Early use of dual anti-platelet therapy (DAPT) in ST elevation myocardial infarction (STEMI) can reduce stent thrombosis and further save the patients. However, it is still difficult to set up ambulance paramedics DAPT system for patients after STEMI. Therefore, the aim of this study is to investigate improving use of DAPT in ambulance for STEMI patients in a city-based program.

A multidisciplinary team among 15 hospitals, fire bureau and department of health, Kaohsiung city government was organized since 2016. The key interventions include Asian first innovative city-based pre-hospital ambulance paramedic STEMI dual anti-platelet medication on-line instruction system, direct chewing DAPT at ambulance, training program for ambulance paramedics, 24 hours STEMI interpretation and on-line intrusction team. The consecutive STEMI diagnosed by ambulance electrocardiogram system were enrolled from Jan. 2011 to Dec. 2018 in Kaohsiung city. The patients were divided into three group: pre-interventional group from 2011-2015, Interventional group from Jan to Dec 2016 and post-interventional group from 2016 to 2018.

The percentage of ambulance DAPT use in adequate STEMI patients increased from 0% in pre-interventional group, to 2.8% in interventional group and to 57.8% in post-interventional group (p<0.001). In these STEMI patients received DAPT at ambulance, there was not any bleeding complications. Furthermore, the mortality was 0% in these patients.

This study showed, from 2011 to 2018, innovative city-based pre-hospital ambulance paramedic STEMI dual anti-platelet medication on-line instruction system can improve percentage of ambulance DAPT use and also outcomes in STEMI patients.