Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jan 30, 2022
Date Accepted: Oct 20, 2022
Optimizing Emergency Medical Dispatch System to Improve Prehospital Diagnosis and Treatment for Acute Coronary Syndrome: A Nationwide Study in China
ABSTRACT
Background:
Acute coronary syndrome (ACS) is the most time-sensitive acute cardiac event, which require rapid dispatching and response. The Medical Priority Dispatch system (MPDS), one of the mostly used types of emergency dispatching, is hypothesized to provide better quality of prehospital emergency treatment. Few studies have revealed the impact of MPDS use on process of ACS care.
Objective:
To investigate whether the use of MPDS was associated with higher prehospital diagnosis accuracy and shorter prehospital delay for ACS patients transferred by emergency medical service (EMS), using a national database in China.
Methods:
This retrospective analysis was based on an integrated database of China MPDS and hospital registry. From January 1, 2016, to December 31, 2020, EMS-treated ACS cases were divided into before-MPDS and after-MPDS group according to MPDS launch time in each EMS centers. The primary outcomes included consistency (Kappa value) between ambulance diagnosis and hospital discharge, and prehospital delay (call-to-EMS arrival, EMS arrival-to-door). Multivariable logistic regression and propensity score matching analysis were applied to compare outcomes between two groups for total ACS and subtypes.
Results:
A total of 9,806 ACS cases (3,561 before MPDS and 6,245 after MPDS) treated by 43 EMS centers were included. The overall diagnosis consistency after MPDS (κ=0.918, P<0.001) was higher than that of before-MPDS group (κ=0.889, P<0.001). After the use of MPDS, call-to-EMS arrival time was shortened in the propensity score matched population (20.0 vs. 16.0 min, P<0.001) and in the subtype of STEMI (adjusted difference: -3.81, 95%CI: -4.63, -2.98, P<0.001), while the EMS arrival-to-door time (22.0 vs. 22.0 min, P=0.348) was of no significant difference.
Conclusions:
The optimized use of MPDS in China was associated with higher diagnosis consistency, shorter call-to-EMS arrival time among EMS-treated ACS patients. Emergency medical dispatch system should be designed specifically to fit into different prehospital modes in the EMS system on a regional basis.
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