Evaluating the views of paramedics, cardiologists, emergency department physicians and nurses on advanced prehospital management of acute ST elevation myocardial infarction

Evaluation of attitudes and perceptions of key clinical stakeholders regarding out-of-hospital diagnosis and treatment of ST elevation myocardial infarction patients using a region-wide survey

“…The majority of participants felt that paramedic-based PHM reduces treatment delay in both rural and urban regions. These views are consistent with those captured from stakeholder groups in our previous focus group study13 and evidence from studies demonstrating significant time-to-treatment11 and mortality reduction1 20 related to PHM.…”

“…For example, data from a survey demonstrated that 30% of paramedics and 16–23% of hospital staff did not have confidence in the ability of the prehospital ECG technology to transmit data for remote physician interpretation. Participants, primarily the paramedics, from the focus group explained that this perception may deter some paramedics from providing PHM 13. However, this perception is inconsistent with statistics from past clinical trial-based regional results, which demonstrated a 6% failure in ECG transmission 11.…”

“…In our previous focus group study, a majority of participants were against obtaining a signed informed consent before PHM and fibrinolysis as a result of reported issues relating to time consumption, and difficulty in obtaining consent from STEMI patients who were likely to be under physiological and psychological stress 13. Participants felt that calling 911 implied consent for treatment.…”

“…Implementing routine simulations can complement clinical practice, because many paramedics will not consistently see enough STEMI patients to maintain their knowledge and skills of providing PHM 13. This information was added to our survey and 98% of paramedics, and 98–100% of hospital staff felt that formal intermittent reviews of the PHM protocol was key to the programme’s success.…”

“…Recognising that knowledge of underlying barriers as well as facilitators to PHM implementation in North America has not been adequately explored, we completed a focus group study identifying the perceptions of paramedics, cardiologists, emergency nurses and emergency physicians on PHM 13. This study revealed a variety of in-depth perspectives on issues such as differences in PHM delivery between rural and urban paramedics, inter-stakeholder group collaboration, technology and patient consent to treatment.…”