwaidi J, Almahmeed W, Alsheikh-Ali AA, Amin H, et al. Patient and System-Related Delays of Emergency Medical Services Use in Acute ST Elevation Myocardial Infarction: Results from the Third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps). PLOS ONE. 2016; 11: e0147385.

Callachan EL, Alsheikh-Ali AA, Nair SC, Bruijns S, Wallis LA. Outcomes by mode of transport of ST elevation MI patients in the United Arab Emirates. Western Journal of Emergency Medicine. 2017; 18: 349.

Chandran A, Ejaz K, Karani R, Baqir M, Razzak J, Hyder AA. Insights on the effects of patient perceptions and

awareness on ambulance usage in Karachi, Pakistan. Emergency Medicine Journal. 2014; 31: 990-3.

Phillips JS. Paramedics' perceptions and experiences of NHS 111 in the south west of England. Journal of Paramedic Practice. 2020; 12: 227-34.

Lowthian JA, Cameron PA, Stoelwinder JU, Curtis A, Currell A, Cooke MW, et al. Increasing utilisation of emergency ambulances. Australian Health Review. 2011; 35: 63-9.

Published
2021-06-29
Section
Original Article