Objective: To investigate patients who called the emergency medical services (EMS) for primary healthcare (PHC) problems.Design: A retrospective and exploratory patient record study from an EMS perspective, comparing two groups: those who were potential candidates for PHC and those who were not. All data were gathered from EMS and hospital records.Settings: The study was completed at the EMS and five hospital areas in the western region of Sweden.Subjects: The patients (n = 3001) who called the EMS in 2011. Data were missing for 10%.Main outcome measures: The frequency and the clinical characteristics of the patients who called the EMS and were actually potential candidates for PHC.Results: Of a total of 2703 patients, a group of 426 (16%) were assessed as potential candidates for PHC and could thus be treated at a level of care other than the emergency department. Patients who were classified as suitable for PHC were found at all priority levels and within all symptom groups, but were younger and healthier than the other group.Conclusion: Numerous patients seeking help from the EMS do not end up at the most appropriate level in the healthcare system.Implications: In the EMS, guidelines are needed to enable pre-hospital emergency nurses to assess and triage patients to the most appropriate level of healthcare.Key pointsPatients calling the emergency medical services do not always end up at an appropriate level of healthcare.In total, 16% of patients were identified by the Swedish emergency medical services as potential candidates for primary healthcare.These patients were younger and healthier than those needing care at the emergency department.They were found at all priority levels and within all symptom groups.

Among patients who used EMS on multiple occasions, the most common symptoms on-scene were dyspnea, chest pain, and abdominal pain. The most common final diagnosis was chronic obstructive pulmonary disease. In 13.0%, the final diagnosis of a potentially life-threatening condition was indicated. In a minority of these cases, the assessment on-scene was judged as potentially inappropriate. Tärnqvist J , Dahlén E , Norberg G , Magnusson C , Herlitz J , Strömsöe A , Axelsson C , Andersson Hagiwara M . On-scene and final assessments and their interrelationship among patients who use the EMS on multiple occasions. Prehosp Disaster Med. 2017;32(5):528-535.

BackgroundFor each hour of delay from fist medical contact until reperfusion in ST-elevation myocardial infarction (STEMI) there is a 10% increase in risk of death and heart failure. The aim of this review is to describe the impact of the direct admission of patients with STEMI to a Catheterisation laboratory (cath lab) as compared with transport to the emergency department (ED) with regard to delays and outcome.MethodsDatabases were searched for from April-June 2012 and updated January 2014: 1) Pubmed; 2) Embase; 3) Cochrane Library; 4) ProQuest Nursing and 5) Allied Health Sources. The search was restricted to studies in English, Swedish, Danish and Norwegian languages.The intervention was a protocol-based clinical pre-hospital pathway and main outcome measurements were the delay to balloon inflation and hospital mortality.ResultsMedian delay from door to balloon was significantly shorter in the intervention group in all 5 studies reported. Difference in median delay varied between 16 minutes and 47 minutes.In all 7 included studies the time from symptom onset or first medical contact to balloon time was significantly shorter in the intervention group. The difference in median delay varied between 15 minutes and 1 hour and 35 minutes. Only two studies described hospital mortality. When combined the risk of death was reduced by 37%.ConclusionAn overview of available studies of the impact of a protocol-based pre-hospital clinical pathway with direct admission to a cath lab as compared with the standard transport to the ED in ST-elevation AMI suggests the following. The delay to the start of revascularisation will be reduced. The clinical benefit is not clearly evidence based. However, the documented association between system delay and outcome defends the use of the pathway.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-014-0067-x) contains supplementary material, which is available to authorized users.