Rural emergency care and retrieval coordination — KFP-style written assessment

KFP 1 (10 marks)

A 62-year-old man presents to your rural hospital (2 hours by road from the nearest PCI centre) with 90 minutes of chest pain. ECG: anterior STEMI. He is hypertensive but stable. Your hospital can thrombolyse. ^{[29] [24]}

1. Quantify the delay problem his geography creates, with the documented numbers. (3) ^[29]
2. What did the Western NSW centralised management system with hot transfer achieve in long transfer zones, and what did it not change? (4) ^[24]
3. State the two coordination actions that most reduce the risk of his transfer failing operationally. (3) ^[18]

Model answers

1. Rural residence is an independent predictor of PCI delay (aOR 4.75, 95% CI 2.95-7.65). Rural patients had door-to-balloon of 105.5 ± 15.8 vs 84.1 ± 11.9 minutes urban, and symptom-to-door 295 ± 80 vs 145 ± 50 minutes; delays over 90 minutes occurred in 82.5% of rural versus 27.9% of urban patients. His 2-hour road transfer sits inside that risk envelope. ^[29]
2. In the long transfer zone, first-contact-to-reperfusion improved from 48 to 40 minutes, first-contact-to-PCI-centre from 344 to 296 minutes, and 24-hour angiography rose from 58% to 77% (all significant), with no significant difference in major adverse clinical events. The system compressed process intervals; the hard mortality endpoint did not move. ^[24]
3. First, match the referral urgency to transport priority and then verify it — 42.6% of high-urgency vCare referrals did not receive high-priority transport. Second, obtain receiving-hospital acceptance with a named clinician before the patient leaves, and send a written handover including what was deliberately not done. ^{[18] [16]}