A recent study shows that it took emergency medical services (EMS) five and a half more minutes to arrive on the scene for a patient experiencing a heart attack, also known as ST-elevation myocardial infarctions (STEMI), compared to their urban counterparts.
The report, titled “Prehospital Time Disparities for Rural Patients with Suspected STEMI,” also found that it took EMS nearly twice as long to transport a patient to a care facility in the rural setting compared to the urban setting.
“When a patient has a clogged blood vessel, time is the most important thing,” said Jason P. Stopyra, the lead researcher for the study, a physician, and an associate professor of emergency medicine at Wake Forest University in North Carolina. “The only way to open that is by either being stented through angioplasty or for us to administer the clot-busting drugs. So we need to equip our rural agencies to do that.”
He said the study found there’s a large difference between urban and rural time from the event to receiving help.
“The percentage of patients that failed to meet the time goal … from dispatch to destination, the percentage of people in rural areas that do not meet the goal is significantly higher than urban and, honestly, it’s higher than I even thought,” he said in an interview with the Daily Yonder.
Stopyra said rural providers in lower-performing agencies are more likely to perform treatment prior to leaving the scene and prior to activating the catheterization lab.
The study examined records from 1,366 emergency medical services agencies. Of 15,915,027 adult 9-1-1 transports, 23,655 records with suspected STEMI were included in the analysis.
The researchers also had some patients take part in qualitative interviews.
“…we found that agencies that had a strong chain of command, a stable leadership, a system with a strong quality improvement structure within their agencies, were more likely to be top performing agencies,” Stopyra said. “Agency paramedics frequently discussed the importance of being very direct, and almost hurrying the patient to get into the ambulance and off the scene, versus the lower performing agencies that were more gentle with the patient and explained more and got all of their ducks in a row before they started.”
Remle Crowe is director of Clinical and Operational Research at ESO, which provides software and data to EMS, fire services, and hospitals and has one of the largest collections of prehospital data in the country. She said that the time to assess the patient, do any procedures that need to happen before they move, and then decide where to take the patient was similar for both rural and urban settings. It took about 15 minutes.
One positive she said about the longer time for rural settings in the time it took to arrive at a destination was that most likely shows the EMS recognized the emergency in the rural setting.
“They recognize[d] that person needed a specialty level of care, and they chose to perhaps bypass the closest hospital that would not have been able to provide the type of care that they needed definitively,” she told the Daily Yonder. “And so they actually prevented a delay by going a little bit longer distance to the appropriate facility, rather than stopping at that first facility.”