Acute myocardial infarction in the prehospital setting.

Despite research and public education, myocardial disease, infarction, and death from cardiac arrest continue to be one of the top public health issues. Many patients experiencing AMIs access health care and receive initial treatment from EMS personnel in the prehospital setting. Prompt identification and diagnosis of these patients, relief of chest pain, and shortening delays to definitive care can decrease morbidity and mortality. Prehospital diagnosis of AMI is enhanced with the use of 12-lead electrocardiograms, which can shorten time to thrombolysis or angiography. Prehospital use of thrombolytic agents has not gained widespread use in this country; it is, however, commonplace in Europe, where research suggests improved outcomes when thrombolysis is initiated prior to hospital arrival. Resuscitation of out-of-hospital cardiac arrest patients is difficult, resulting in dismal survival rates. Factors that appear to be associated with enhanced survival are witnessed arrest, bystander CPR, and short response times to defibrillation.