{
  "abstract": "Background The favoured treatment for patients experiencing a ST-segment elevation myocardial infarction (STEMI) is reperfusion via Primary Percutaneous Coronary Intervention (PCI). This method comes with target times of <90 minutes (hospital door-to-balloon) and <150 minutes (call-to-balloon). However, there is a paucity of literature regarding pre-hospital call-to-door time (CTD). This abstract presents the qualitative phase 2 of a mixed-methods study exploring ambulance staff perceptions of the factors that influence CDT.Methods Semi-structured, online interviews were conducted with Northern Ireland Ambulance Service (NIAS) staff, with participants selected using purposive sampling. Audio recordings were transcribed verbatim and thematically analysed.Results A total of 13 NIAS staff participated. Interviews lasted 15-30 minutes. Five main themes were constructed: Systemic and operational delays - ‘Hospital turnaround times are a big issue. Emergency Departments are overwhelmed, so crews can’t offload patients quickly, impacting response times’. Human factors and decision making - ‘We’ll do a 12-lead ECG to confirm STEMI. Experienced paramedics do this quickly. Less experienced ones might focus on other things, adding time’. The role of the Integrated Clinical Hub (ICH) - ‘If a call is not flagged early on, it might sit in the queue as a Category 2. The ICH can comfortably upgrade the call to Category 1 and dispatch resources faster’. Technology and communication factors - ‘The dispatch model we use is outdated. It doesn’t effectively extract critical details for chest pain calls’. Transfer time delays - ‘It’s mainly geography and infrastructure…urban areas are closer to hospital, have better roads and ambulance resources, so transfers are faster compared to rural’.Conclusions CTD delay is multifactorial and stems from system-wide inefficiencies. This study positions CTD as a distinct and modifiable metric in STEMI care that has the potential to influence service evaluation and resource planning across similar Emergency Medical Services systems.",
  "authors": [
    {
      "affiliations": [
        "Northern Ireland Ambulance Service Health and Social Care Trust, Belfast, UK"
      ],
      "name": "Barry Costello"
    },
    {
      "affiliations": [
        "Northern Ireland Ambulance Service Health and Social Care Trust, Belfast, UK"
      ],
      "name": "Julia Wolfe"
    },
    {
      "affiliations": [
        "Northern Ireland Ambulance Service Health and Social Care Trust, Belfast, UK"
      ],
      "name": "Karen Dunlop"
    },
    {
      "affiliations": [
        "Northern Ireland Ambulance Service Health and Social Care Trust, Belfast, UK"
      ],
      "name": "Neil Sinclair"
    }
  ],
  "title": "PP21 Ambulance staff perceptions of factors influencing 999 call-to-door time in ST segment elevation myocardial infarction patients transported for primary percutaneous coronary intervention: the qualitative phase of a mixed methods study",
  "uid": "57f930ba-18c7-5193-a92c-3f19bc7d8f10"
}