{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T06:02:55Z","timestamp":1781848975463,"version":"3.54.5"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2020,9,3]],"date-time":"2020-09-03T00:00:00Z","timestamp":1599091200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2020,9,3]],"date-time":"2020-09-03T00:00:00Z","timestamp":1599091200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"National Health and Medical Research Council (NHMRC) Early Career Fellowship","award":["#1146809"],"award-info":[{"award-number":["#1146809"]}]},{"name":"National Heart Foundation Fellowship and Viertel Foundation award"},{"name":"National Heart Foundation Fellowship"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,4,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The purpose of this study was to identify factors associated with time delay to emergency medical services for patients with suspected ST-elevation myocardial infarction.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This observational study involved 1994 suspected ST-elevation myocardial infarction patients presenting to the emergency medical services in Melbourne, Australia, between October 2011\u2013January 2014. Factors associated with delays to emergency medical services call of &amp;gt;1 h and emergency medical services self-referral were analyzed using multivariable logistic regression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The time of symptom onset was reported for 1819 patients (91.2%), the median symptom onset-to-call time was 52 min (interquartile range\u2009=\u200917\u2013176). Of all emergency medical services calls, 17% were referred by healthcare professionals. Compared to self-referred patients, patients who presented to a general practitioner or hospital had higher odds of delay &amp;gt;1 h to emergency medical services activation (adjusted odds ratio 7.76; 95% confidence interval 5.10\u201311.83; and 8.02; 3.65\u201317.64, respectively). The other factors associated with emergency medical services call delays of &amp;gt;1 h were living alone, non-English speaking background, a history of substance abuse, less severe symptoms, symptom onset at home and at rest, and self-treatment. Emergency medical services self-referred patients were more likely to be older than 75 years, have a history of ischemic heart disease or revascularization, more severe symptoms, and symptom onset at home, with activity, during the weekends and out-of-hours.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Almost one-fifth of emergency medical services calls for suspected ST-elevation myocardial infarction were healthcare referrals, and this was associated with increased delays. A wide range of factors could influence a patient\u2019s decision to directly and rapidly seek emergency medical services. More efforts are needed to educate at-risk populations about early self-referral to the emergency medical services.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1177\/1474515120953737","type":"journal-article","created":{"date-parts":[[2020,9,4]],"date-time":"2020-09-04T06:10:26Z","timestamp":1599199826000},"page":"243-251","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Factors influencing patient decision delay in activation of emergency medical services for suspected ST-elevation myocardial infarction"],"prefix":"10.1093","volume":"20","author":[{"given":"Ahmad","family":"Alrawashdeh","sequence":"first","affiliation":[{"name":"Department of Paramedicine, Monash University, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziad","family":"Nehme","sequence":"additional","affiliation":[{"name":"Department of Paramedicine, Monash University, Australia"},{"name":"Department of Epidemiology and Preventive Medicine, Monash University, Australia"},{"name":"Ambulance Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Paramedicine, Monash University, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Paramedicine, Monash University, Australia"},{"name":"Department of Epidemiology and Preventive Medicine, Monash University, Australia"},{"name":"Ambulance Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Stephenson","sequence":"additional","affiliation":[{"name":"Department of Paramedicine, Monash University, Australia"},{"name":"Department of Epidemiology and Preventive Medicine, Monash University, Australia"},{"name":"Ambulance Victoria, 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