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Too long on scene
‘Door to treatment’ times have acted as an important quality control measure to assess treatments of patients with ST elevation myocardial infarctions (STEMI). Most emergency department strategies to improve STEMI treatment aim to reduce this time. A study from the United States examines the effect of prehospital time on treatment and complications of patients with STEMI. Patients were divided into two groups according to whether the prehospital time was less than or more than 30 min. Patients with increased prehospital times had increased mortality, more cardiac arrests and increased transfer to tertiary centre rates. The longest component of the prehospital time was the on scene time. Although the power of this study was low, it does provide some interesting insights (Am J Emerg Med 2011;29:396–400).
Diagnosing coronary artery disease
The ideal way to exclude coronary artery disease in patients presenting with chest pain remains to be found. In Academic Emergency Medicine (2011;18:458–67), the addition of CT coronary angiography to ‘standardised care’ was investigated as a way of trying to reduce use of resources …