Innovations in prehospital emergency cardiac care: alleviating the strain on overcrowded hospitals

Koning, E.R. de

This thesis addresses the growing pressure on healthcare caused by population aging, increasing care demand, and workforce shortages, and explores innovative strategies to reduce overcrowding through improved prehospital cardiac triage. Central to this work is the development and evaluation of a novel digital prehospital triage approach (HART-c), integrating paramedic data, hospital information, real-time regional capacity, and remote cardiologist consultation.

The HART-c study demonstrated that significantly more patients could safely remain at home after EMS evaluation, with fewer interhospital transfers and high satisfaction among patients and clinicians, while maintaining safety outcomes. These findings indicate more efficient use of healthcare resources and meaningful relief of hospital overcrowding.

The thesis further highlights the importance of regional coordination during crises, illustrated by COVID-19 capacity management, and shows that reluctance to seek...Show moreThis thesis addresses the growing pressure on healthcare caused by population aging, increasing care demand, and workforce shortages, and explores innovative strategies to reduce overcrowding through improved prehospital cardiac triage. Central to this work is the development and evaluation of a novel digital prehospital triage approach (HART-c), integrating paramedic data, hospital information, real-time regional capacity, and remote cardiologist consultation.

The HART-c study demonstrated that significantly more patients could safely remain at home after EMS evaluation, with fewer interhospital transfers and high satisfaction among patients and clinicians, while maintaining safety outcomes. These findings indicate more efficient use of healthcare resources and meaningful relief of hospital overcrowding.

The thesis further highlights the importance of regional coordination during crises, illustrated by COVID-19 capacity management, and shows that reluctance to seek care during lockdowns may cause indirect health harm.

Finally, a proof-of-concept AI model based on textual prehospital data showed that artificial intelligence can safely enhance decision-making by improving risk stratification without sacrificing sensitivity.

Future perspectives include integrating point-of-care high-sensitivity troponin testing, nationwide implementation of digital triage hubs, robust data stewardship, and validated AI support to enable faster, safer, and more patient-centered prehospital cardiac care.
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Innovations in prehospital emergency cardiac care: alleviating the strain on overcrowded hospitals

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