{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T02:54:47Z","timestamp":1791341687312,"version":"4.3.1"},"reference-count":58,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,8,4]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Timely recognition and response to acute coronary syndrome (ACS) by emergency medical services is critical to reducing delays and improving outcomes. This study examines whether emergency medical services identification, care, and times (the interval from emergency medical services call to hospital arrival) differ by culturally and linguistically diverse (CALD) background among patients with ACS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We conducted a retrospective cohort study using ambulance data linked with the Department of Health's hospital data sets (January 2015\u2013June 2019). The CALD group comprised individuals born in non\u2013English\u2010speaking countries or who preferred to speak a language other than English (LOTE). Based on preferred language, the CALD group was stratified as CALD\u2010LOTE versus CALD\u2010English.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Of the 28\u2009557 ACS cases, 30.2% were CALD immigrants: 9.5% CALD\u2010LOTE and 20.7% CALD\u2010English. Chest pain was the most common chief complaint (69.1%) but was lowest among CALD\u2010LOTE patients (59.4%) (CALD\u2010English=68.6%, Australian born=70.8%). Time\u2010critical ambulance dispatch (lights and sirens) was not statistically different across groups, but paramedic ACS identification was lower in CALD\u2010LOTE than in Australian\u2010born patients (57.2% versus 69.0%; adjusted odds ratio=0.84 [95% CI, 0.76\u20130.92]). CALD\u2010LOTE and CALD\u2010English patients had higher rates of direct transfer to percutaneous coronary intervention\u2013capable hospitals compared with Australian\u2010born patients with ACS. Emergency medical services times were not statistically different in metropolitan areas but were marginally longer in rural areas among CALD patients than among non\u2010CALD patients (67.5 versus 63.7 minutes;\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.02).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Despite lower ACS identification by paramedics, CALD\u2010LOTE patients were more often transported to percutaneous coronary intervention\u2013capable hospitals. Given the implications of missed early identification of ACS for outcomes, further research is needed to understand this variation and to inform tailored strategies for improvement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.048335","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T11:17:44Z","timestamp":1785496664000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Emergency Medical Service Identification and Prehospital Care of Acute Coronary Syndrome Among Culturally and Linguistically Diverse Immigrants: Statewide Linkage Study"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1646-3571","authenticated-orcid":false,"given":"Ararso Baru","family":"Olani","sequence":"first","affiliation":[{"name":"Monash University","place":["Melbourne, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart","family":"Howell","sequence":"additional","affiliation":[{"name":"Monash University","place":["Melbourne, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8442-4617","authenticated-orcid":false,"given":"Kathryn","family":"Eastwood","sequence":"additional","affiliation":[{"name":"Monash University","place":["Melbourne, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2432-1645","authenticated-orcid":false,"given":"Ziad","family":"Nehme","sequence":"additional","affiliation":[{"name":"Monash University","place":["Melbourne, Australia"]},{"name":"Ambulance Victoria","place":["Blackburn North, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5254-354X","authenticated-orcid":false,"given":"Emily","family":"Mahony","sequence":"additional","affiliation":[{"name":"Ambulance Victoria","place":["Blackburn North, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1579-9279","authenticated-orcid":false,"given":"Emily","family":"Nehme","sequence":"additional","affiliation":[{"name":"Monash University","place":["Melbourne, Australia"]},{"name":"Ambulance Victoria","place":["Blackburn North, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8686-2709","authenticated-orcid":false,"given":"Dion","family":"Stub","sequence":"additional","affiliation":[{"name":"Monash University","place":["Melbourne, Australia"]},{"name":"The Alfred Hospital","place":["Melbourne, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1559-5882","authenticated-orcid":false,"given":"Janet E.","family":"Bray","sequence":"additional","affiliation":[{"name":"Monash University","place":["Melbourne, Australia"]},{"name":"Curtin University","place":["Perth, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","volume-title":"Culturally and linguistically diverse Australians Overview","author":"Australian Institute of Health and Welfare","year":"2023","unstructured":"Australian Institute of Health and Welfare . 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