{"pk":8282,"title":"National Trends in the Utilization of Emergency Medical Services for Acute Myocardial Infarction and Stroke","subtitle":null,"abstract":"Introduction: \nThe emergency medical services (EMS) system plays a crucial role in the chain of survival for acute myocardial infarction (AMI) and stroke. While regional studies have shown underutilization of the 911 system for these time-sensitive conditions, national trends have not been studied. Our objective was to describe the national prevalence of EMS use for AMI and stroke, examine trends over a six-year period, and identify patient factors that may contribute to utilization.\nMethods:\n Using the National Hospital Ambulatory Medical Care Survey-ED (NHAMCS) dataset from 2003-2009, we looked at patients with a discharge diagnosis of AMI or stroke who arrived to the emergency department (ED) by ambulance. We used a survey-weighted χ2 test for trend and logistic regression analysis.\nResults:\n In the study, there were 442 actual AMI patients and 220 (49.8%) presented via EMS. There were 1,324 actual stroke patients and 666 (50.3%) presented via EMS. There was no significant change in EMS usage for AMI or stroke over the six-year period. Factors independently associated with EMS use for AMI and stroke included age (OR 1.21; 95% CI 1.12-1.31), Non-Hispanic black race (OR 1.72; 95% CI 1.16-2.29), and nursing home residence (OR 11.50; 95% CI 6.19-21.36).\nConclusion:\n In a nationally representative sample of ED visits from 20003-2009, there were no trends of increasing EMS use for AMI and stroke. Efforts to improve access to care could focus on patient groups that underutilize the EMS system for such conditions. [West J Emerg Med. 2014;15(7):–0.]","language":"en","license":{"name":"Creative Commons Attribution-NonCommercial  4.0","short_name":"CC BY-NC 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc/4.0"},"keywords":[{"word":"Acute myocardial infarction, stroke, emergency medical services, utilization"}],"section":"Prehospital Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5qj001zd","frozenauthors":[{"first_name":"Katie","middle_name":"","last_name":"Tataris","name_suffix":"","institution":"University of California at San Francisco, Department of Emergency Medicine, San Francisco, California","department":"None"},{"first_name":"Sean","middle_name":"","last_name":"Kivlehan","name_suffix":"","institution":"University of California at San Francisco, Department of Emergency Medicine, San Francisco, California","department":"None"},{"first_name":"Prasanthi","middle_name":"","last_name":"Govindarajan","name_suffix":"","institution":"University of California at San Francisco, Department of Emergency Medicine, San Francisco, California","department":"None"}],"date_submitted":"2014-06-12T18:27:49Z","date_accepted":"2014-06-12T18:27:49Z","date_published":"2014-10-28T19:46:10Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8282/galley/4742/download/"}]}