Enhancing Pre-Hospital Emergency Care for Cardiovascular Patients: A Scoping Review

Background Acute Coronary Syndrome (ACS) is responsible for substantial morbidity and mortality globally, with 35–45% of deaths occurring in pre-hospital settings. Despite advances in emergency protocols, assessment methods for pre-hospital emergency medical services often rely on limited metrics that fail to capture care quality comprehensively. Objective To identify quality assessment criteria for pre-hospital emergency services in ACS patients and develop a framework for a comprehensive quality assessment tool. Methods A scoping review following Arksey and O'Malley's framework was conducted. Studies published between January 2014 and October 2024 were identified through searches of Scopus, PubMed, ProQuest, Embase, Web of Science, and SID. Quality assessment domains were categorized using combined Institute of Medicine and Donabedian frameworks. Results Twenty-eight studies met inclusion criteria. Key quality indicators included implementation of pre-hospital ECG, timeliness metrics, telemedicine integration, clinical decision support, education, and equity considerations. The combined quality framework identified 18 domain intersections spanning structure, process, and outcome dimensions across effectiveness, efficiency, safety, timeliness, equity, and patient-centeredness. Conclusion This review highlights the necessity for multi-domain assessment of pre-hospital emergency cardiovascular care. Implementation of standardized protocols, point-of-care diagnostics, telemedicine, and ongoing training programs demonstrably improves ACS care quality. Future research should address implementation strategies, equity interventions, and comprehensive outcome measurement.