Prehospital Care and its Association with Patient Outcomes in Emergency Department of Cardiac Hospital, Kathmandu

Abstract

Emergency medical care is a critical component of healthcare systems, especially in resource limited settings like Nepal. This study aimed to evaluate the mode of arrival and its impact on short term outcomes of cardiac patients presenting to Cardiac center ED. The study was conducted as a prospective observational study among 200 patients with cardiac illness in the emergency department of Manmohan Cardiothoracic Vascular and Transplant center (MCVTC) from July 17 to September 16, 2025, by means of a standardized questionnaire. Analysis was done using descriptive and inferential statistics. The most common clinical presentation were chest pain/SOB (54 %), referred from another healthcare facility through ambulance were 7% (n =14), Only 18 patients used ambulance services, which were with 7 trained EMT, Duration from the call to ambulance arrival were within 10-30 minutes 7.0%, ACLS equipped ambulances 7.5%, about 6.5% patients initially managed during transportation, 11 patients required Emergency resuscitation. Admission for critical areas 23.5%. About 35% patients managed with Inotropes, need for surgery 4.5%, 10 patients needed Mechanical Ventilation and Mortality in ED within 24 hours was 2.5%. There were statistically significant association between Ambulances equipped with Advanced Life Support and Need for Surgery (p=0.021), and between Intervention during transportation and need for inotropic support (p=0.048). The EMS services were underutilized. The majority of the ambulances lacked the necessary personnel and equipment to perform prehospital intervention. It suggests pre-hospital care needs to be improved through strengthening ambulance services and improving public awareness of the importance of early emergency medical services. Keywords: Ambulance utilization, Cardiac illness, Care outcomes, Emergency department, Emergency medical services, Prehospital care