T-MACS is an excellent decision aid tool. However, my primary concern is whether, when a patient presents with acute chest pain, we might overlook other life-threatening emergencies that can also manifest as chest pain if we are are leaving them in the community without ED transfer. When they arrive in ED, patients do also get work up such as CXR.
It’s a very valid concern. Most patients with suspected ACS could safely stay at home if we were able to rule out ACS and other serious diagnoses. But you’re absolutely right that it’s not just about ruling out ACS. So the question is whether paramedics can identify the right patient group to use T-MACS in - patients who have suspected ACS but no concerns about other serious pathology. Our data from the PRESTO study suggest that they can. The ARTICA trial and the FAMOUS-TRIAGE study, which were both interventional, seem to agree - there was no suggestion of any increase in safety events when patients were left at the scene. Actually leaving patients at the scene will be the last part of this project, and we may well need an RCT before it could be considered for wide roll out. Also, there’s a lot of work to do to build shared decision making aids and care pathways that would allow patients to be sufficiently supported and cared for out of hospital but without overburdening primary care. So there’s clear potential to improve both patient care and efficiency here - but there’s still a lot of work to do!
T-MACS is an excellent decision aid tool. However, my primary concern is whether, when a patient presents with acute chest pain, we might overlook other life-threatening emergencies that can also manifest as chest pain if we are are leaving them in the community without ED transfer. When they arrive in ED, patients do also get work up such as CXR.
It’s a very valid concern. Most patients with suspected ACS could safely stay at home if we were able to rule out ACS and other serious diagnoses. But you’re absolutely right that it’s not just about ruling out ACS. So the question is whether paramedics can identify the right patient group to use T-MACS in - patients who have suspected ACS but no concerns about other serious pathology.
Our data from the PRESTO study suggest that they can. The ARTICA trial and the FAMOUS-TRIAGE study, which were both interventional, seem to agree - there was no suggestion of any increase in safety events when patients were left at the scene.
Actually leaving patients at the scene will be the last part of this project, and we may well need an RCT before it could be considered for wide roll out. Also, there’s a lot of work to do to build shared decision making aids and care pathways that would allow patients to be sufficiently supported and cared for out of hospital but without overburdening primary care.
So there’s clear potential to improve both patient care and efficiency here - but there’s still a lot of work to do!
@@RichardBody Thank you Dr Body. I will read those articles to learn more about this topic.