Treatment of acute coronary syndrome by ground and helicopter ambulance services in Poland: a five-year retrospective study.

BACKGROUND

Acute coronary syndrome (ACS) is a serious health problem, sometimes directly threatening a patient's life. According to current medical knowledge, appropriate management should be implemented as early as in the prehospital settings. The authors conducted an analysis aimed at comparing EMS (with physician) and HEMS interventions over a five-year period in patients with suspected or diagnosed acute coronary syndrome. The objective of the study was to outline the profile of a patient with ACS who requires assistance in pre-hospital conditions.

METHODS

87,716 interventions by ground teams (EMS-emergency medical service) and 3,045 by air teams (HEMS-helicopter emergency medical service) were included in the study. The analysis covered the period from 2018 to 2022, including nationwide data made available from information technology systems. The material was selected from an extensive collection using the International Classification of Disease Diagnoses, ICD-10: I21 (I21.0, I21.1, I21.2, I21.3, I21.4, and I21.9). Statistical design was used, allowing for correlations of variables, at a significance level of p < 0.05.

RESULTS

The majority of the subjects were women (65.2%), and the mean age was 65.94 years (SD ± 12.30; Min: 13 years old; Max: 126 years old). In both ground team patients (95.7%) and helicopter team patients (98.2%), the predominant mechanism of OHCA was non-defibrillatory rhythm (PEA/asystole). In airborne teams, external electrical stimulation, bladder catheterization and gastric tube placement were implemented significantly more often than in ground teams (p < 0.001). An evaluation of pharmacotherapy with opioid agents showed relatively frequent administration of morphine (EMS: 33.2%; HEMS: 20.1%), and occasional administration of fentanyl (EMS: 4.7%; HEMS: 6.1%). Both types of teams occasionally (EMS: 16.4%; HEMS: 1.9%) administered Clopidogrel, with Ticagrelor being more frequent (EMS: 21.2%; HEMS: 6.5%).

CONCLUSIONS

There are significant differences in the behavior of EMS and HEMS physicians. Future studies are worth considering to understand the correlation between the performance of these procedures by EMS physicians before hospitalization.