Table 1.
Protocolized actions contained in the acute heart failure management protocol and in the other three additional pre‐hospital protocols surveyed
| AHF | Dyspnoea | Chest pain | STEMI | |
|---|---|---|---|---|
| N = 84 | N = 79 | N = 84 | N = 99 | |
|
Diagnostic actions Total % (% permission request needed/% permanent standing order) | ||||
| Take a 12‐lead ECG | 92.1 (20.5/71.6) *** | 84.5 (20.2/64.3) | 98.8 (21.8/77.0) | 99.0 (19.0/80.0) |
| Run a POC‐testing for troponin | 6.0 (2.4/3.6) | 7.2 (3.6/3.6) | 8.2 (3.5/4.7) | 8.2 (1.0/7.2) |
| Run a POC‐testing for BNP/NT‐proBNP | 3.5 (3.5/0.0) | 3.6 (3.6/0.0) | 3.5 (3.5/0.0) | 2.1 (0.0/2.1) |
| Do ultrasound | 16.0 (5.7/10.3) | 15.5 (6.0/9.5) | 14.9 (5.7/9.2) | 15.0 (4.0/11.0) |
|
Therapeutic actions Total % (% permission request needed/% permanent standing order) | ||||
| Insert an IV line | 94.3 (21.6/72.7) | 90.4 (21.4/69.0) | 95.4 (21.8/73.6) | 98.0 (20.2/77.8) |
| Provide supplementary oxygen | 93.2 (21.6/71.6) | 92.8 (23.8/69.0) | 86.2 (17.2/69.0) | 87.0 (24.0/63.0) |
| Provide IV diuretics | 69.0(29.9/39.1)* , ** , *** | 49.4 (24.1/25.3) | 32.6 (14.0/18.6) | 36.4 (17.2/19.2) |
| Provide morphine or another opiate | 68.6 (22.1/46.5)*** | 54.9 (19.5/35.4) | 80.0 (25.9/54.1) | 89.8 (29.6/60.2) |
| Provide IV nitroglycerine | 57.0 (31.4/25.6)* | 31.4 (16.9/14.5) | 50.6 (18.8/31.8) | 60.2 (24.5/35.7) |
| Provide non‐invasive ventilation | 80.7(25.0/55.7)** , *** | 82.2 (28.6/53.6) | 45.4 (16.3/29.1) | 50.5 (22.8/27.7) |
| Perform intubation | 71.5 (29.5/42.0) | 77.3 (33.3/44.0) | 64.3 (24.1/40.2) | 65.0 (27.0/38.0) |
AHF, acute heart failure; BNP, brain natriuretic peptide; ECG, electrocardiogram; IV, intravenous; NT‐proBNP, N terminal pro brain natriuretic peptide; POC, point of care; STEMI, ST‐elevation myocardial infarction.
*
P < 0.05 in comparison with the dyspnea protocol.
**
P < 0.05 in comparison with the chest pain protocol.
***
P < 0.05 in comparison with the STEMI protocol.