Residents in rural communities have higher incident of cardiac death and risk factors associated with cardiac disease. Living in a rural region can add precious time that amplifies cardiac death during a ST-elevated myocardial infarction (STEMI) episode. The consensus is that improved efficiencies can increase myocardial salvage and decrease STEMI mortality rates. This article identifies issues that may impact pre-hospital STEMI triage of patients in a rural region of the United States (U.S.). A qualitative research design was chosen to gain insight into emergency personnel perceptions of pre-hospital STEMI triage. The participants (n=18) were obtained from a convenience sample in rural Northeast Texas, U.S. Data were gathered by individual and group semi-structured interviews. Themes were identified, synthesized, and oriented to offer a basis for understanding opportunities to improve the delivery of rural STEMI care. This study demonstrated that quality improvement initiatives aimed at achieving pre-hospital STEMI triage efficiencies have dependencies on teamwork, technology, and training in the context of three stages a) pre-transport, b) door-to-door, and c) post-transport. A pre-hospital STEMI triage model is considered. By incorporating this model, emergency medical coordinators in rural communities have a better opportunity to facilitate timely reperfusion therapy for this high risk populous.


This article, originally published in Health Services Insights by SAGE, is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission.



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Carpenter, R., McWhorter, R., Donaldson, S., Silberman, D., & Maffei, S. (2021). Working Against the Clock: A Model for Rural STEMI Triage. Health Services Insights. https://doi.org/10.1177/11786329211037521