Requirements for STEMI bypass

[WolfmanHarris]

So this topic is twofold:

1) First I'm curious as to how much variation exists in STEMI bypass medical directives. So if you would be willing to post your local directive that would be great. I'd like to explore these different protocols and discuss the reasoning behind some of the variations (aside from the medic vs. machine interpretation argument if possible.)

STEMI Bypass Medical Directive: (Only changed to remove identifiers for where I work.)

When the following indications and conditions exist, a Primary Care Paramedic may bypass the closest hospital to transport a patient from within [Geographc Area of the Service] to [indicated Hospital] for Primary Coronary Intervention (PCI), according to the following:

Indications:

Patient who is experiencing cardiac ischemic “chest pain” or discomfort OR experiencing symptoms consistent with their typical angina / infarct events.

Conditions:

Patient is alert and ≥ 16 years of age

Current episode of cardiac ischemia ≤ 12 hours in duration

Paramedic interpretation of the 12 or 15 lead identifies an AMI (ST segment elevation in 2 or more anatomically contiguous leads: ≥ 1 mm in limb leads or ≥ 2 mm in precordial leads)

Call location is based in [Geographic Area]

Time from patient contact to arrival at [Hospital] will be ≤ 60 minutes.

Contraindications:

SBP ≤ 100 mmHg

HR < 60 or > 160 bpm

Left Bundle Branch block (LBBB) or Ventricular Paced Rhythm

Hemodynamically unstable patient

Procedure

1. Continue the care started according to the Acute Coronary Syndrome Medical Directive

2. Acquire and print a diagnostic 12 and/or 15 lead demonstrating evidence of AMI (based on paramedic interpretation and not

the LP12’s interpretative software)

3. Confirm that the call is based in [Geographic Area] and that the time from patient contact to arrival at [Hospital] will be less than 60 minutes

4. Contact CACC to advise of the bypass and initiate transport.

5. Call [Phone number] as soon as possible to activate “CODE STEMI”. Advise you are EMS, from [service] and your ETA and the patient’s age and gender.

6. Continue care including oxygen administration, vital signs, pharmacological interventions and repeat 12 cardiograms.

7. On arrival at [Hospital], pick up the swipe card and bypass the Emergency department and proceed directly to the CCU on the 5th floor.

2) I know certain demographics are far more prone to atypical presentation MI's. I'm having trouble finding good info that really explores this concept and maybe has some numbers.

[CBEMT]

When we get it, our STEMI protocol will instruct Medical Control contact with the nearest PCI center, where the ER physician will authorize either diversion to their facility or order the patient transported to the closest ER, depending on the situation.