The newest suggestion that EMS be able to obtain an electrocardiogram and bypass the emergency department to go directly to the catheterization laboratory to reduce door-to-balloon times in ST-elevation MI patients is a further advantage of EMS transport [11].
The use of undetectable high-sensitivity troponin levels and risk scores in combination with early biomarker testing have recently been put forward as diagnostic tools aiming to reduce door-to-discharge times in patients with suspected acute coronary syndromes.
On the LS 400, engineers reduced door panel gaps in half versus Toyota-brand vehicles, from 7 mm to 4 mm, with measurements made within 0.01 mm; on the LS 430, measurement margins were increased tenfold, to 0.001 mm.
Developing services around door recovery and remanufacturing seems promising in reducing doors environmental impacts.
As such, our findings suggest a benefit from reducing door-to-balloon time for all patients undergoing primary percutaneous coronary intervention, including those currently treated within 90 minutes of hospital admission.
4 Ward et al 5 identified periods during the sequence of events where time delays were unacceptable (mainly ECG to exit emergency room (ER) and sheath to balloon inflation) and they made changes in their local guidelines for STEMI that reduced door-to-balloon times from 136 to 82 min.
Telestroke programs reduce the door-to-treatment time and have also improved patient outcomes [6, 7].
Sierro et al., (2000) found paramedic initiated referral to be even more effective than hospital based strategies to reduce PCI door-to-balloon times [ 21].
There seems to be no other nationwide studies on trends in time from diagnosis to invasive treatment; however, in 2009 Bradley et al 19 reported a decrease in door-to-balloon time for patients with STEMI after enrolment in a national quality campaign with the aim to reduce the door-to-balloon time to less than 90 min for this group.
It should be noted that the transmitted ECG report from an ambulance is then integrated in PACS and HIS system, so that off-site cardiologist can rapidly perform pre-hospital diagnosis with sufficient references and reduce the "door-to-balloon" time, which means the time elapses starting from the patient's arrival in hospital and ending when a catheter crosses the blocked coronary artery.
Supply-exhaust flow rate differential reduced the door motion-induced air transfer significantly with both door types.
