Objectives: In this three-part quantitative, observational study, I sought to (1) assess physicians’ perceptions of and recommendations for utilizations and improvement of EMS, (2) assess patients’ awareness of EMS, mode of transport use in decision to seek care and reasons for their decision, and (3) establish if in the current study setting, mode of transport used, has implications for in hospital adverse events, as well as short and long term clinical outcomes. The goal was to present recommendations for further developing EMS in Abu Dhabi, increasing public awareness to signs and symptoms of acute coronary syndromes and the importance of EMS use in decision to seek care, ultimately leading to better clinical outcomes. 

Methods: At four government-operated hospitals in Abu Dhabi, I administered surveys to 106 physicians involved in acute coronary syndromes care to measure (a) likelihood of recommending EMS, (b) satisfaction with EMS, (c) likelihood of using EMS for self or family, and (d) recommendations for prehospital care of acute coronary syndromes. I also gathered medical records from 587 consecutive STEMI patients over an 18-month period and conducted semi structured follow-up interviews with patients at 30, 180, and 365 post discharge. Variables included treatment times, outcomes, and readmission events. 

Results: Physician participants were most supportive of prehospital 12-lead ECG for STEMI, but indicated low satisfaction with existing EMS services in Abu Dhabi. EMS was underutilized among patients with STEMI in Abu Dhabi; over half (55%) of patients surveyed did not know the phone number to contact EMS, and only 14.7% used EMS in their decision to seek care even with results showing the benefits of doing so. EMS-transported patients receiving more timely treatment (door-to-diagnostic ECG time, doorto-balloon time) and lower mortality in the EMS group. 

Conclusions: These findings suggest a need to raise public awareness of EMS and its importance for coronary symptoms. Broader application of prehospital ECG, including prehospital activation of cardiac catheterization labs, bypassing non-interventional cardiology centers, and admission directly to facilities that provide these services without initial admission to the emergency department, could help improve physicians’ perceptions of EMS and outcomes for ST elevation myocardial infarction patients.

Callachan, EL., Alsheikh-Ali, AA., Bruijns, S., Chandrasekhar-Nair, S & Wallis, LA. Utilization and perceptions of emergency medical services by patients with ST-segment elevation myocardial infarction in Abu Dhabi: a multicenter study Heart Views: Journal of the Gulf Heart Association. 2016; 17:49-54, https://www.ncbi.nlm.nih.gov/pubmed/27512532 

Callachan, EL., Alsheikh-Ali, AA., Bruijns, S., Chandrasekhar-Nair, S., & Wallis, LA. Outcomes by Mode of Transport of ST Elevation MI Patients in the United Arab Emirates. Western Journal of Emergency Medicine 2017;18(3):349-355 

Callachan, EL., Alsheikh-Ali, AA. & Wallis, LA. 

Analysis of risk factors, presentation and in hospital events of young patients presenting with STEMI. Journal of the Saudi Heart Association. 2017;29(4):270-275