Study confirms increased heart attack deaths in NYC ambulance ...(ere associated with a 14.1 to 15.7% incr...),Health

In effect, an additional "borough-day" of gridlock was associated with a 39.0 to 68.4% increase in AMI outpatient deaths. As a result, there were between 201 and 390 additional AMI deaths during the study period associated with ambulance diversions.

Although health care observers have long assumed that ambulance diversion was associated with serious medical consequences for patients with serious illness or injury, Prof. Green and her colleagues are the first to document a connection between ambulance diversion and an increased number of deaths. The authors chose to focus on heart attack deaths because of the critical nature of providing rapid care during the "Golden Hour" and the availability of data. They used operations research and statistical techniques to reach their conclusions.

The authors examined data about all 9,743 adult patients who died of myocardial infarctions in New York during the study period of January 2, 1999, to December 31, 2000. Diversion status data from 58 New York hospitals was obtained from the New York City Fire Department.

These findings differ from previously published results, which showed no increase in transport-related deaths over a concomitant period of increasing ambulance diversion. Unlike previous studies, the authors' primary outcome measure was deaths from myocardial infarction, a smaller and more sensitive subset of patients. The analysis included all deaths within a day occurring either in the emergency department or outside a hospital setting, rather than solely those that occurred during transport. This inclusion may capture deaths that occurred after the time of transport but which were nonetheless associated with the degree of emergency department crowding.

The findings suggest that ambulance diversion may have serious consequences for other emergency patients, as well.

Prof. Green delivered the paper last month at the INFO
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