Impact of mode of transportation on time to treatment in patients transferred for primary percutaneous coronary intervention.

BACKGROUND: Patients suffering ST segment elevation myocardial infarction (STEMI) requiring transfer from a non-percutaneous coronary intervention (PCI) hospital to a PCI-capable hospital often have prolonged treatment times.

OBJECTIVE: For STEMI transfers, we changed from air to ground transportation, and carefully documented the impact on treatment times.

METHODS: This is a retrospective report between two hospitals within one STEMI system. The referring facility controls both air and ground ambulance services. After a 2-year period of air transportation with suboptimal treatment times, the referring hospital switched to ground transport. All pertinent times were carefully recorded and are reported here.

RESULTS: There were 43 patients included, approximately half were transported by air and half by ground. Comparing our early experience (air only) vs. our later experience (predominantly ground-transported patients), median door-in-door-out (DIDO) time at the first facility was 70 min vs. 35 min (p<0.001), median transport time was 20 min vs. 30 min (p<0.001), and median first medical contact to balloon time (FMC2b time) was 123 min vs. 90 min (p<0.001). After changing mode of transport, achievement of the national FMC2b time goal of <120 min rose from 47% to 92% (p<0.001).

CONCLUSIONS: We document a significantly reduced DIDO and FMC2b time after changing mode of transportation for STEMI patients transferred 30 miles for primary PCI. Utilizing ground rather than air transportation, the median FMC2b time was reduced from 123 to 90 min. We show that mode of transportation can dramatically reduce both DIDO time and FMC2b time.