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Original Articles

Elapsed Time in Emergency Medical Services for Patients With Cardiac Complaints

Are Some Patients at Greater Risk for Delay?

Thomas W. Concannon, PhD; John L. Griffith, PhD; David M. Kent, MD, MS; Sharon-Lise Normand, PhD; Joseph P. Newhouse, PhD; James Atkins, MD; Joni R. Beshansky, RN, MPH and Harry P. Selker, MD, MSPH

From the Institute for Clinical Research and Health Policy Studies (T.W.C., J.L.G., D.M.K., J.R.B., H.P.S.), Tufts Medical Center and Tufts University School of Medicine, Boston, Mass; Department of Health Care Policy (S.-L.N., J.P.N.), Harvard Medical School, Boston, Mass; Harvard School of Public Health (S-L.N., J.P.N.), Boston, Mass; Kennedy School of Government (J.P.N.), Harvard University, Cambridge, Mass; Faculty of Arts and Sciences (J.P.N.), Harvard University, Cambridge, Mass; and University of Texas Southwestern Medical School (J.A.), Dallas, Tex.

Correspondence to Thomas W. Concannon, PhD, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington Street #063, Boston, MA 02111. E-mail tconcannon{at}tuftsmedicalcenter.org

Received August 12, 2008; accepted November 14, 2008.

Background— In patients with a major cardiac event, the first priority is to minimize time to treatment. For many patients, first contact with the health system is through emergency medical services (EMS). We set out to identify patient-level and neighborhood-level factors that were associated with elapsed time in EMS.

Methods and Results— A retrospective cohort study was conducted in 10 municipalities in Dallas County, Tex, from January 1 through December 31, 2004. The data set included 5887 patients with suspected cardiac-related symptoms. The region was served by 29 hospitals and 98 EMS depots. Multivariate models included measures of distance traveled, time of day, day of week, and patient and neighborhood characteristics. The main outcomes were elapsed time in EMS (continuous; in minutes) and delay in EMS (dichotomous; >15 minutes beyond median elapsed time). We found positive associations between patient characteristics and both average elapsed time and delay in EMS care. Variation in average elapsed time was not large enough to be clinically meaningful. However, approximately 11% (n=647) of patients were delayed 15 minutes. Women were more likely to be delayed (adjusted odds ratio, 1.52; 95% confidence interval, 1.32 to 1.74), and this association did not change after adjusting for other characteristics, including neighborhood socioeconomic composition.

Conclusions— Compared with otherwise similar men, women have 50% greater odds of being delayed in the EMS setting. The determinants of delay should be a special focus of EMS studies in which time to treatment is a priority.

Key Words: heart diseases • population • patients • women

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CLINICAL PERSPECTIVE

Guest editor for this article was Eric D. Peterson, MD.

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