Many thanks to Dr. Meißner for his critical comments. We share his view that quality of care and care times for acute myocardial infarction are determined by multiple factors, including some that go beyond correct primary diagnosis of STEMI by emergency physicians. Correct initial allocation of a case by the emergency services central office, with sufficient requesting of emergency physicians, certainly plays a major role in this. A high level of well-integrated collaboration is also required for the interface between prehospital care by emergency physicians and subsequent hospital treatment to function smoothly. This is why the First Medical Contact Study of the Berlin Myocardial Infarction Registry (BHIR, Berliner Herzinfarktregister) (1) was conducted jointly by hospital departments and the Berlin Fire Department as suppliers of emergency medical services and care by emergency physicians.
Exploratory analysis of outlier values in BHIR procedure data had once again shown the marked trigger function of ECG diagnosis of STEMI by emergency physicians for subsequent inpatient care. This had already been described elsewhere (2). The First Medical Contact Study was initiated to provide quantitative analysis of this trigger and to identify any potential for improvement. Its findings do indeed indicate that there is potential for optimization. However, this by no means attributes all errors to a single party as Dr. Meißner suspects; unfortunately, representation of an analysis of all issues, from initial diagnosis to catheter intervention, goes beyond the scope of an article in Deutsches Ärzteblatt. Like Dr. Meißner, we believe that structured prehospital care with quality ensured by, for example, telemedical transfer is particularly important, also regarding the introduction of emergency paramedics. Detailed planning is currently underway for another, multimodal, collaborative regional project to improve various aspects of prehospital care for myocardial infarction.
PD Dr. med. Martin Stockburger
Medizinische Klinik I, Nauen
Conflict of interest statement
The authors of all contributions declare that no conflict of interest exists.
|1.||Stockburger M, Maier B, Fröhlich G, et al.: The emergency medical care of patients with acute myocardial infarction—results from the First Medical Contact Study in the context of the Berlin Myocardial Infarction Registry. Dtsch Arztebl Int 2016; 113: 497–502 VOLLTEXT|
|2.||Brown JP, Mahmud E, Dunford JV, Ben-Yehuda O: Effect of prehospital 12-lead electrocardiogram on activation of the cardiac catheterization laboratory and door-to-balloon time in ST-segment elevation acute myocardial infarction. Am J Cardiol 2008;101: 158–61 CrossRef MEDLINE|