{"paper_id":"4e7ce4fa-2a4e-477d-8216-83e346c3706f","body_text":"Factors associated with achieving the 10-minute scene-to-ECG transmission target in prehospital care: the role of EMS agency-level cumulative ECG transmissions | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors associated with achieving the 10-minute scene-to-ECG transmission target in prehospital care: the role of EMS agency-level cumulative ECG transmissions Hiroki Sato, Kunio Yufu, Tatsunori Nakashima, Hidefumi Akioka, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8033271/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Prehospital 12-lead electrocardiogram (ECG) improves outcomes in ST-segment elevation myocardial infarction, yet meeting the 10-minute target from first medical contact remains difficult. We evaluated determinants of faster prehospital ECG performance. Methods We analysed a prefecture-wide registry in Japan (September 2021 to August 2025) of patients with suspected acute coronary syndrome who had prehospital ECG transmission. Prehospital ECG performance was assessed using the scene-to-ECG interval, from emergency medical services (EMS) on-scene arrival to ECG transmission. The primary outcome was scene-to-ECG ≤ 10 minutes; the secondary outcome was interval length. Agency experience was measured by cumulative ECG transmissions. Mixed-effects logistic and linear models with agency random intercepts adjusted for age, sex, and time of arrival, and included calendar-period indicators and a period-by-experience interaction. Results Of 1,748 patients, 672 (38.4%) achieved ≤ 10 minutes; the median scene-to-ECG was 12 minutes (interquartile range 9 to 17). Greater cumulative transmissions were associated with higher odds of ≤ 10 minutes (adjusted odds ratio 1.07 per 100 cases, 95% confidence interval 1.02 to 1.14) and shorter intervals (β − 0.29 minutes per 100 cases, 95% confidence interval − 0.39 to − 0.19) but were not statistically significant after adding period and the interaction. Older age, female sex, and nighttime arrival were associated with longer intervals. Conclusions At the EMS agency level, higher cumulative ECG transmissions were associated with achieving the ≤ 10-minute scene-to-ECG target. This suggests that focused onboarding and continued EMS training may enhance prehospital ECG performance. Older age, female sex, and night-time arrival were associated with not achieving the target. acute coronary syndrome electrocardiogram emergency medical services prehospital care Figures Figure 1 Figure 2 Background Prehospital acquisition of a 12-lead electrocardiogram (ECG), often transmitted for remote interpretation, in patients with suspected acute coronary syndrome (ACS) enables early prenotification and activation of the cardiac catheterization laboratory. This process facilitates destination triage to percutaneous coronary intervention (PCI)–capable hospitals and direct transfer to the catheterization laboratory, thereby reducing door-to-device time and improving outcomes in patients with ST-segment elevation myocardial infarction (STEMI) [ 1 – 3 ]. Although door-to-device time, defined as the interval from hospital arrival to first device activation, has been a central focus of STEMI care systems, further improvement requires optimization of the prehospital phase [ 4 ]. During this phase, rapid on-scene ECG acquisition at the first medical contact (FMC) by emergency medical services (EMS) is a key modifiable factor that shortens the FMC-to-device interval [ 5 ]. Current guidelines recommend that EMS personnel acquire and interpret a 12-lead ECG within 10 minutes of FMC in patients with suspected ACS, aligning with the 10-minute benchmark after emergency department (ED) arrival [ 6 – 8 ]. In ED settings, numerous studies have evaluated the door-to-ECG interval (ED arrival to first ECG). Across diverse populations, female sex, older age, and atypical presenting symptoms are consistently associated with longer door-to-ECG intervals [ 9 – 12 ], whereas standardized triage protocols, ED staff training, and workflow optimization reduce these delays [ 13 – 16 ]. In contrast, relatively few investigations have assessed the prehospital FMC-to-ECG interval among patients with suspected ACS or STEMI [ 5 , 17 – 20 ]. Notably, prior studies indicate that more than half of patients did not receive an ECG within 10 minutes of FMC [ 5 , 17 , 18 , 20 ]. Longer FMC-to-ECG intervals have been linked to female sex [ 17 , 18 , 20 ], older age [ 17 ], and absence of chest pain as the primary complaint [ 17 ]. However, determinants of prehospital ECG interval remain incompletely defined, and evidence regarding system-level interventions that reliably shorten this interval is limited. Therefore, this study aimed to identify factors associated with the prehospital FMC-to-ECG interval to guide targeted strategies that may improve outcomes in patients with STEMI. Methods Prehospital ECG transmission system in Oita Prefecture Oita Prefecture, located on the northeastern coast of Kyushu in southwestern Japan, has a population of approximately 1.1 million. A mobile ECG transmission system (Cloud Cardiology; Labtech, Debrecen, Hungary) integrated with a secure cloud server (SCUNA; Mehergen, Fukuoka, Japan) operates as part of a cloud-based emergency support network [ 21 ]. EMS personnel acquire 12-lead ECGs on scene for patients with suspected ACS and upload them to the cloud server, which transmits the ECGs to hospitals for immediate prearrival interpretation. As of 2025, the system was implemented in 24 hospitals and 57 of 64 ambulances in Oita Prefecture. Participating facilities include all four emergency centres, all 19 PCI–capable hospitals (four of which are also emergency centres), and five designated regional hub hospitals, thereby encompassing all major medical institutions in the prefecture. Study Design This retrospective study analysed registry data from patients whose prehospital 12-lead ECGs were transmitted via the Oita prehospital ECG system between September 2021 (registry initiation) and August 2025. Eleven of 14 regional EMS agencies participated. For each case, agencies provided patient-level data on sex and age, along with prehospital timestamps for emergency call receipt, EMS on-scene arrival, ECG transmission, scene departure, and hospital arrival. Hospital-phase information, including final diagnoses, treatments (e.g., whether PCI was performed), and outcomes, was not collected. The study complied with the Declaration of Helsinki and was approved by the Human Research Committee of Oita University (approval no. 3239). In accordance with the Ethical Guidelines for Medical and Health Research Involving Human Subjects established by the Japanese Ministry of Health, Labour, and Welfare, individual informed consent was not required. Study details were publicly disclosed, and participants were provided an opt-out option. Outcome The scene-to-ECG interval was defined as the time from EMS on-scene arrival to completion of ECG transmission, calculated by subtracting the recorded arrival time from the system-logged transmission time. Because the registry records on-scene arrival but not the exact time of FMC, the scene-to-ECG interval was analysed instead of the FMC-to-ECG interval. This metric encompasses several on-scene steps, including patient assessment, identification of the need for a 12-lead ECG, electrode placement, acquisition, and transmission. Therefore, a shorter interval represents a more efficient diagnostic process. Because this measure begins at on-scene arrival rather than FMC, it imposes a stricter benchmark than guideline standards. The primary outcome was achievement of a scene-to-ECG interval ≤ 10 minutes, consistent with recommendations for completing and interpreting a 12-lead ECG within 10 minutes. The secondary outcome was the scene-to-ECG interval as a continuous variable. Candidate factors for outcomes Prespecified covariates potentially associated with the scene-to-ECG interval included three domains: (1) patient demographics (sex and age); (2) EMS on-scene arrival time, categorized as daytime (09:00–17:59) or nighttime (18:00–08:59, next day); and (3) the EMS agency–level cumulative number of ECG transmissions completed before the index patient’s transmission (i.e., the total number previously completed by that agency). The cumulative count served as a proxy for agency experience and learning effects. Statistical analysis Continuous variables were summarized as mean with standard deviation or median with interquartile range, and compared using the Student’s t test or Wilcoxon rank-sum test, as appropriate. Comparisons across more than two groups were conducted with the Kruskal–Wallis test. Categorical variables were expressed as counts and percentages and compared using the chi-square test. Scene-to-ECG intervals were compared by patient characteristics (sex and age), EMS on-scene arrival time (daytime vs nighttime), and EMS agency. The primary outcome was achievement of a scene-to-ECG interval ≤ 10 minutes. Generalized linear mixed-effects models with a logit link and a random intercept for EMS agency were used. The primary exposure was each agency’s cumulative number of prior prehospital 12-lead ECG transmissions. To assess robustness, four prespecified models were evaluated: Model 1: cumulative number of prior prehospital 12-lead ECG transmissions. Model 2: Model 1 plus sex and age. Model 3: Model 2 plus on-scene arrival time (daytime vs. nighttime). Model 4: Model 3 plus four study-period indicators and included an interaction between study period and the cumulative number of prehospital ECG transmissions. The study period was defined a priori as four consecutive 12-month intervals: September 1, 2021–August 31, 2022; September 1, 2022–August 31, 2023; September 1, 2023–August 31, 2024; and September 1, 2024–August 31, 2025. To estimate within-period associations and limit collinearity, cumulative transmission counts were centred within each period (deviation from the period mean). These terms were included as design controls to account for secular or operational changes, such as COVID-19–related workflow shifts, rather than as clinical predictors. The secondary outcome was the scene-to-ECG interval in minutes, analysed using linear mixed-effects models with identical covariate sets and a random intercept for EMS agency. Missing data were handled using multiple imputation with fully conditional specification (100 imputations, fixed random seed). The imputation model included all analysis variables and selected prehospital timestamps as auxiliary variables. Estimates were combined using Rubin’s rules. Sensitivity analyses included complete-case analyses and reanalyses excluding patients with scene-to-ECG intervals above the 97.5th percentile of the overall distribution. Statistical significance was defined as p < 0.05. All analyses were conducted using SAS software, version 9.4 (SAS Institute Inc., Cary, NC). Results Patient characteristics and EMS related intervals A total of 1,748 patients were enrolled (Fig. 1 ). The median scene-to-ECG interval was 12 minutes (interquartile range [IQR], 9–17), with 672 patients (38.4%) achieving ≤ 10 minutes. Baseline characteristics by study period are summarized in Table 1 . No significant differences were observed across the four annual periods in sex, age, on-scene arrival time, or prehospital time intervals; however, the distribution of cases across EMS agencies differed significantly. Table 1 Baseline Characteristics of Patients with ECG Transmission Period 1 Period 2 Period 3 Period 4 Total p value Sep2021 - Aug2022 Sep2022 - Aug2023 Sep2023 - Aug2024 Sep2024 - Aug2025 Variables n = 378 n = 505 n = 485 n = 380 n = 1,748 Sex, n (%), n = 1,743 Male 227 (60.1) 330 (65.9) 284 (58.7) 244 (64.2) 1085 (62.2) 0.078 Female 151 (40.0) 171 (34.1) 200 (41.3) 136 (35.8) 658 (37.8) Age, year, mean (SD), n = 1,746 75.0 (14.0) 74.2 (14.5) 74.7 (14.8) 73.4 (15.4) 74.3 (14.7) 0.490 On-scene arrival time*, n (%), n = 1,748 Daytime 213 (56.4) 275 (54.5) 249 (51.3) 192 (50.5) 929 (53.1) 0.310 Nighttime 165 (43.7) 230 (45.5) 236 (48.7) 188 (49.5) 819 (46.9) Prehospital time interval†, minutes, median [IQR]‡ Call to scene, n = 1,747 8.0 [7.0–11.0] 8.0 [7.0–11.0] 8.0 [6.0–11.0] 8.0 [6.0–11.0] 8.0 [6.0–11.0] 0.588 Scene-to-ECG, n = 1,748 12.0 [9.0–17.0] 13.0 [9.0–18.0] 12.0 [9.0–17.0] 12.0 [9.0–16.0] 12.0 [9.0–17.0] 0.165 On-scene, n = 1,725 18.0 [13.0–23.0] 17.0 [13.0–23.0] 17.0 [12.0–23.0] 17.0 [13.0–23.0] 17.0 [13.0–23.0] 0.865 Scene-to-hospital, n = 1,717 12.0 [7.0–23.0] 13.0 [7.0–25.0] 13.0 [7.0–26.0] 15.0 [8.0–29.0] 13.0 [7.0–26.0] 0.084 EMS agency, n (%), n = 1,748 #1 231 (61.1) 250 (49.5) 188 (38.8) 115 (30.3) 784 (44.9) < 0.001 #2 0 (0.0) 3 (0.6) 8 (1.7) 19 (5) 30 (1.7) #3 1 (0.3) 4 (0.8) 9 (1.9) 6 (1.6) 20 (1.1) #4 72 (19.1) 93 (18.4) 87 (17.9) 95 (25) 347 (19.9) #5 13 (3.4) 6 (1.2) 8 (1.7) 10 (2.6) 37 (2.1) #6 25 (6.6) 44 (8.7) 28 (5.8) 26 (6.8) 123 (7.0) #7 4 (1.1) 2 (0.4) 0 (0.0) 0 (0.0) 6 (0.3) #8 4 (1.1) 32 (6.3) 31 (6.4) 20 (5.3) 87 (5.0) #9 10 (2.7) 14 (2.8) 16 (3.3) 13 (3.4) 53 (3.0) #10 14 (3.7) 22 (4.4) 49 (10.1) 32 (8.4) 117 (6.7) #11 4 (1.1) 35 (6.9) 61 (12.6) 44 (11.6) 144 (8.2) ECG indicates electrocardiogram; EMS, emergency medical services. * On-scene arrival time was categorized by the EMS on-scene arrival timestamp: Daytime, 09:00–17:59; Nighttime, 18:00–08:59 (spanning midnight to the following day). † Call-to-scene: time from receipt of the emergency call to EMS on-scene arrival; Scene-to-ECG interval: time from EMS on-scene arrival to ECG transmission; On-scene time: time from EMS on-scene arrival to scene departure. ‡ [IQR]: [25th percentile–75th percentile] As shown in Table 2 , patients with scene-to-ECG intervals ≤ 10 minutes were younger (mean ± SD, 72.9 ± 15.2 vs 75.2 ± 14.3 years; p < 0.001) and less likely to be female (31.5% vs 41.7%; p < 0.001) than those with intervals > 10 minutes. The distribution of EMS agencies also varied between these groups (p < 0.001). Table 2 Baseline Characteristics of Patients by Scene-to-ECG Interval ( ≤ 10 min vs > 10 min) Total Scene-to-ECG Scene-to-ECG P value ≤ 10 minutes > 10 minutes Variables n = 1748 n = 672 n = 1076 Sex, n (%), n = 1,743 Male 1085 (62.2) 459 (68.5) 626 (58.3) < 0.001 Female 658 (37.8) 211 (31.5) 447 (41.7) Age, year, mean (SD), n = 1,746 74.3 (14.8) 72.9 (15.2) 75.2 (14.3) < 0.001 On-scene arrival time*, n (%), n = 1,748 Daytime 929 (53.1) 382 (56.9) 547 (50.8) 0.014 Nighttime 819 (46.9) 290 (43.2) 529 (49.2) Prehospital time interval†, minutes, median [IQR]‡ Call to scene, n = 1,747 8.0 [6.0–11.0] 8.0 [7.0–11.0] 8.0 [6.0–11.0] 0.851 Scene-to-ECG, n = 1,748 12.0 [9.0–17.0] 8.0 [7.0–9.0] 16.0 [13.0–21.0] < 0.001 On-scene, n = 1,725 17.0 [13.0–23.0] 14.0 [11.0–19.0] 19.0 [14.0–25.0] < 0.001 Scene-to-hospital, n = 1,717 13.0 [7.0–26.0] 10.0 [6.0–20.0] 16.0 [8.0–29.0] < 0.001 EMS agency, n (%), n = 1,748 #1 784 (44.9) 322 (47.9) 462 (42.9) < 0.001 #2 30 (1.7) 9 (1.3) 21 (2.0) #3 20 (1.1) 4 (0.6) 16 (1.5) #4 347 (19.9) 182 (27.1) 165 (15.3) #5 37 (2.1) 10 (1.5) 27 (2.5) #6 123 (7.0) 25 (3.7) 98 (9.1) #7 6 (0.3) 2 (0.3) 4 (0.4) #8 87 (5.0) 14 (2.1) 73 (6.8) #9 53 (3.0) 31 (4.6) 22 (2.0) #10 117 (6.7) 19 (2.8) 98 (9.1) #11 144 (8.2) 54 (8.0) 90 (8.4) ECG indicates electrocardiogram; EMS, emergency medical services. * On-scene arrival time was categorized by the EMS on-scene arrival timestamp: Daytime, 09:00–17:59; Nighttime, 18:00–08:59 (spanning midnight to the following day). † Call-to-scene: time from receipt of the emergency call to EMS on-scene arrival; Scene-to-ECG interval: time from EMS on-scene arrival to ECG transmission; On-scene time: time from EMS on-scene arrival to scene departure. ‡ [IQR]: [25th percentile–75th percentile] Scene-to-ECG intervals As summarized in Table 3 , scene-to-ECG intervals were shorter in males (male vs female: 12.0 [9.0–17.0] vs 13.0 [10.0–17.0] minutes; p = 0.001) and in daytime arrivals (daytime vs nighttime: 12.0 [9.0–16.0] vs 13.0 [9.0–18.0] minutes; p = 0.026). The interval did not differ by age (< 75 vs ≥ 75 years; p = 0.170) but varied significantly across EMS agencies (Kruskal–Wallis p < 0.001). Figure 2 illustrates agency-specific distributions, showing right-skewed patterns for agencies #1 and #3, which had higher cumulative numbers of ECG transmissions. Table 3 Scene-to-ECG Intervals by Patient Characteristics and EMS Agency Variables Scene-to-ECG interval*, minutes, median [IQR]† P value Sex Male 12.0 [9.0–17.0] 0.001 Female 13.0 [10.0–17.0] Age < 75 year 12.0 [9.0–17.0] 0.170 ≥ 75 year 13.0 [9.0–17.0] On-scene arrival time‡ Daytime 12.0 [9.0–16.0] 0.026 Nighttime 13.0 [9.0–18.0] EMS agency #1 12.0 [9.0–16.0] < 0.001 #2 13.5 [10.0–19.0] #3 17.0 [11.0–28.5] #4 10.0 [8.0–14.0] #5 15.0 [10.0–22.0] #6 15.0 [11.0–21.0] #7 13.5 [9.0–22.0] #8 16.0 [12.0–22.0] #9 10.0 [8.0–15.0] #10 16.0 [12.0–21.0] #11 13.0 [8.0–21.0] * Scene-to-ECG interval: time from EMS on-scene arrival to ECG transmission. † [IQR]: [25th percentile–75th percentile] ‡ On-scene arrival time was categorized by the EMS on-scene arrival timestamp: Daytime, 09:00–17:59; Nighttime, 18:00–08:59 (spanning midnight to the following day). ECG indicates electrocardiogram; EMS: emergency medical services. Factors Associated with the scene-to-ECG intervals Primary outcome (scene-to-ECG interval ≤ 10 minutes) Across Models 1–3, the agency-level cumulative number of ECG transmissions was positively associated with achieving ≤ 10 minutes (Model 3 adjusted odds ratio, 1.07 per 100 transmissions; 95% confidence interval [CI], 1.02–1.14; Table 4 ). In Model 4, which included study period and its interaction with the centred cumulative number of ECG transmissions, the association between the cumulative number of ECG transmissions and scene-to-ECG interval was not statistically significant. Female sex, older age, and nighttime arrival were associated with lower odds of achieving the 10-minute target (Table 4 ). Table 4 Factors Associated with Achieving a Scene-to-ECG Interval ≤ 10 Minutes: Logistic Mixed-Effects Models with Multiple Imputation Model 1 Model 2 Model 3 Model 4§ OR 95% CI P value OR 95% CI P value OR 95% CI P value OR 95% CI P value Cumulative number of ECG transmissions, by 100 cases 1.07 1.01–1.13 0.022 1.07 1.01–1.13 0.022 1.07 1.02–1.14 0.011 1.33 0.95–1.87 0.099 Sex, female - - - 0.66 0.53–0.81 < 0.001 0.66 0.53–0.82 < 0.001 0.65 0.52–0.81 < 0.001 Age, by 10 years - - - 0.92 0.86–0.99 0.020 0.91 0.85–0.97 0.007 0.91 0.85–0.98 0.009 On-scene arrival time, nighttime* - - - - - - 0.71 0.58–0.87 0.001 0.71 0.58–0.87 0.001 Period† Period 2 vs Period 1 - - - - - - - - - 0.84 0.62–1.13 0.246 Period 3 vs Period 1 - - - - - - - - - 1.16 0.84–1.59 0.366 Period 4 vs Period 1 - - - - - - - - - 1.16 0.82–1.65 0.401 Cumulative number of ECG transmissions, by 100 cases × period‡ × Period 2 - - - - - - - - - 0.93 0.68–1.28 0.666 × Period 3 - - - - - - - - - 0.79 0.58–1.08 0.133 × Period 4 - - - - - - - - - 0.81 0.59–1.11 0.189 OR indicates Odds ratio. *On-scene arrival time was categorized by the EMS on-scene arrival timestamp: Daytime, 09:00–17:59; Nighttime, 18:00–08:59 (spanning midnight to the following day). †Period divides the 4-year study period into four 12-month intervals: Period 1 (Sep 2021–Aug 2022), Period 2 (Sep 2022–Aug 2023), Period 3 (Sep 2023–Aug 2024), and Period 4 (Sep 2024–Aug 2025). ‡× denotes an interaction term. §Cumulative number was centred within period (deviation from the period mean) to estimate within-period associations. Secondary outcome (scene-to-ECG interval, minutes) The cumulative number of ECG transmissions was inversely associated with interval duration in Models 1–3 (e.g., Model 3 β = −0.29 minutes per 100 transmissions; 95% CI, − 0.39 to − 0.19; Table 5 ); however, the association was not significant in Model 4. Older age and nighttime arrival were linked to longer intervals. Table 5 Factors Associated with Scene-to-ECG Interval: Linear Mixed-Effects Models with Multiple Imputation Model 1 Model 2 Model 3 Model 4§ Parameter estimates 95% CI P value Parameter estimates 95% CI P value Parameter estimates 95% CI P value Parameter estimates 95% CI P value Cumulative number of ECG transmissions, by 100 cases −0.27 -0.47 to -0.07 0.010 -0.26 -0.47 to 0.06 0.012 -0.29 -0.39 to -0.19 0.005 -1.13 -2.39 to 0.12 0.076 Sex, female - - - 0.13 -0.63 to 0.88 0.744 0.09 -0.66 to 0.85 0.811 0.16 -0.59 to 0.92 0.671 Age, by 10 years - - - 0.27 0.02 to 0.52 0.034 0.32 0.07 to 0.57 0.013 0.31 0.06 to 0.56 0.015 On-scene arrival time, nighttime* - - - - - - 1.30 0.58 to 2.02 < 0.001 1.31 0.59 to 2.03 < 0.001 Period† Period 2 vs Period 1 - - - - - - - - - 0.32 -0.72 to 1.37 0.544 Period 3 vs Period 1 - - - - - - - - - -0.79 -1.91 to 0.34 0.172 Period 4 vs Period 1 - - - - - - - - - -0.76 -2.00 to 0.47 0.226 Cumulative number of ECG transmissions × period‡ × Period 2 - - - - - - - - - 0.47 -0.65 to 1.59 0.413 × Period 3 - - - - - - - - - 0.91 -0.22 to 2.04 0.114 × Period 4 - - - - - - - - - 0.90 -0.25 to 2.05 0.123 *On-scene arrival time was categorized by the EMS on-scene arrival timestamp: Daytime, 09:00–17:59; Nighttime, 18:00–08:59 (spanning midnight to the following day). †Period divides the 4-year study period into four 12-month intervals: Period 1 (Sep 2021–Aug 2022), Period 2 (Sep 2022–Aug 2023), Period 3 (Sep 2023–Aug 2024), and Period 4 (Sep 2024–Aug 2025). ‡× denotes an interaction term. §Cumulative number was centred within period (deviation from the period mean) to estimate within-period associations. Sensitivity analyses excluding patients with scene-to-ECG intervals ≥ 34 minutes (97.5th percentile) yielded consistent results (Tables S1 and S2). Complete-case analyses also showed concordant findings (Tables S3 and S4). Discussion In this prefecture-wide cohort of 1748 patients with prehospital ECG transmission, 38.4% (672 of 1748) achieved transmission within 10 minutes, with a median scene-to-ECG interval of 12 minutes (IQR 9–17). These findings align with prior prehospital studies, in which meeting the ≤ 10-minute target remains uncommon [ 5 , 17 , 18 , 20 ]. Greater cumulative EMS-agency experience was associated with shorter scene-to-ECG intervals and higher odds of meeting the 10-minute benchmark. Female sex, older age, and nighttime arrival were linked to lower odds of achieving ≤ 10 minutes. When modelled as a continuous outcome, older age and nighttime arrival corresponded to longer scene-to-ECG intervals, whereas sex did not. Although models adjusting for annual periods and their interaction with agency experience lost statistical significance for the cumulative number of ECG transmissions, the point estimates remained directionally consistent. Results were consistent across sensitivity analyses. Collectively, these results indicate an experience-related improvement in on-scene ECG efficiency. By examining the prehospital phase and evaluating cumulative agency experience as a process measure, this study underscores system-level factors beyond patient characteristics and identifies modifiable targets within prehospital workflows. A greater cumulative number of ECG transmissions correlated with shorter scene-to-ECG intervals, suggesting that routine ECG use by EMS personnel may enhance on-scene efficiency. Because intermediate workflow elements (for example, task delegation, lead placement, and device setup time) were not measured, the underlying mechanisms remain uncertain, and causal inferences cannot be made. Within this framework, structured onboarding and periodic practice may warrant prospective evaluation to determine whether similar efficiency can be replicated in lower-experience contexts. After incorporating calendar-period indicators, centring cumulative experience within each period, and including a period–experience interaction, the experience coefficient reflected within-period contrasts rather than overall yearly trends. Allowing the experience effect to vary by year introduced additional parameters and shared variance, reducing precision. Under this specification, the experience term was not statistically significant, although its direction and all sensitivity analyses paralleled the simpler models. This pattern suggests that observed improvements largely reflect system maturation over time, with experience and secular trends evolving together and limiting independent variation. The loss of significance likely reflects temporal overlap rather than absence of an experience effect. Prior ED studies have linked female sex, older age, and atypical presentations to longer door-to-ECG intervals [ 12 , 22 – 24 ]. By contrast, standardized triage protocols, staff education, and workflow redesign have been shown to shorten these intervals [ 13 – 16 ]. Evidence regarding the prehospital FMC-to-ECG interval is more limited; however, existing studies similarly report low achievement of the 10-minute benchmark and identify patient-related contributors to delay [ 5 , 17 , 18 , 20 ]. Longer intervals among older patients have been documented in previous prehospital studies [ 17 ]. This pattern may reflect additional time required for multiple on-scene procedures, including assessment, positioning, intravenous access, and patient transfer [ 17 ]. In the ED, older age has also been associated with prolonged door-to-ECG intervals, although results vary across studies [ 6 , 9 , 11 , 12 ]. Prior prehospital reports have attributed longer times in females to a higher frequency of atypical symptoms that delay recognition [ 17 , 20 ]. In our cohort, females had lower odds of achieving ≤ 10 minutes; however, the sex term was not statistically significant when modelled as a continuous outcome. This discrepancy aligns with the empirical distribution of scene-to-ECG intervals. A small number of males had exceptionally long intervals, influencing linear models and diminishing the statistical significance of the sex difference. In sensitivity analyses excluding values above the 97.5th percentile (Table S2), the sex term retained the same direction of association as in the primary models but yielded smaller p values (0.052–0.062 in Models 2–4). By comparison, full-sample continuous models were nonsignificant, with larger p values (0.671–0.811 in Models 2–4; Table 5 ). With the ≤ 10-minute outcome, only whether the benchmark is crossed is relevant; values far above 10 minutes do not contribute additional weight. Therefore, a difference by sex is more easily detected with this threshold outcome than with a continuous model encompassing the full distribution, where a few extreme male values can distort estimates. Consistent with prior prehospital findings [ 17 , 20 ], our results indicate longer intervals in females. Evidence regarding time-of-day differences in prehospital ECG acquisition remains limited. In one multicenter analysis, the interval from EMS arrival to out-of-hospital ECG was longer during daytime than nighttime, suggesting that delays are not consistently worse after hours [ 17 ]. In contrast, our findings associate nighttime arrival with longer scene-to-ECG intervals, implying that time-of-day effects may differ by system and warrant local assessment. Given the sparse and heterogeneous literature, these findings should be generalized cautiously. This study’s strengths include prefecture-wide coverage of nearly all prehospital ECG transmissions over a four-year period and the use of multivariable mixed-effects models with EMS-agency random intercepts to account for clustering. Directional consistency across prespecified sensitivity analyses supports the robustness of the results. By shifting the focus from patient characteristics to modifiable operational processes, this study quantifies agency-level cumulative transmission experience in real-world prehospital care. Although intermediate workflow mechanisms were not directly measured, the results identify training and structured onboarding as pragmatic targets for prospective evaluation aimed at reducing scene-to-ECG intervals. This study has several limitations. First, although the operational policy recommends prehospital 12-lead ECG acquisition for patients with suspected ACS, the final decision rests with individual EMS personnel. In the absence of a standardized triage protocol or validated scoring system to define suspected ACS, patient selection may differ across EMS agencies, and residual selection or indication bias cannot be excluded. Nevertheless, current guidelines recommend prompt acquisition of a prehospital 12-lead ECG whenever ACS is suspected, without requiring a formal triage tool [ 7 , 8 ]. We sought to mitigate this potential bias by using multivariable mixed-effects models with EMS-agency random intercepts, and the results were consistent in sensitivity analyses that excluded extreme interval values and in complete-case analyses. Second, the registry included prehospital process measures only and was not linked to in-hospital data. As a result, final diagnoses, treatments received, and clinical outcomes after hospital arrival could not be ascertained. Among patients with prehospital ECG transmission, the proportions ultimately diagnosed with STEMI or receiving reperfusion therapy remain unknown. Consequently, whether shorter scene-to-ECG intervals translate into improved clinical outcomes could not be determined. Third, this retrospective analysis was conducted within a single Japanese prefecture, which may limit generalizability to systems with different EMS configurations, patient populations, or health care structures. Not all EMS agencies in the prefecture participated (11 of 14), raising the possibility of participation bias and limiting the representativeness of agency-level practices. These findings should therefore be extrapolated cautiously to other settings. Fourth, because the study period (September 2021–August 2025) overlapped with the COVID-19 pandemic, changes in EMS operations and patient characteristics related to the pandemic cannot be ruled out as potential influences on scene-to-ECG intervals. To account for temporal effects, we included calendar-period indicators and their interactions with the cumulative number of ECG transmissions in the multivariable mixed-effects models. Neither variable reached statistical significance, although modest residual effects may persist. Fifth, the design cannot fully separate the effects of accumulating experience from time-related system maturation. Thus, the observed association may reflect training-related improvements, temporal system development, or both. Future work should assess whether targeted training reduces scene-to-ECG intervals and identify the specific on-scene procedures that contribute to this effect. Granular time analyses should decompose the interval into recognition, preparation and role allocation, lead placement, acquisition, and transmission to pinpoint major sources of delay. Based on these findings, a standardized onboarding and training programme focused on rapid ECG acquisition and transmission should be implemented and prospectively evaluated using a prespecified analysis plan comparing pre- and post-intervention performance. Reporting changes not only in total interval length but also in sub-intervals would clarify mechanisms of improvement. Finally, linking prehospital and in-hospital data would enable evaluation of whether process improvements correspond with better clinical outcomes in patients with suspected ACS. Conclusions At the EMS agency level, a higher cumulative number of prehospital ECG transmissions was associated with achieving the ≤ 10-minute scene-to-ECG target. This association suggests that focused onboarding and continued EMS training may enhance prehospital ECG performance. Older age, female sex, and night-time arrival were associated with not achieving the target. Abbreviations ACS acute coronary syndrome ECG electrocardiogram ED emergency department EMS emergency medical services FMC first medical contact PCI percutaneous coronary intervention STEMI ST-segment elevation myocardial infarction Declarations Ethics approval and consent to participate This study was approved by the Oita University Human Research Committee (Oita University Research Ethics Committee; approval no. 3239). In accordance with the Ethical Guidelines for Medical and Health Research Involving Human Subjects in Japan, the requirement for individual informed consent was waived. Study information was disclosed on the institutional website, and patients were provided with an opportunity to opt out. Consent for publication Not applicable. This manuscript does not contain any individual person’s identifiable data in any form (including images, videos, or detailed case descriptions). Funding This research did not receive financial support or grants from any funding agency in the public, commercial, or not-for-profit sectors. Author Contribution HS conceived and designed the study, performed the statistical analyses, and drafted the manuscript. KY, TN, HA, RA, TS, and NT contributed to study design, data interpretation, and critical revision of the manuscript for important intellectual content. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work. Acknowledgement The authors thank Masae Hayashi, Tomomi Shuto, and Yoshimi Fujimaru for their valuable assistance with the manuscript. The authors thank Editage (www.editage.jp) for English language editing. The authors used an AI-assisted writing tool (ChatGPT, OpenAI) to improve grammar and clarity. The tool did not generate scientific content, data, analyses, references, or images. All authors have reviewed and approved the final manuscript and take full responsibility for its content. Data Availability The data analysed in this study are derived from the Oita Prehospital ECG Registry. Due to ethical restrictions regarding patient privacy and the terms of approval from the Oita University Human Research Committee, the deidentified individual patient data are not publicly available. Data may be made available from the corresponding author (Hiroki Sato) on reasonable request and following additional approval from the Oita University Human Research Committee. References Jacobs AK, Ali MJ, Best PJ, Bieniarz MC, Bufalino VJ, French WJ, et al. Systems of care for ST-segment-elevation myocardial infarction: A policy statement from the American heart association. Circulation. 2021;144:e310–27. https://doi.org/10.1161/CIR.0000000000001025 . Nakashima T, Hashiba K, Kikuchi M, Yamaguchi J, Kojima S, Hanada H, et al. Impact of prehospital 12-lead electrocardiography and destination hospital notification on mortality in patients with chest pain - A systematic review. Circ Rep. 2022;4:187–93. https://doi.org/10.1253/circrep.CR-22-0003 . Moxham RN, d’Entremont M-A, Mir H, Schwalm JD, Natarajan MK, Jolly SS. Effect of prehospital digital electrocardiogram transmission on revascularization delays and mortality in ST-elevation myocardial infarction patients: Systematic review and meta-analysis. CJC Open. 2024;6:1199–206. https://doi.org/10.1016/j.cjco.2024.06.012 . Menees DS, Peterson ED, Wang Y, Curtis JP, Messenger JC, Rumsfeld JS, et al. Door-to-balloon time and mortality among patients undergoing primary PCI. N Engl J Med. 2013;369:901–9. https://doi.org/10.1056/NEJMoa1208200 . Żurowska-Wolak M, Piekos P, Jąkała J, Mikos M. The effects of prehospital system delays on the treatment efficacy of STEMI patients. Scand J Trauma Resusc Emerg Med. 2019;27:39. https://doi.org/10.1186/s13049-019-0616-4 . Diercks DB, Peacock WF, Hiestand BC, Chen AY, Pollack CV Jr, Kirk JD, et al. Frequency and consequences of recording an electrocardiogram > 10 minutes after arrival in an emergency room in non-ST-segment elevation acute coronary syndromes (from the CRUSADE Initiative). Am J Cardiol. 2006;97:437–42. https://doi.org/10.1016/j.amjcard.2005.09.073 . Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44:3720–826. https://doi.org/10.1093/eurheartj/ehad191 . Rao SV, O’Donoghue ML, Ruel M, Rab T, Tamis-Holland JE, Alexander JH, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the Management of Patients With Acute Coronary Syndromes: A report of the American college of cardiology/American heart association joint committee on clinical practice guidelines. Circulation. 2025;151:e771–862. https://doi.org/10.1161/CIR.0000000000001309 . Takakuwa KM, Shofer FS, Hollander JE. The influence of race and gender on time to initial electrocardiogram for patients with chest pain. Acad Emerg Med. 2006;13:867–72. https://doi.org/10.1197/j.aem.2006.03.566 . Zègre-Hemsey J, Sommargren CE, Drew BJ. Initial ECG acquisition within 10 minutes of arrival at the emergency department in persons with chest pain: time and gender differences. J Emerg Nurs. 2011;37:109–12. https://doi.org/10.1016/j.jen.2009.11.004 . Yiadom MYAB, Gong W, Patterson BW, Baugh CW, Mills AM, Gavin N, et al. Fallacy of median door-to-ECG time: Hidden opportunities for STEMI screening improvement. J Am Heart Assoc. 2022;11:e024067. https://doi.org/10.1161/JAHA.121.024067 . Lin Y-T, Chen H-A, Wu H-Y, Fan C-M, Hsu J-C, Chen K-C. Influence of the door-to-ECG time on the prognosis of patients with acute coronary syndrome. Acta Cardiol Sin. 2023;39:127–34. https://doi.org/10.6515/ACS.202301_39(1).20220602B . Takakuwa KM, Burek GA, Estepa AT, Shofer FS. A method for improving arrival-to-electrocardiogram time in emergency department chest pain patients and the effect on door-to-balloon time for ST-segment elevation myocardial infarction. Acad Emerg Med. 2009;16:921–7. https://doi.org/10.1111/j.1553-2712.2009.00493.x . Chhabra S, Eagles D, Kwok ESH, Perry JJ. Interventions to reduce emergency department door-to- electrocardiogram times: A systematic review. CJEM. 2019;21:607–17. https://doi.org/10.1017/cem.2019.342 . Lee C-K, Meng S-W, Lee M-H, Chen H-C, Wang C-L, Wang H-N, et al. The impact of door-to-electrocardiogram time on door-to-balloon time after achieving the guideline-recommended target rate. PLoS ONE. 2019;14:e0222019. https://doi.org/10.1371/journal.pone.0222019 . Su H-Y, Tsai J-L, Hsu Y-C, Lee K-H, Chang C-S, Sun C-K, et al. A modified cardiac triage strategy reduces door to ECG time in patients with ST elevation myocardial infarction. Sci Rep. 2021;11:6358. https://doi.org/10.1038/s41598-021-86013-8 . Sullivan AL, Beshansky JR, Ruthazer R, Murman DH, Mader TJ, Selker HP. Factors associated with longer time to treatment for patients with suspected acute coronary syndromes: a cohort study: A cohort study. Circ Cardiovasc Qual Outcomes. 2014;7:86–94. https://doi.org/10.1161/CIRCOUTCOMES.113.000396 . Muhrbeck J, Persson J, Hofman-Bang C. Catheterization laboratory activations and time intervals for patients with pre-hospital ECGs. Scand Cardiovasc J. 2018;52:74–9. https://doi.org/10.1080/14017431.2018.1430899 . Park K, Park JS, Cho YR, Park TH, Kim MH, Yang TH, et al. Community-based pre-hospital electrocardiogram transmission program for reducing systemic time delay in acute ST-segment elevation myocardial infarction. Korean Circ J. 2020;50:709–19. https://doi.org/10.4070/kcj.2019.0337 . Muhrbeck J, Maliniak E, Eurenius L, Hofman-Bang C, Persson J. Few with ST-segment elevation myocardial infarction are diagnosed within 10 minutes from first medical contact, and women have longer delay times than men. Int J Cardiol Heart Vasc. 2020;26:100458. https://doi.org/10.1016/j.ijcha.2019.100458 . Yufu K, Shimomura T, Kawano K, Sato H, Yonezu K, Saito S, et al. Usefulness of prehospital 12-lead electrocardiography system in ST-segment elevation myocardial infarction patients in Oita - comparison between urban and rural areas, weekday daytime and weekday nighttime/holidays. Circ J. 2023. https://doi.org/10.1253/circj.CJ-23-0365 . advpub:CJ-23-0365. Zègre-Hemsey JK, Patel MD, Fernandez AR, Pelter MM, Brice J, Rosamond W. A statewide assessment of prehospital electrocardiography approaches of acquisition and interpretation for ST-elevation myocardial infarction based on Emergency Medical Services characteristics. Prehosp Emerg Care. 2020;24:550–6. https://doi.org/10.1080/10903127.2019.1677831 . Inoue A, Mizobe M, Takahashi J, Funakoshi H. Factors for delays in door-to-balloon time ≤ 90 min in an electrocardiogram triage system among patients with ST-segment elevation myocardial infarction: a retrospective study. Int J Emerg Med. 2023;16:77. https://doi.org/10.1186/s12245-023-00562-5 . Brush JE Jr, Chaudhry SI, Dreyer RP, D’Onofrio G, Greene EJ, Hajduk AM, et al. Sex differences in symptom complexity and door-to-balloon time in patients with ST-elevation myocardial infarction. Am J Cardiol. 2023;197:101–7. https://doi.org/10.1016/j.amjcard.2023.03.009 . Additional Declarations No competing interests reported. Supplementary Files Supplementalmaterial.pdf Tables S1–S4 Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 07 May, 2026 Reviews received at journal 07 May, 2026 Reviews received at journal 03 May, 2026 Reviewers agreed at journal 21 Apr, 2026 Reviews received at journal 09 Dec, 2025 Reviewers agreed at journal 28 Nov, 2025 Reviewers invited by journal 28 Nov, 2025 Editor invited by journal 07 Nov, 2025 Editor assigned by journal 05 Nov, 2025 Submission checks completed at journal 05 Nov, 2025 First submitted to journal 04 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8033271\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":553022753,\"identity\":\"60d4ba7c-6a7a-4d35-9724-ef1a14c98117\",\"order_by\":0,\"name\":\"Hiroki Sato\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYBACAwY2MC3HwIwQTCBCSwKDMQMzQg9xWhIbkK3BC8yljyV/+PnDJr2fnf/gB8Y2Bnn+BoZnD/BpsexLOybZk5CWO7OZmVkCqMVwxgGGdAO8DjvD3sbAk3A4d8NhZgbpv20MjBsYGNIkCGhp/vgn4XC6wWFm5h9AW+yJ0MJ2QBpoSwJQCxvIYYnEaEmTlklLMwT6xcyC4ZxE8ozDBP3CZvzxjY2NPD//wcc3GMpsbPvbe9Ie4NOCDoBOYuZJI0UHGLAfI1nLKBgFo2AUDGsAAP3YPxUxzAtIAAAAAElFTkSuQmCC\",\"orcid\":\"\",\"institution\":\"Oita University Hospital\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Hiroki\",\"middleName\":\"\",\"lastName\":\"Sato\",\"suffix\":\"\"},{\"id\":553022754,\"identity\":\"f2d9f72f-e049-4f48-a142-8b70684bb38d\",\"order_by\":1,\"name\":\"Kunio Yufu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Oita Red Cross Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Kunio\",\"middleName\":\"\",\"lastName\":\"Yufu\",\"suffix\":\"\"},{\"id\":553022755,\"identity\":\"9fc11e8f-ee3b-47be-94aa-0d5c3e1cf1a7\",\"order_by\":2,\"name\":\"Tatsunori Nakashima\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Oita University Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Tatsunori\",\"middleName\":\"\",\"lastName\":\"Nakashima\",\"suffix\":\"\"},{\"id\":553022756,\"identity\":\"1c995359-99f5-45a5-9706-4b5e25323c33\",\"order_by\":3,\"name\":\"Hidefumi Akioka\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Oita University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Hidefumi\",\"middleName\":\"\",\"lastName\":\"Akioka\",\"suffix\":\"\"},{\"id\":553022757,\"identity\":\"92f39d05-5987-43f1-b6b5-76217f864ba0\",\"order_by\":4,\"name\":\"Ryuzo Abe\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Oita University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Ryuzo\",\"middleName\":\"\",\"lastName\":\"Abe\",\"suffix\":\"\"},{\"id\":553022758,\"identity\":\"fa884716-fbe6-4d97-98a0-173e24a3cb53\",\"order_by\":5,\"name\":\"Tsuyoshi Shimomura\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Oita University Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Tsuyoshi\",\"middleName\":\"\",\"lastName\":\"Shimomura\",\"suffix\":\"\"},{\"id\":553022759,\"identity\":\"b292bcca-c75c-46b2-80b6-6b0fcc92be8a\",\"order_by\":6,\"name\":\"Naohiko Takahashi\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Oita University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Naohiko\",\"middleName\":\"\",\"lastName\":\"Takahashi\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-11-05 02:23:18\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-8033271/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-8033271/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":97367937,\"identity\":\"974c589b-fc3f-463e-8881-43c64f741768\",\"added_by\":\"auto\",\"created_at\":\"2025-12-03 16:21:04\",\"extension\":\"docx\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":568606,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscriptwithtablesBMC.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8033271/v1/97d9f7da9ee3117cb239cab2.docx\"},{\"id\":97266199,\"identity\":\"79170fbe-81a4-4d34-8098-7f5e673a839a\",\"added_by\":\"auto\",\"created_at\":\"2025-12-02 14:33:02\",\"extension\":\"json\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":9350,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"7faf4cca52394fc5b897e093decf1ac4.json\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8033271/v1/6eae2b27c8adb25f3012235f.json\"},{\"id\":97266196,\"identity\":\"49409919-38df-4df8-b1df-0d8d1e014e39\",\"added_by\":\"auto\",\"created_at\":\"2025-12-02 14:33:02\",\"extension\":\"pdf\",\"order_by\":2,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":42450,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Supplementalmaterial.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8033271/v1/0bce35c57f7b9318ad5e3545.pdf\"},{\"id\":97266202,\"identity\":\"0cd497ae-d38f-47fc-b252-c253cc9ebeae\",\"added_by\":\"auto\",\"created_at\":\"2025-12-02 14:33:02\",\"extension\":\"xml\",\"order_by\":3,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":149478,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"7faf4cca52394fc5b897e093decf1ac41enriched.xml\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8033271/v1/2a552b39a07497baaa402002.xml\"},{\"id\":97266205,\"identity\":\"e30c88c5-afbf-4123-8702-cf0b7e1b2f5c\",\"added_by\":\"auto\",\"created_at\":\"2025-12-02 14:33:02\",\"extension\":\"jpeg\",\"order_by\":4,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":109854,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"floatimage1.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8033271/v1/f283464ba262520db7b78acb.jpeg\"},{\"id\":97266200,\"identity\":\"e92eba45-2086-42f4-a723-7f13f8041c51\",\"added_by\":\"auto\",\"created_at\":\"2025-12-02 14:33:02\",\"extension\":\"png\",\"order_by\":7,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":49400,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Onlinefloatimage2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8033271/v1/78f81bfa6bc54903e7b73764.png\"},{\"id\":97367850,\"identity\":\"b55686d0-be36-43a1-a359-4976f00b0284\",\"added_by\":\"auto\",\"created_at\":\"2025-12-03 16:20:54\",\"extension\":\"xml\",\"order_by\":8,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":147005,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"7faf4cca52394fc5b897e093decf1ac41structuring.xml\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8033271/v1/074f1a077c85d40eb7d80de9.xml\"},{\"id\":97266203,\"identity\":\"10fc8cd1-9cf2-4eeb-b8ae-4491aec578f0\",\"added_by\":\"auto\",\"created_at\":\"2025-12-02 14:33:02\",\"extension\":\"html\",\"order_by\":9,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":156128,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"earlyproof.html\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8033271/v1/d2548770b3120303d7d7d5ad.html\"},{\"id\":97266195,\"identity\":\"490171df-9775-4500-819b-b6602f462d61\",\"added_by\":\"auto\",\"created_at\":\"2025-12-02 14:33:02\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":23692,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eFlow diagram\\u003c/p\\u003e\\n\\u003cp\\u003eAmong eligible patients (n = 1,813), those with missing scene-to-ECG intervals were excluded (n = 65), resulting in a final study population of n = 1,748. For sensitivity analyses, two datasets were created: (1) an extreme-value–excluded dataset removing patients with scene-to-ECG intervals ≥97.5th percentile (≥34 minutes; n = 1,699) and (2) a complete-case dataset excluding patients missing any explanatory variable (n = 1,741).\\u003c/p\\u003e\\n\\u003cp\\u003eAbbreviations: ECG, electrocardiogram\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Onlinefloatimage1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8033271/v1/d05063a4e93445208d67169c.png\"},{\"id\":97266198,\"identity\":\"36d2dd3b-647c-4bf0-91b1-9612a35fa9a8\",\"added_by\":\"auto\",\"created_at\":\"2025-12-02 14:33:02\",\"extension\":\"jpeg\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":291455,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eDistribution of the scene-to-ECG intervals across EMS agencies\\u003c/p\\u003e\\n\\u003cp\\u003eHistograms depict the distribution of scene-to-ECG intervals (minutes) for each EMS agency (#1–#11) and for all patients combined. The y-axis represents the number of patients with ECG transmissions. Black vertical lines indicate the median scene-to-ECG interval for each agency.\\u003c/p\\u003e\\n\\u003cp\\u003eAbbreviations: ECG, electrocardiogram; EMS, emergency medical services.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage2.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8033271/v1/9c82f28921ba2d06f71492c8.jpeg\"},{\"id\":97664574,\"identity\":\"541c4bf9-98ed-45a5-ae15-5dad389bd784\",\"added_by\":\"auto\",\"created_at\":\"2025-12-08 09:10:33\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1504066,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8033271/v1/956c7488-1f69-4fa7-ae28-54b25b2bbf1a.pdf\"},{\"id\":97368057,\"identity\":\"52dab47b-f3a0-4894-99f8-a073bdf19278\",\"added_by\":\"auto\",\"created_at\":\"2025-12-03 16:21:28\",\"extension\":\"pdf\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":42450,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eTables S1–S4\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Supplementalmaterial.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8033271/v1/c3df8f6671f8b16266286b78.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Factors associated with achieving the 10-minute scene-to-ECG transmission target in prehospital care: the role of EMS agency-level cumulative ECG transmissions\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003ePrehospital acquisition of a 12-lead electrocardiogram (ECG), often transmitted for remote interpretation, in patients with suspected acute coronary syndrome (ACS) enables early prenotification and activation of the cardiac catheterization laboratory. This process facilitates destination triage to percutaneous coronary intervention (PCI)\\u0026ndash;capable hospitals and direct transfer to the catheterization laboratory, thereby reducing door-to-device time and improving outcomes in patients with ST-segment elevation myocardial infarction (STEMI) [\\u003cspan additionalcitationids=\\\"CR2\\\" citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. Although door-to-device time, defined as the interval from hospital arrival to first device activation, has been a central focus of STEMI care systems, further improvement requires optimization of the prehospital phase [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eDuring this phase, rapid on-scene ECG acquisition at the first medical contact (FMC) by emergency medical services (EMS) is a key modifiable factor that shortens the FMC-to-device interval [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. Current guidelines recommend that EMS personnel acquire and interpret a 12-lead ECG within 10 minutes of FMC in patients with suspected ACS, aligning with the 10-minute benchmark after emergency department (ED) arrival [\\u003cspan additionalcitationids=\\\"CR7\\\" citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. In ED settings, numerous studies have evaluated the door-to-ECG interval (ED arrival to first ECG). Across diverse populations, female sex, older age, and atypical presenting symptoms are consistently associated with longer door-to-ECG intervals [\\u003cspan additionalcitationids=\\\"CR10 CR11\\\" citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e], whereas standardized triage protocols, ED staff training, and workflow optimization reduce these delays [\\u003cspan additionalcitationids=\\\"CR14 CR15\\\" citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eIn contrast, relatively few investigations have assessed the prehospital FMC-to-ECG interval among patients with suspected ACS or STEMI [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR18 CR19\\\" citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]. Notably, prior studies indicate that more than half of patients did not receive an ECG within 10 minutes of FMC [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]. Longer FMC-to-ECG intervals have been linked to female sex [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e], older age [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e], and absence of chest pain as the primary complaint [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. However, determinants of prehospital ECG interval remain incompletely defined, and evidence regarding system-level interventions that reliably shorten this interval is limited. Therefore, this study aimed to identify factors associated with the prehospital FMC-to-ECG interval to guide targeted strategies that may improve outcomes in patients with STEMI.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003ePrehospital ECG transmission system in Oita Prefecture\\u003c/h2\\u003e\\u003cp\\u003eOita Prefecture, located on the northeastern coast of Kyushu in southwestern Japan, has a population of approximately 1.1\\u0026nbsp;million. A mobile ECG transmission system (Cloud Cardiology; Labtech, Debrecen, Hungary) integrated with a secure cloud server (SCUNA; Mehergen, Fukuoka, Japan) operates as part of a cloud-based emergency support network [\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e]. EMS personnel acquire 12-lead ECGs on scene for patients with suspected ACS and upload them to the cloud server, which transmits the ECGs to hospitals for immediate prearrival interpretation. As of 2025, the system was implemented in 24 hospitals and 57 of 64 ambulances in Oita Prefecture. Participating facilities include all four emergency centres, all 19 PCI\\u0026ndash;capable hospitals (four of which are also emergency centres), and five designated regional hub hospitals, thereby encompassing all major medical institutions in the prefecture.\\u003c/p\\u003e\\u003c/div\\u003e\\n\\u003ch3\\u003eStudy Design\\u003c/h3\\u003e\\n\\u003cp\\u003eThis retrospective study analysed registry data from patients whose prehospital 12-lead ECGs were transmitted via the Oita prehospital ECG system between September 2021 (registry initiation) and August 2025. Eleven of 14 regional EMS agencies participated. For each case, agencies provided patient-level data on sex and age, along with prehospital timestamps for emergency call receipt, EMS on-scene arrival, ECG transmission, scene departure, and hospital arrival. Hospital-phase information, including final diagnoses, treatments (e.g., whether PCI was performed), and outcomes, was not collected.\\u003c/p\\u003e\\u003cp\\u003e The study complied with the Declaration of Helsinki and was approved by the Human Research Committee of Oita University (approval no. 3239). In accordance with the Ethical Guidelines for Medical and Health Research Involving Human Subjects established by the Japanese Ministry of Health, Labour, and Welfare, individual informed consent was not required. Study details were publicly disclosed, and participants were provided an opt-out option.\\u003c/p\\u003e\\n\\u003ch3\\u003eOutcome\\u003c/h3\\u003e\\n\\u003cp\\u003eThe scene-to-ECG interval was defined as the time from EMS on-scene arrival to completion of ECG transmission, calculated by subtracting the recorded arrival time from the system-logged transmission time. Because the registry records on-scene arrival but not the exact time of FMC, the scene-to-ECG interval was analysed instead of the FMC-to-ECG interval. This metric encompasses several on-scene steps, including patient assessment, identification of the need for a 12-lead ECG, electrode placement, acquisition, and transmission. Therefore, a shorter interval represents a more efficient diagnostic process. Because this measure begins at on-scene arrival rather than FMC, it imposes a stricter benchmark than guideline standards.\\u003c/p\\u003e\\u003cp\\u003eThe primary outcome was achievement of a scene-to-ECG interval\\u0026thinsp;\\u0026le;\\u0026thinsp;10 minutes, consistent with recommendations for completing and interpreting a 12-lead ECG within 10 minutes. The secondary outcome was the scene-to-ECG interval as a continuous variable.\\u003c/p\\u003e\\n\\u003ch3\\u003eCandidate factors for outcomes\\u003c/h3\\u003e\\n\\u003cp\\u003ePrespecified covariates potentially associated with the scene-to-ECG interval included three domains: (1) patient demographics (sex and age); (2) EMS on-scene arrival time, categorized as daytime (09:00\\u0026ndash;17:59) or nighttime (18:00\\u0026ndash;08:59, next day); and (3) the EMS agency\\u0026ndash;level cumulative number of ECG transmissions completed before the index patient\\u0026rsquo;s transmission (i.e., the total number previously completed by that agency). The cumulative count served as a proxy for agency experience and learning effects.\\u003c/p\\u003e\\u003cdiv id=\\\"Sec7\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eStatistical analysis\\u003c/h2\\u003e\\u003cp\\u003eContinuous variables were summarized as mean with standard deviation or median with interquartile range, and compared using the Student\\u0026rsquo;s t test or Wilcoxon rank-sum test, as appropriate. Comparisons across more than two groups were conducted with the Kruskal\\u0026ndash;Wallis test. Categorical variables were expressed as counts and percentages and compared using the chi-square test. Scene-to-ECG intervals were compared by patient characteristics (sex and age), EMS on-scene arrival time (daytime vs nighttime), and EMS agency.\\u003c/p\\u003e\\u003cp\\u003eThe primary outcome was achievement of a scene-to-ECG interval\\u0026thinsp;\\u0026le;\\u0026thinsp;10 minutes. Generalized linear mixed-effects models with a logit link and a random intercept for EMS agency were used. The primary exposure was each agency\\u0026rsquo;s cumulative number of prior prehospital 12-lead ECG transmissions. To assess robustness, four prespecified models were evaluated:\\u003c/p\\u003e\\u003cp\\u003eModel 1: cumulative number of prior prehospital 12-lead ECG transmissions.\\u003c/p\\u003e\\u003cp\\u003eModel 2: Model 1 plus sex and age.\\u003c/p\\u003e\\u003cp\\u003eModel 3: Model 2 plus on-scene arrival time (daytime vs. nighttime).\\u003c/p\\u003e\\u003cp\\u003eModel 4: Model 3 plus four study-period indicators and included an interaction between study period and the cumulative number of prehospital ECG transmissions.\\u003c/p\\u003e\\u003cp\\u003eThe study period was defined a priori as four consecutive 12-month intervals: September 1, 2021\\u0026ndash;August 31, 2022; September 1, 2022\\u0026ndash;August 31, 2023; September 1, 2023\\u0026ndash;August 31, 2024; and September 1, 2024\\u0026ndash;August 31, 2025. To estimate within-period associations and limit collinearity, cumulative transmission counts were centred within each period (deviation from the period mean). These terms were included as design controls to account for secular or operational changes, such as COVID-19\\u0026ndash;related workflow shifts, rather than as clinical predictors.\\u003c/p\\u003e\\u003cp\\u003eThe secondary outcome was the scene-to-ECG interval in minutes, analysed using linear mixed-effects models with identical covariate sets and a random intercept for EMS agency.\\u003c/p\\u003e\\u003cp\\u003eMissing data were handled using multiple imputation with fully conditional specification (100 imputations, fixed random seed). The imputation model included all analysis variables and selected prehospital timestamps as auxiliary variables. Estimates were combined using Rubin\\u0026rsquo;s rules. Sensitivity analyses included complete-case analyses and reanalyses excluding patients with scene-to-ECG intervals above the 97.5th percentile of the overall distribution.\\u003c/p\\u003e\\u003cp\\u003eStatistical significance was defined as p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05. All analyses were conducted using SAS software, version 9.4 (SAS Institute Inc., Cary, NC).\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cdiv id=\\\"Sec9\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003ePatient characteristics and EMS related intervals\\u003c/h2\\u003e\\u003cp\\u003eA total of 1,748 patients were enrolled (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). The median scene-to-ECG interval was 12 minutes (interquartile range [IQR], 9\\u0026ndash;17), with 672 patients (38.4%) achieving\\u0026thinsp;\\u0026le;\\u0026thinsp;10 minutes. Baseline characteristics by study period are summarized in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e. No significant differences were observed across the four annual periods in sex, age, on-scene arrival time, or prehospital time intervals; however, the distribution of cases across EMS agencies differed significantly.\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eBaseline Characteristics of Patients with ECG Transmission\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"8\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePeriod 1\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003ePeriod 2\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003ePeriod 3\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003ePeriod 4\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eTotal\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003ep value\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eSep2021 - Aug2022\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eSep2022 - Aug2023\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eSep2023 - Aug2024\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eSep2024 - Aug2025\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eVariables\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;378\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;505\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;485\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;380\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;1,748\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eSex, n (%), n\\u0026thinsp;=\\u0026thinsp;1,743\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMale\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e227 (60.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e330 (65.9)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e284 (58.7)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e244 (64.2)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e1085 (62.2)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.078\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eFemale\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e151 (40.0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e171 (34.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e200 (41.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e136 (35.8)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e658 (37.8)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eAge, year, mean (SD), n\\u0026thinsp;=\\u0026thinsp;1,746\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e75.0 (14.0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e74.2 (14.5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e74.7 (14.8)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e73.4 (15.4)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e74.3 (14.7)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.490\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eOn-scene arrival time*, n (%), n\\u0026thinsp;=\\u0026thinsp;1,748\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDaytime\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e213 (56.4)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e275 (54.5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e249 (51.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e192 (50.5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e929 (53.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.310\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eNighttime\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e165 (43.7)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e230 (45.5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e236 (48.7)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e188 (49.5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e819 (46.9)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003ePrehospital time interval\\u0026dagger;, minutes, median [IQR]\\u0026Dagger;\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eCall to scene, n\\u0026thinsp;=\\u0026thinsp;1,747\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e8.0 [7.0\\u0026ndash;11.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e8.0 [7.0\\u0026ndash;11.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e8.0 [6.0\\u0026ndash;11.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e8.0 [6.0\\u0026ndash;11.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e8.0 [6.0\\u0026ndash;11.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.588\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eScene-to-ECG, n\\u0026thinsp;=\\u0026thinsp;1,748\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e12.0 [9.0\\u0026ndash;17.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e13.0 [9.0\\u0026ndash;18.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e12.0 [9.0\\u0026ndash;17.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e12.0 [9.0\\u0026ndash;16.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e12.0 [9.0\\u0026ndash;17.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.165\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eOn-scene, n\\u0026thinsp;=\\u0026thinsp;1,725\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e18.0 [13.0\\u0026ndash;23.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e17.0 [13.0\\u0026ndash;23.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e17.0 [12.0\\u0026ndash;23.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e17.0 [13.0\\u0026ndash;23.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e17.0 [13.0\\u0026ndash;23.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.865\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eScene-to-hospital, n\\u0026thinsp;=\\u0026thinsp;1,717\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e12.0 [7.0\\u0026ndash;23.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e13.0 [7.0\\u0026ndash;25.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e13.0 [7.0\\u0026ndash;26.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e15.0 [8.0\\u0026ndash;29.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e13.0 [7.0\\u0026ndash;26.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.084\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eEMS agency, n (%), n\\u0026thinsp;=\\u0026thinsp;1,748\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e231 (61.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e250 (49.5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e188 (38.8)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e115 (30.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e784 (44.9)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0 (0.0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e3 (0.6)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e8 (1.7)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e19 (5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e30 (1.7)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1 (0.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e4 (0.8)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e9 (1.9)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e6 (1.6)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e20 (1.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e72 (19.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e93 (18.4)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e87 (17.9)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e95 (25)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e347 (19.9)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#5\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e13 (3.4)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e6 (1.2)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e8 (1.7)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e10 (2.6)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e37 (2.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#6\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e25 (6.6)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e44 (8.7)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e28 (5.8)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e26 (6.8)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e123 (7.0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#7\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e4 (1.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e2 (0.4)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0 (0.0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0 (0.0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e6 (0.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#8\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e4 (1.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e32 (6.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e31 (6.4)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e20 (5.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e87 (5.0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#9\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e10 (2.7)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e14 (2.8)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e16 (3.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e13 (3.4)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e53 (3.0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e14 (3.7)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e22 (4.4)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e49 (10.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e32 (8.4)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e117 (6.7)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#11\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e4 (1.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e35 (6.9)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e61 (12.6)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e44 (11.6)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e144 (8.2)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003ctfoot\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"8\\\"\\u003eECG indicates electrocardiogram; EMS, emergency medical services.\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"8\\\"\\u003e* On-scene arrival time was categorized by the EMS on-scene arrival timestamp: Daytime, 09:00\\u0026ndash;17:59; Nighttime, 18:00\\u0026ndash;08:59 (spanning midnight to the following day).\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"8\\\"\\u003e\\u0026dagger; Call-to-scene: time from receipt of the emergency call to EMS on-scene arrival; Scene-to-ECG interval: time from EMS on-scene arrival to ECG transmission; On-scene time: time from EMS on-scene arrival to scene departure.\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"8\\\"\\u003e\\u0026Dagger; [IQR]: [25th percentile\\u0026ndash;75th percentile]\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tfoot\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eAs shown in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e, patients with scene-to-ECG intervals\\u0026thinsp;\\u0026le;\\u0026thinsp;10 minutes were younger (mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD, 72.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;15.2 vs 75.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;14.3 years; p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) and less likely to be female (31.5% vs 41.7%; p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) than those with intervals\\u0026thinsp;\\u0026gt;\\u0026thinsp;10 minutes. The distribution of EMS agencies also varied between these groups (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001).\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eBaseline Characteristics of Patients by Scene-to-ECG Interval (\\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003e\\u0026le;\\u003c/span\\u003e\\u0026thinsp;10 min vs\\u0026thinsp;\\u0026gt;\\u0026thinsp;10 min)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"6\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eTotal\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eScene-to-ECG\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eScene-to-ECG\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eP value\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003e\\u0026le;\\u003c/span\\u003e\\u0026thinsp;10 minutes\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u0026gt;\\u0026thinsp;10 minutes\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eVariables\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;1748\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;672\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;1076\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eSex, n (%), n\\u0026thinsp;=\\u0026thinsp;1,743\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMale\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1085 (62.2)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e459 (68.5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e626 (58.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eFemale\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e658 (37.8)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e211 (31.5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e447 (41.7)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eAge, year, mean (SD), n\\u0026thinsp;=\\u0026thinsp;1,746\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e74.3 (14.8)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e72.9 (15.2)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e75.2 (14.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eOn-scene arrival time*, n (%), n\\u0026thinsp;=\\u0026thinsp;1,748\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDaytime\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e929 (53.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e382 (56.9)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e547 (50.8)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.014\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eNighttime\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e819 (46.9)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e290 (43.2)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e529 (49.2)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003ePrehospital time interval\\u0026dagger;, minutes, median [IQR]\\u0026Dagger;\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eCall to scene, n\\u0026thinsp;=\\u0026thinsp;1,747\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e8.0 [6.0\\u0026ndash;11.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e8.0 [7.0\\u0026ndash;11.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e8.0 [6.0\\u0026ndash;11.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.851\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eScene-to-ECG, n\\u0026thinsp;=\\u0026thinsp;1,748\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e12.0 [9.0\\u0026ndash;17.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e8.0 [7.0\\u0026ndash;9.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e16.0 [13.0\\u0026ndash;21.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eOn-scene, n\\u0026thinsp;=\\u0026thinsp;1,725\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e17.0 [13.0\\u0026ndash;23.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e14.0 [11.0\\u0026ndash;19.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e19.0 [14.0\\u0026ndash;25.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eScene-to-hospital, n\\u0026thinsp;=\\u0026thinsp;1,717\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e13.0 [7.0\\u0026ndash;26.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e10.0 [6.0\\u0026ndash;20.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e16.0 [8.0\\u0026ndash;29.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eEMS agency, n (%), n\\u0026thinsp;=\\u0026thinsp;1,748\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e784 (44.9)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e322 (47.9)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e462 (42.9)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e30 (1.7)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e9 (1.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e21 (2.0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e20 (1.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e4 (0.6)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e16 (1.5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e347 (19.9)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e182 (27.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e165 (15.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#5\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e37 (2.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e10 (1.5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e27 (2.5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#6\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e123 (7.0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25 (3.7)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e98 (9.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#7\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e6 (0.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e2 (0.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e4 (0.4)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#8\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e87 (5.0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e14 (2.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e73 (6.8)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#9\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e53 (3.0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e31 (4.6)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e22 (2.0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e117 (6.7)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e19 (2.8)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e98 (9.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#11\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e144 (8.2)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e54 (8.0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e90 (8.4)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003ctfoot\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"6\\\"\\u003eECG indicates electrocardiogram; EMS, emergency medical services.\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"6\\\"\\u003e* On-scene arrival time was categorized by the EMS on-scene arrival timestamp: Daytime, 09:00\\u0026ndash;17:59; Nighttime, 18:00\\u0026ndash;08:59 (spanning midnight to the following day).\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"6\\\"\\u003e\\u0026dagger; Call-to-scene: time from receipt of the emergency call to EMS on-scene arrival; Scene-to-ECG interval: time from EMS on-scene arrival to ECG transmission; On-scene time: time from EMS on-scene arrival to scene departure.\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"6\\\"\\u003e\\u0026Dagger; [IQR]: [25th percentile\\u0026ndash;75th percentile]\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tfoot\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\n\\u003ch3\\u003eScene-to-ECG intervals\\u003c/h3\\u003e\\n\\u003cp\\u003eAs summarized in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e, scene-to-ECG intervals were shorter in males (male vs female: 12.0 [9.0\\u0026ndash;17.0] vs 13.0 [10.0\\u0026ndash;17.0] minutes; p\\u0026thinsp;=\\u0026thinsp;0.001) and in daytime arrivals (daytime vs nighttime: 12.0 [9.0\\u0026ndash;16.0] vs 13.0 [9.0\\u0026ndash;18.0] minutes; p\\u0026thinsp;=\\u0026thinsp;0.026). The interval did not differ by age (\\u0026lt;\\u0026thinsp;75 vs\\u0026thinsp;\\u0026ge;\\u0026thinsp;75 years; p\\u0026thinsp;=\\u0026thinsp;0.170) but varied significantly across EMS agencies (Kruskal\\u0026ndash;Wallis p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). Figure\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e illustrates agency-specific distributions, showing right-skewed patterns for agencies #1 and #3, which had higher cumulative numbers of ECG transmissions.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eScene-to-ECG Intervals by Patient Characteristics and EMS Agency\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"4\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eVariables\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eScene-to-ECG interval*, minutes, median [IQR]\\u0026dagger;\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eP value\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eSex\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMale\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e12.0 [9.0\\u0026ndash;17.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eFemale\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e13.0 [10.0\\u0026ndash;17.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eAge\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;75 year\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e12.0 [9.0\\u0026ndash;17.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.170\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003e\\u0026ge;\\u003c/span\\u003e\\u0026thinsp;75 year\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e13.0 [9.0\\u0026ndash;17.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eOn-scene arrival time\\u0026Dagger;\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDaytime\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e12.0 [9.0\\u0026ndash;16.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.026\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eNighttime\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e13.0 [9.0\\u0026ndash;18.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eEMS agency\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e12.0 [9.0\\u0026ndash;16.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e13.5 [10.0\\u0026ndash;19.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e17.0 [11.0\\u0026ndash;28.5]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e10.0 [8.0\\u0026ndash;14.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#5\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e15.0 [10.0\\u0026ndash;22.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#6\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e15.0 [11.0\\u0026ndash;21.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#7\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e13.5 [9.0\\u0026ndash;22.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#8\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e16.0 [12.0\\u0026ndash;22.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#9\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e10.0 [8.0\\u0026ndash;15.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e16.0 [12.0\\u0026ndash;21.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e#11\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e13.0 [8.0\\u0026ndash;21.0]\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003ctfoot\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"4\\\"\\u003e* Scene-to-ECG interval: time from EMS on-scene arrival to ECG transmission.\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"4\\\"\\u003e\\u0026dagger; [IQR]: [25th percentile\\u0026ndash;75th percentile]\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"4\\\"\\u003e\\u0026Dagger; On-scene arrival time was categorized by the EMS on-scene arrival timestamp: Daytime, 09:00\\u0026ndash;17:59; Nighttime, 18:00\\u0026ndash;08:59 (spanning midnight to the following day).\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"4\\\"\\u003eECG indicates electrocardiogram; EMS: emergency medical services.\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tfoot\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eFactors Associated with the scene-to-ECG intervals\\u003c/h2\\u003e\\u003cdiv id=\\\"Sec12\\\" class=\\\"Section3\\\"\\u003e\\u003ch2\\u003ePrimary outcome (scene-to-ECG interval\\u0026thinsp;\\u0026le;\\u0026thinsp;10 minutes)\\u003c/h2\\u003e\\u003cp\\u003eAcross Models 1\\u0026ndash;3, the agency-level cumulative number of ECG transmissions was positively associated with achieving\\u0026thinsp;\\u0026le;\\u0026thinsp;10 minutes (Model 3 adjusted odds ratio, 1.07 per 100 transmissions; 95% confidence interval [CI], 1.02\\u0026ndash;1.14; Table\\u0026nbsp;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e). In Model 4, which included study period and its interaction with the centred cumulative number of ECG transmissions, the association between the cumulative number of ECG transmissions and scene-to-ECG interval was not statistically significant. Female sex, older age, and nighttime arrival were associated with lower odds of achieving the 10-minute target (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eFactors Associated with Achieving a Scene-to-ECG Interval\\u0026thinsp;\\u0026le;\\u0026thinsp;10 Minutes: Logistic Mixed-Effects Models with Multiple Imputation\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"13\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c10\\\" colnum=\\\"10\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c11\\\" colnum=\\\"11\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c12\\\" colnum=\\\"12\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c13\\\" colnum=\\\"13\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c4\\\" namest=\\\"c2\\\"\\u003e\\u003cp\\u003eModel 1\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c7\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003eModel 2\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c10\\\" namest=\\\"c8\\\"\\u003e\\u003cp\\u003eModel 3\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u003cp\\u003eModel 4\\u0026sect;\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eOR\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e95% CI\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eP value\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eOR\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e95% CI\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eP value\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eOR\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e95% CI\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003eP value\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003eOR\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e95% CI\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cp\\u003eP value\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCumulative number of ECG transmissions, by 100 cases\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.07\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.01\\u0026ndash;1.13\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.022\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1.07\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.01\\u0026ndash;1.13\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0.022\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e1.07\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e1.02\\u0026ndash;1.14\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e0.011\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e1.33\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e0.95\\u0026ndash;1.87\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cp\\u003e0.099\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSex, female\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.66\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.53\\u0026ndash;0.81\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.66\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.53\\u0026ndash;0.82\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.65\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e0.52\\u0026ndash;0.81\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAge, by 10 years\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.92\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.86\\u0026ndash;0.99\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0.020\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.91\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.85\\u0026ndash;0.97\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e0.007\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.91\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e0.85\\u0026ndash;0.98\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cp\\u003e0.009\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eOn-scene arrival time, nighttime*\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.71\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.58\\u0026ndash;0.87\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.71\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e0.58\\u0026ndash;0.87\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cp\\u003e0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePeriod\\u0026dagger;\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePeriod 2 vs Period 1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.84\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e0.62\\u0026ndash;1.13\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cp\\u003e0.246\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePeriod 3 vs Period 1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e1.16\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e0.84\\u0026ndash;1.59\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cp\\u003e0.366\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePeriod 4 vs Period 1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e1.16\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e0.82\\u0026ndash;1.65\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cp\\u003e0.401\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCumulative number of ECG transmissions, by 100 cases \\u0026times; period\\u0026Dagger;\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u0026times; Period 2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.93\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e0.68\\u0026ndash;1.28\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cp\\u003e0.666\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u0026times; Period 3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.79\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e0.58\\u0026ndash;1.08\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cp\\u003e0.133\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u0026times; Period 4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.81\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e0.59\\u0026ndash;1.11\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cp\\u003e0.189\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003ctfoot\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"13\\\"\\u003eOR indicates Odds ratio.\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"13\\\"\\u003e*On-scene arrival time was categorized by the EMS on-scene arrival timestamp: Daytime, 09:00\\u0026ndash;17:59; Nighttime, 18:00\\u0026ndash;08:59 (spanning midnight to the following day).\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"13\\\"\\u003e\\u0026dagger;Period divides the 4-year study period into four 12-month intervals: Period 1 (Sep 2021\\u0026ndash;Aug 2022), Period 2 (Sep 2022\\u0026ndash;Aug 2023), Period 3 (Sep 2023\\u0026ndash;Aug 2024), and Period 4 (Sep 2024\\u0026ndash;Aug 2025).\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"13\\\"\\u003e\\u0026Dagger;\\u0026times; denotes an interaction term.\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"13\\\"\\u003e\\u0026sect;Cumulative number was centred within period (deviation from the period mean) to estimate within-period associations.\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tfoot\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eSecondary outcome (scene-to-ECG interval, minutes)\\u003c/h2\\u003e\\u003cp\\u003eThe cumulative number of ECG transmissions was inversely associated with interval duration in Models 1\\u0026ndash;3 (e.g., Model 3 β = \\u0026minus;0.29 minutes per 100 transmissions; 95% CI, \\u0026minus;\\u0026thinsp;0.39 to \\u0026minus;\\u0026thinsp;0.19; Table\\u0026nbsp;\\u003cspan refid=\\\"Tab5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e); however, the association was not significant in Model 4. Older age and nighttime arrival were linked to longer intervals.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab5\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 5\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eFactors Associated with Scene-to-ECG Interval: Linear Mixed-Effects Models with Multiple Imputation\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"13\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c10\\\" colnum=\\\"10\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c11\\\" colnum=\\\"11\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c12\\\" colnum=\\\"12\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c13\\\" colnum=\\\"13\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c4\\\" namest=\\\"c2\\\"\\u003e\\u003cp\\u003eModel 1\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c7\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003eModel 2\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c10\\\" namest=\\\"c8\\\"\\u003e\\u003cp\\u003eModel 3\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u003cp\\u003eModel 4\\u0026sect;\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eParameter estimates\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e95% CI\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eP value\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eParameter estimates\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e95% CI\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eP value\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eParameter estimates\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e95% CI\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003eP value\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003eParameter estimates\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e95% CI\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cp\\u003eP value\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCumulative number of ECG transmissions, by 100 cases\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u0026minus;0.27\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-0.47 to -0.07\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.010\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-0.26\\u003c/p\\u003e \\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-0.47 to 0.06\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0.012\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e-0.29\\u003c/p\\u003e \\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e-0.39 to\\u003c/p\\u003e \\u003cp\\u003e-0.19\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e0.005\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e-1.13\\u003c/p\\u003e \\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e-2.39 to 0.12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cp\\u003e0.076\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSex, female\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.13\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-0.63 to 0.88\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0.744\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.09\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e-0.66 to 0.85\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e0.811\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.16\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e-0.59 to 0.92\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cp\\u003e0.671\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAge, by 10 years\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.27\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.02 to 0.52\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0.034\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.32\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.07 to 0.57\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e0.013\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.31\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e0.06 to 0.56\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cp\\u003e0.015\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eOn-scene arrival time, nighttime*\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e1.30\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.58 to 2.02\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e1.31\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e0.59 to 2.03\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePeriod\\u0026dagger;\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePeriod 2 vs Period 1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.32\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e-0.72 to 1.37\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cp\\u003e0.544\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePeriod 3 vs Period 1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e-0.79\\u003c/p\\u003e \\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e-1.91 to 0.34\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cp\\u003e0.172\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePeriod 4 vs Period 1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e-0.76\\u003c/p\\u003e \\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e-2.00 to 0.47\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cp\\u003e0.226\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCumulative number of ECG transmissions \\u0026times; period\\u0026Dagger;\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u0026times; Period 2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.47\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e-0.65 to 1.59\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cp\\u003e0.413\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u0026times; Period 3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.91\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e-0.22 to 2.04\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cp\\u003e0.114\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u0026times; Period 4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.90\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e-0.25 to 2.05\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cp\\u003e0.123\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003ctfoot\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"13\\\"\\u003e*On-scene arrival time was categorized by the EMS on-scene arrival timestamp: Daytime, 09:00\\u0026ndash;17:59; Nighttime, 18:00\\u0026ndash;08:59 (spanning midnight to the following day).\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"13\\\"\\u003e\\u0026dagger;Period divides the 4-year study period into four 12-month intervals: Period 1 (Sep 2021\\u0026ndash;Aug 2022), Period 2 (Sep 2022\\u0026ndash;Aug 2023), Period 3 (Sep 2023\\u0026ndash;Aug 2024), and Period 4 (Sep 2024\\u0026ndash;Aug 2025).\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"13\\\"\\u003e\\u0026Dagger;\\u0026times; denotes an interaction term.\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"13\\\"\\u003e\\u0026sect;Cumulative number was centred within period (deviation from the period mean) to estimate within-period associations.\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tfoot\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eSensitivity analyses excluding patients with scene-to-ECG intervals\\u0026thinsp;\\u0026ge;\\u0026thinsp;34 minutes (97.5th percentile) yielded consistent results (Tables S1 and S2). Complete-case analyses also showed concordant findings (Tables S3 and S4).\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eIn this prefecture-wide cohort of 1748 patients with prehospital ECG transmission, 38.4% (672 of 1748) achieved transmission within 10 minutes, with a median scene-to-ECG interval of 12 minutes (IQR 9\\u0026ndash;17). These findings align with prior prehospital studies, in which meeting the \\u0026le;\\u0026thinsp;10-minute target remains uncommon [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eGreater cumulative EMS-agency experience was associated with shorter scene-to-ECG intervals and higher odds of meeting the 10-minute benchmark. Female sex, older age, and nighttime arrival were linked to lower odds of achieving\\u0026thinsp;\\u0026le;\\u0026thinsp;10 minutes. When modelled as a continuous outcome, older age and nighttime arrival corresponded to longer scene-to-ECG intervals, whereas sex did not. Although models adjusting for annual periods and their interaction with agency experience lost statistical significance for the cumulative number of ECG transmissions, the point estimates remained directionally consistent. Results were consistent across sensitivity analyses. Collectively, these results indicate an experience-related improvement in on-scene ECG efficiency.\\u003c/p\\u003e\\u003cp\\u003eBy examining the prehospital phase and evaluating cumulative agency experience as a process measure, this study underscores system-level factors beyond patient characteristics and identifies modifiable targets within prehospital workflows. A greater cumulative number of ECG transmissions correlated with shorter scene-to-ECG intervals, suggesting that routine ECG use by EMS personnel may enhance on-scene efficiency. Because intermediate workflow elements (for example, task delegation, lead placement, and device setup time) were not measured, the underlying mechanisms remain uncertain, and causal inferences cannot be made. Within this framework, structured onboarding and periodic practice may warrant prospective evaluation to determine whether similar efficiency can be replicated in lower-experience contexts.\\u003c/p\\u003e\\u003cp\\u003eAfter incorporating calendar-period indicators, centring cumulative experience within each period, and including a period\\u0026ndash;experience interaction, the experience coefficient reflected within-period contrasts rather than overall yearly trends. Allowing the experience effect to vary by year introduced additional parameters and shared variance, reducing precision. Under this specification, the experience term was not statistically significant, although its direction and all sensitivity analyses paralleled the simpler models. This pattern suggests that observed improvements largely reflect system maturation over time, with experience and secular trends evolving together and limiting independent variation. The loss of significance likely reflects temporal overlap rather than absence of an experience effect.\\u003c/p\\u003e\\u003cp\\u003ePrior ED studies have linked female sex, older age, and atypical presentations to longer door-to-ECG intervals [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR23\\\" citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]. By contrast, standardized triage protocols, staff education, and workflow redesign have been shown to shorten these intervals [\\u003cspan additionalcitationids=\\\"CR14 CR15\\\" citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]. Evidence regarding the prehospital FMC-to-ECG interval is more limited; however, existing studies similarly report low achievement of the 10-minute benchmark and identify patient-related contributors to delay [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eLonger intervals among older patients have been documented in previous prehospital studies [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. This pattern may reflect additional time required for multiple on-scene procedures, including assessment, positioning, intravenous access, and patient transfer [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. In the ED, older age has also been associated with prolonged door-to-ECG intervals, although results vary across studies [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003ePrior prehospital reports have attributed longer times in females to a higher frequency of atypical symptoms that delay recognition [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]. In our cohort, females had lower odds of achieving\\u0026thinsp;\\u0026le;\\u0026thinsp;10 minutes; however, the sex term was not statistically significant when modelled as a continuous outcome. This discrepancy aligns with the empirical distribution of scene-to-ECG intervals. A small number of males had exceptionally long intervals, influencing linear models and diminishing the statistical significance of the sex difference. In sensitivity analyses excluding values above the 97.5th percentile (Table S2), the sex term retained the same direction of association as in the primary models but yielded smaller p values (0.052\\u0026ndash;0.062 in Models 2\\u0026ndash;4). By comparison, full-sample continuous models were nonsignificant, with larger p values (0.671\\u0026ndash;0.811 in Models 2\\u0026ndash;4; Table\\u0026nbsp;\\u003cspan refid=\\\"Tab5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e). With the \\u0026le;\\u0026thinsp;10-minute outcome, only whether the benchmark is crossed is relevant; values far above 10 minutes do not contribute additional weight. Therefore, a difference by sex is more easily detected with this threshold outcome than with a continuous model encompassing the full distribution, where a few extreme male values can distort estimates. Consistent with prior prehospital findings [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e], our results indicate longer intervals in females.\\u003c/p\\u003e\\u003cp\\u003eEvidence regarding time-of-day differences in prehospital ECG acquisition remains limited. In one multicenter analysis, the interval from EMS arrival to out-of-hospital ECG was longer during daytime than nighttime, suggesting that delays are not consistently worse after hours [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. In contrast, our findings associate nighttime arrival with longer scene-to-ECG intervals, implying that time-of-day effects may differ by system and warrant local assessment. Given the sparse and heterogeneous literature, these findings should be generalized cautiously.\\u003c/p\\u003e\\u003cp\\u003eThis study\\u0026rsquo;s strengths include prefecture-wide coverage of nearly all prehospital ECG transmissions over a four-year period and the use of multivariable mixed-effects models with EMS-agency random intercepts to account for clustering. Directional consistency across prespecified sensitivity analyses supports the robustness of the results.\\u003c/p\\u003e\\u003cp\\u003eBy shifting the focus from patient characteristics to modifiable operational processes, this study quantifies agency-level cumulative transmission experience in real-world prehospital care. Although intermediate workflow mechanisms were not directly measured, the results identify training and structured onboarding as pragmatic targets for prospective evaluation aimed at reducing scene-to-ECG intervals.\\u003c/p\\u003e\\u003cp\\u003eThis study has several limitations. First, although the operational policy recommends prehospital 12-lead ECG acquisition for patients with suspected ACS, the final decision rests with individual EMS personnel. In the absence of a standardized triage protocol or validated scoring system to define suspected ACS, patient selection may differ across EMS agencies, and residual selection or indication bias cannot be excluded. Nevertheless, current guidelines recommend prompt acquisition of a prehospital 12-lead ECG whenever ACS is suspected, without requiring a formal triage tool [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. We sought to mitigate this potential bias by using multivariable mixed-effects models with EMS-agency random intercepts, and the results were consistent in sensitivity analyses that excluded extreme interval values and in complete-case analyses.\\u003c/p\\u003e\\u003cp\\u003eSecond, the registry included prehospital process measures only and was not linked to in-hospital data. As a result, final diagnoses, treatments received, and clinical outcomes after hospital arrival could not be ascertained. Among patients with prehospital ECG transmission, the proportions ultimately diagnosed with STEMI or receiving reperfusion therapy remain unknown. Consequently, whether shorter scene-to-ECG intervals translate into improved clinical outcomes could not be determined.\\u003c/p\\u003e\\u003cp\\u003eThird, this retrospective analysis was conducted within a single Japanese prefecture, which may limit generalizability to systems with different EMS configurations, patient populations, or health care structures. Not all EMS agencies in the prefecture participated (11 of 14), raising the possibility of participation bias and limiting the representativeness of agency-level practices. These findings should therefore be extrapolated cautiously to other settings.\\u003c/p\\u003e\\u003cp\\u003eFourth, because the study period (September 2021\\u0026ndash;August 2025) overlapped with the COVID-19 pandemic, changes in EMS operations and patient characteristics related to the pandemic cannot be ruled out as potential influences on scene-to-ECG intervals. To account for temporal effects, we included calendar-period indicators and their interactions with the cumulative number of ECG transmissions in the multivariable mixed-effects models. Neither variable reached statistical significance, although modest residual effects may persist.\\u003c/p\\u003e\\u003cp\\u003eFifth, the design cannot fully separate the effects of accumulating experience from time-related system maturation. Thus, the observed association may reflect training-related improvements, temporal system development, or both.\\u003c/p\\u003e\\u003cp\\u003eFuture work should assess whether targeted training reduces scene-to-ECG intervals and identify the specific on-scene procedures that contribute to this effect. Granular time analyses should decompose the interval into recognition, preparation and role allocation, lead placement, acquisition, and transmission to pinpoint major sources of delay. Based on these findings, a standardized onboarding and training programme focused on rapid ECG acquisition and transmission should be implemented and prospectively evaluated using a prespecified analysis plan comparing pre- and post-intervention performance. Reporting changes not only in total interval length but also in sub-intervals would clarify mechanisms of improvement. Finally, linking prehospital and in-hospital data would enable evaluation of whether process improvements correspond with better clinical outcomes in patients with suspected ACS.\\u003c/p\\u003e\"},{\"header\":\"Conclusions\",\"content\":\"\\u003cp\\u003eAt the EMS agency level, a higher cumulative number of prehospital ECG transmissions was associated with achieving the \\u0026le;\\u0026thinsp;10-minute scene-to-ECG target. This association suggests that focused onboarding and continued EMS training may enhance prehospital ECG performance. Older age, female sex, and night-time arrival were associated with not achieving the target.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003eACS acute coronary syndrome\\u003c/p\\u003e\\n\\u003cp\\u003eECG electrocardiogram\\u003c/p\\u003e\\n\\u003cp\\u003eED emergency department\\u003c/p\\u003e\\n\\u003cp\\u003eEMS emergency medical services\\u003c/p\\u003e\\n\\u003cp\\u003eFMC first medical contact\\u003c/p\\u003e\\n\\u003cp\\u003ePCI percutaneous coronary intervention\\u003c/p\\u003e\\n\\u003cp\\u003eSTEMI ST-segment elevation myocardial infarction\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study was approved by the Oita University Human Research Committee (Oita University Research Ethics Committee; approval no. 3239). In accordance with the Ethical Guidelines for Medical and Health Research Involving Human Subjects in Japan, the requirement for individual informed consent was waived. Study information was disclosed on the institutional website, and patients were provided with an opportunity to opt out.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable. This manuscript does not contain any individual person\\u0026rsquo;s identifiable data in any form (including images, videos, or detailed case descriptions).\\u003c/p\\u003e\\n\\u003ch2\\u003eFunding\\u003c/h2\\u003e\\n\\u003cp\\u003eThis research did not receive financial support or grants from any funding agency in the public, commercial, or not-for-profit sectors.\\u003c/p\\u003e\\n\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\n\\u003cp\\u003eHS conceived and designed the study, performed the statistical analyses, and drafted the manuscript. KY, TN, HA, RA, TS, and NT contributed to study design, data interpretation, and critical revision of the manuscript for important intellectual content. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work.\\u003c/p\\u003e\\n\\u003ch2\\u003eAcknowledgement\\u003c/h2\\u003e\\n\\u003cp\\u003eThe authors thank Masae Hayashi, Tomomi Shuto, and Yoshimi Fujimaru for their valuable assistance with the manuscript. The authors thank Editage (www.editage.jp) for English language editing. The authors used an AI-assisted writing tool (ChatGPT, OpenAI) to improve grammar and clarity. The tool did not generate scientific content, data, analyses, references, or images. All authors have reviewed and approved the final manuscript and take full responsibility for its content.\\u003c/p\\u003e\\n\\u003ch2\\u003eData Availability\\u003c/h2\\u003e\\n\\u003cp\\u003eThe data analysed in this study are derived from the Oita Prehospital ECG Registry. Due to ethical restrictions regarding patient privacy and the terms of approval from the Oita University Human Research Committee, the deidentified individual patient data are not publicly available. Data may be made available from the corresponding author (Hiroki Sato) on reasonable request and following additional approval from the Oita University Human Research Committee.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eJacobs AK, Ali MJ, Best PJ, Bieniarz MC, Bufalino VJ, French WJ, et al. Systems of care for ST-segment-elevation myocardial infarction: A policy statement from the American heart association. Circulation. 2021;144:e310\\u0026ndash;27. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1161/CIR.0000000000001025\\u003c/span\\u003e\\u003cspan address=\\\"10.1161/CIR.0000000000001025\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eNakashima T, Hashiba K, Kikuchi M, Yamaguchi J, Kojima S, Hanada H, et al. Impact of prehospital 12-lead electrocardiography and destination hospital notification on mortality in patients with chest pain - A systematic review. Circ Rep. 2022;4:187\\u0026ndash;93. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1253/circrep.CR-22-0003\\u003c/span\\u003e\\u003cspan address=\\\"10.1253/circrep.CR-22-0003\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMoxham RN, d\\u0026rsquo;Entremont M-A, Mir H, Schwalm JD, Natarajan MK, Jolly SS. Effect of prehospital digital electrocardiogram transmission on revascularization delays and mortality in ST-elevation myocardial infarction patients: Systematic review and meta-analysis. CJC Open. 2024;6:1199\\u0026ndash;206. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1016/j.cjco.2024.06.012\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.cjco.2024.06.012\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMenees DS, Peterson ED, Wang Y, Curtis JP, Messenger JC, Rumsfeld JS, et al. Door-to-balloon time and mortality among patients undergoing primary PCI. N Engl J Med. 2013;369:901\\u0026ndash;9. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1056/NEJMoa1208200\\u003c/span\\u003e\\u003cspan address=\\\"10.1056/NEJMoa1208200\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eŻurowska-Wolak M, Piekos P, Jąkała J, Mikos M. The effects of prehospital system delays on the treatment efficacy of STEMI patients. Scand J Trauma Resusc Emerg Med. 2019;27:39. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1186/s13049-019-0616-4\\u003c/span\\u003e\\u003cspan address=\\\"10.1186/s13049-019-0616-4\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eDiercks DB, Peacock WF, Hiestand BC, Chen AY, Pollack CV Jr, Kirk JD, et al. Frequency and consequences of recording an electrocardiogram\\u0026thinsp;\\u0026gt;\\u0026thinsp;10 minutes after arrival in an emergency room in non-ST-segment elevation acute coronary syndromes (from the CRUSADE Initiative). Am J Cardiol. 2006;97:437\\u0026ndash;42. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1016/j.amjcard.2005.09.073\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.amjcard.2005.09.073\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eByrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44:3720\\u0026ndash;826. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1093/eurheartj/ehad191\\u003c/span\\u003e\\u003cspan address=\\\"10.1093/eurheartj/ehad191\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eRao SV, O\\u0026rsquo;Donoghue ML, Ruel M, Rab T, Tamis-Holland JE, Alexander JH, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the Management of Patients With Acute Coronary Syndromes: A report of the American college of cardiology/American heart association joint committee on clinical practice guidelines. Circulation. 2025;151:e771\\u0026ndash;862. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1161/CIR.0000000000001309\\u003c/span\\u003e\\u003cspan address=\\\"10.1161/CIR.0000000000001309\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eTakakuwa KM, Shofer FS, Hollander JE. The influence of race and gender on time to initial electrocardiogram for patients with chest pain. Acad Emerg Med. 2006;13:867\\u0026ndash;72. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1197/j.aem.2006.03.566\\u003c/span\\u003e\\u003cspan address=\\\"10.1197/j.aem.2006.03.566\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eZ\\u0026egrave;gre-Hemsey J, Sommargren CE, Drew BJ. Initial ECG acquisition within 10 minutes of arrival at the emergency department in persons with chest pain: time and gender differences. J Emerg Nurs. 2011;37:109\\u0026ndash;12. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1016/j.jen.2009.11.004\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.jen.2009.11.004\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eYiadom MYAB, Gong W, Patterson BW, Baugh CW, Mills AM, Gavin N, et al. Fallacy of median door-to-ECG time: Hidden opportunities for STEMI screening improvement. J Am Heart Assoc. 2022;11:e024067. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1161/JAHA.121.024067\\u003c/span\\u003e\\u003cspan address=\\\"10.1161/JAHA.121.024067\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eLin Y-T, Chen H-A, Wu H-Y, Fan C-M, Hsu J-C, Chen K-C. Influence of the door-to-ECG time on the prognosis of patients with acute coronary syndrome. Acta Cardiol Sin. 2023;39:127\\u0026ndash;34. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.6515/ACS.202301_39(1).20220602B\\u003c/span\\u003e\\u003cspan address=\\\"10.6515/ACS.202301_39(1).20220602B\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eTakakuwa KM, Burek GA, Estepa AT, Shofer FS. A method for improving arrival-to-electrocardiogram time in emergency department chest pain patients and the effect on door-to-balloon time for ST-segment elevation myocardial infarction. Acad Emerg Med. 2009;16:921\\u0026ndash;7. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1111/j.1553-2712.2009.00493.x\\u003c/span\\u003e\\u003cspan address=\\\"10.1111/j.1553-2712.2009.00493.x\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eChhabra S, Eagles D, Kwok ESH, Perry JJ. Interventions to reduce emergency department door-to- electrocardiogram times: A systematic review. CJEM. 2019;21:607\\u0026ndash;17. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1017/cem.2019.342\\u003c/span\\u003e\\u003cspan address=\\\"10.1017/cem.2019.342\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eLee C-K, Meng S-W, Lee M-H, Chen H-C, Wang C-L, Wang H-N, et al. The impact of door-to-electrocardiogram time on door-to-balloon time after achieving the guideline-recommended target rate. PLoS ONE. 2019;14:e0222019. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1371/journal.pone.0222019\\u003c/span\\u003e\\u003cspan address=\\\"10.1371/journal.pone.0222019\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSu H-Y, Tsai J-L, Hsu Y-C, Lee K-H, Chang C-S, Sun C-K, et al. A modified cardiac triage strategy reduces door to ECG time in patients with ST elevation myocardial infarction. Sci Rep. 2021;11:6358. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1038/s41598-021-86013-8\\u003c/span\\u003e\\u003cspan address=\\\"10.1038/s41598-021-86013-8\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSullivan AL, Beshansky JR, Ruthazer R, Murman DH, Mader TJ, Selker HP. Factors associated with longer time to treatment for patients with suspected acute coronary syndromes: a cohort study: A cohort study. Circ Cardiovasc Qual Outcomes. 2014;7:86\\u0026ndash;94. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1161/CIRCOUTCOMES.113.000396\\u003c/span\\u003e\\u003cspan address=\\\"10.1161/CIRCOUTCOMES.113.000396\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMuhrbeck J, Persson J, Hofman-Bang C. Catheterization laboratory activations and time intervals for patients with pre-hospital ECGs. Scand Cardiovasc J. 2018;52:74\\u0026ndash;9. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1080/14017431.2018.1430899\\u003c/span\\u003e\\u003cspan address=\\\"10.1080/14017431.2018.1430899\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003ePark K, Park JS, Cho YR, Park TH, Kim MH, Yang TH, et al. Community-based pre-hospital electrocardiogram transmission program for reducing systemic time delay in acute ST-segment elevation myocardial infarction. Korean Circ J. 2020;50:709\\u0026ndash;19. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.4070/kcj.2019.0337\\u003c/span\\u003e\\u003cspan address=\\\"10.4070/kcj.2019.0337\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMuhrbeck J, Maliniak E, Eurenius L, Hofman-Bang C, Persson J. Few with ST-segment elevation myocardial infarction are diagnosed within 10 minutes from first medical contact, and women have longer delay times than men. Int J Cardiol Heart Vasc. 2020;26:100458. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1016/j.ijcha.2019.100458\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.ijcha.2019.100458\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eYufu K, Shimomura T, Kawano K, Sato H, Yonezu K, Saito S, et al. Usefulness of prehospital 12-lead electrocardiography system in ST-segment elevation myocardial infarction patients in Oita - comparison between urban and rural areas, weekday daytime and weekday nighttime/holidays. Circ J. 2023. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1253/circj.CJ-23-0365\\u003c/span\\u003e\\u003cspan address=\\\"10.1253/circj.CJ-23-0365\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e. advpub:CJ-23-0365.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eZ\\u0026egrave;gre-Hemsey JK, Patel MD, Fernandez AR, Pelter MM, Brice J, Rosamond W. A statewide assessment of prehospital electrocardiography approaches of acquisition and interpretation for ST-elevation myocardial infarction based on Emergency Medical Services characteristics. Prehosp Emerg Care. 2020;24:550\\u0026ndash;6. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1080/10903127.2019.1677831\\u003c/span\\u003e\\u003cspan address=\\\"10.1080/10903127.2019.1677831\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eInoue A, Mizobe M, Takahashi J, Funakoshi H. Factors for delays in door-to-balloon time\\u0026thinsp;\\u0026le;\\u0026thinsp;90 min in an electrocardiogram triage system among patients with ST-segment elevation myocardial infarction: a retrospective study. Int J Emerg Med. 2023;16:77. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1186/s12245-023-00562-5\\u003c/span\\u003e\\u003cspan address=\\\"10.1186/s12245-023-00562-5\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eBrush JE Jr, Chaudhry SI, Dreyer RP, D\\u0026rsquo;Onofrio G, Greene EJ, Hajduk AM, et al. Sex differences in symptom complexity and door-to-balloon time in patients with ST-elevation myocardial infarction. Am J Cardiol. 2023;197:101\\u0026ndash;7. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1016/j.amjcard.2023.03.009\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.amjcard.2023.03.009\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-emergency-medicine\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"emmd\",\"sideBox\":\"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/emmd\",\"title\":\"BMC Emergency Medicine\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"acute coronary syndrome, electrocardiogram, emergency medical services, prehospital care\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8033271/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8033271/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e\\u003cp\\u003ePrehospital 12-lead electrocardiogram (ECG) improves outcomes in ST-segment elevation myocardial infarction, yet meeting the 10-minute target from first medical contact remains difficult. We evaluated determinants of faster prehospital ECG performance.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e\\u003cp\\u003eWe analysed a prefecture-wide registry in Japan (September 2021 to August 2025) of patients with suspected acute coronary syndrome who had prehospital ECG transmission. Prehospital ECG performance was assessed using the scene-to-ECG interval, from emergency medical services (EMS) on-scene arrival to ECG transmission. The primary outcome was scene-to-ECG\\u0026thinsp;\\u0026le;\\u0026thinsp;10 minutes; the secondary outcome was interval length. Agency experience was measured by cumulative ECG transmissions. Mixed-effects logistic and linear models with agency random intercepts adjusted for age, sex, and time of arrival, and included calendar-period indicators and a period-by-experience interaction.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e\\u003cp\\u003eOf 1,748 patients, 672 (38.4%) achieved\\u0026thinsp;\\u0026le;\\u0026thinsp;10 minutes; the median scene-to-ECG was 12 minutes (interquartile range 9 to 17). Greater cumulative transmissions were associated with higher odds of \\u0026le;\\u0026thinsp;10 minutes (adjusted odds ratio 1.07 per 100 cases, 95% confidence interval 1.02 to 1.14) and shorter intervals (β\\u0026thinsp;\\u0026minus;\\u0026thinsp;0.29 minutes per 100 cases, 95% confidence interval \\u0026minus;\\u0026thinsp;0.39 to \\u0026minus;\\u0026thinsp;0.19) but were not statistically significant after adding period and the interaction. Older age, female sex, and nighttime arrival were associated with longer intervals.\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e\\u003cp\\u003eAt the EMS agency level, higher cumulative ECG transmissions were associated with achieving the \\u0026le;\\u0026thinsp;10-minute scene-to-ECG target. This suggests that focused onboarding and continued EMS training may enhance prehospital ECG performance. Older age, female sex, and night-time arrival were associated with not achieving the target.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Factors associated with achieving the 10-minute scene-to-ECG transmission target in prehospital care: the role of EMS agency-level cumulative ECG transmissions\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-12-02 14:32:58\",\"doi\":\"10.21203/rs.3.rs-8033271/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2026-05-07T11:22:40+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-05-07T11:19:25+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-05-03T07:23:57+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"86234728887737161428047496186636614068\",\"date\":\"2026-04-21T06:19:26+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-12-10T01:28:15+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"101720310750240465441758463440834020080\",\"date\":\"2025-11-29T01:30:56+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-11-28T10:36:14+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2025-11-07T10:49:00+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-11-05T10:38:59+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-11-05T10:35:08+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Emergency Medicine\",\"date\":\"2025-11-05T02:14:23+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-emergency-medicine\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"emmd\",\"sideBox\":\"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/emmd\",\"title\":\"BMC Emergency Medicine\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"0d825ac6-6173-4621-9851-b31521a50641\",\"owner\":[],\"postedDate\":\"December 2nd, 2025\",\"published\":true,\"recentEditorialEvents\":[{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2026-05-07T11:22:40+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-05-07T11:19:25+00:00\",\"index\":124,\"fulltext\":\"\"}],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-05-15T13:39:31+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-12-02 14:32:58\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8033271\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8033271\",\"identity\":\"rs-8033271\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}