Monthly meetings to review heart attack cases between EMS and hospital personnel is one key factor in reducing mortality rates, researchers report in a study published in the May issue of Annals of Internal Medicine. Researchers from Yale University surveyed more than 500 hospitals nationwide about their best practices for treating heart attack patients and found that several factors were significantly associated with lower death rates: monthly meetings between hospital and EMS staff to review heart attack cases; the constant presence of a cardiologist on site or, if not possible, a pharmacist on the daily care team; encouraging creative problem-solving by clinicians; and physicians and nurses working together.
Yet fewer than 10 percent of hospitals use these strategies, several of which are rooted in encouraging collaboration and communication among all those taking care of heart attack victims. Researchers note the strategies are inexpensive and should be something every hospital can do.
Helicopter Transport to Trauma Centers Improves Survival
Seriously injured patients transported to level I or II trauma centers via helicopter are more likely to survive than patients transported by ground EMS, finds a study by researchers from Johns Hopkins University that looked at more than 200,000 transports among people aged 15 and older.
The study, in the April 18 issue of JAMA, was part of a theme issue on comparative effectiveness research, which pits one strategy or treatment against another to determine which is superior. Whether mode of transport affected patient outcomes deserved “rigorous investigation because helicopter transport is more costly than ground and because trauma is the leading cause of death and disability worldwide each year,” the researchers write.
Among the 62,000 patients with major trauma transported by air and 162,000 transported by ground, unadjusted mortality was higher for those transported by helicopter than ground—12.6 percent compared to 11 percent. But patients transported by helicopter tended to have higher injury severity scores.
After taking into account this and other factors, patients taken by helicopter to a level I trauma center had a 16 percent greater chance of survival than those taken by ground; those transported to a level II trauma center had a 15 percent greater chance of survival. “Thus, for patients transported to level I trauma centers by helicopter, 65 patients would need to be transported to save 1 life; for patients transported to level II trauma centers, the number needed to treat is 69,” the authors write.
Future studies should investigate whether “prehospital interventions, total prehospital time, crew configuration, and distance … may in part or whole explain the benefit of helicopter EMS for adults with major trauma because understanding the effectiveness of each may help determine which patients benefit most from this resource,” the researchers conclude.
GIK Doesn’t Halt Heart Attacks
Having prehospital providers give chest pain patients an intravenous solution containing glucose-insulin-potassium (GIK) doesn’t reduce the likelihood of progression to heart attack or improve 30-day survival, according to a study in the March 27 online issue of JAMA.
Lab studies have suggested that quickly giving IV GIK to patients with heart blockages could reduce arrhythmia, heart muscle damage and potentially cardiac arrest. But the randomized placebo controlled study, led by researchers from Tufts University School of Medicine in Boston and conducted in 13 U.S. cities involving 36 EMS agencies, found no statistically significant reduction in progression to heart attack or survival.
Too Few Patients Calling 911 for Stroke
Researchers from Weill Cornell Medical College in New York City have found that nationwide, only about one-half of stroke patients arrive to the hospital via ambulance, potentially delaying the time to clot-busting (thrombolytic) treatment that could improve their chances of leaving the hospital without significant disability.
For the most part, the percentage of patients going by ambulance to the hospital with stroke symptoms (51 percent) didn’t budge in the decade between 1997 and 2008, according to the study, which appeared in the March 14 issue of JAMA. “Our findings suggest that national efforts to address barriers to ambulance use among patients with stroke need to be intensified or adjusted,” the researchers write.
Thrombolytic therapy must be given within a few hours of symptom onset in order to be effective, according to the study, but many patients arrive too late. The study was based on data from annual surveys of as many as 408 hospitals.
Overall, 19 percent of adults nationwide presented to the emergency department via ambulance between 1997 and 2008, which remained stable.
