Cardiac Cath Lab - Specialty Referral?

[RedZone]

Here in NYC, our protocols demand that "under no circumstances" we bring unstable patients anywhere but the nearest "911 receiving hospital". The only exceptions are for specialty care referrals or by telemetry physician order. Presently, the fire department (which regulates the 911 EMS system), is taking steps to enforce protocol issues with hospital selection.

Recognized Specialty Care Centers:

- Trauma Center

- Burn Center (Trauma takes precedence)

- Hyperbaric Center

- Replantation Center

- Spinal Cord Injury Center

- Venomous Bite Center

Most recently (Aug. 2006), Stroke Center is now recognized.

My bass ackwards city (and state) DOES NOT recognize cardiac center! If I have a patient having an acute MI, I am required to bring that patient to the nearest emergency room even if that hospital does not have a cardiac cath lab. Because I have a close working relationship with one particular cath lab (from several jobs, past and present), I know how important it is for an AMI pt to be on the cath table ASAP.

I've been able to manipulate the system sometimes in the past, but now I am just going to have to call telemetry for every MI unless they shut me up or change the rule.

Does your region recognize cardiac centers?

[JPINFV]

Where I'm at they've just recently (within the past 2 years) introduced cardiovascular receiving centers. Paramedics can be rerouted to them ONLY by the base hospital physician ONLY after the 12 lead interprets the rhythm to be an acute MI (yes, the medics don't get to do the interpretation themselves).

[RedZone]

ONLY after the 12 lead interprets the rhythm to be an acute MI (yes, the medics don't get to do the interpretation themselves).

Oh my... please tell me that your protocols don't tell you to provide treatment based on the machine's interpretation too.

[AnthonyM83]

We have ST Elevation MI Receiving Centers. If the 12 lead shows the ST elevation, we call it in and go to the nearest STEMI Center with cath lab. A new trend is for hospitals to push for getting setup as a receving center. Though, apparently now they're finding bypass is more effective. Oh well.

[RedZone]

We have ST Elevation MI Receiving Centers. If the 12 lead shows the ST elevation, we call it in and go to the nearest STEMI Center with cath lab. A new trend is for hospitals to push for getting setup as a receving center. Though, apparently now they're finding bypass is more effective. Oh well.

Ugh! I do a lot of transfers from ER directly to the cath table. Lots of times the patient is freaking out and one of the things I say to help calm them is, "They try not to crack chests anymore if at all possible." Where did you hear about that bypass thing?

Once I brought a patient from the Dr's office to the closest hospital knowing that I was going to have to come back and take him to the cath table at another hospital. For ED's here it used to be: cath now if you have the ability or else thrombolytics and arrange for cath later. I don't know if it's a "trend" in all the city, but the hospitals I do transfers for are putting a lot of pressure on the ER to cath within one hour for STEMIs, immediate transfer if necessary.

[scratrat]

Both of our hospitals are cardiac centers with a cath lab.

Only one is a certified stroke center though. And by State law, we are required to bring any suspected stroke to that hospital, regardless of what the pt wants.

[RedZone]

Both of our hospitals are cardiac centers with a cath lab.

Only one is a certified stroke center though. And by State law, we are required to bring any suspected stroke to that hospital, regardless of what the pt wants.

Interesting. For us it is a consent issue. If the patient is not oriented, we have implied consent and may make the decision for them. If the patient is oriented, we have a responsibility to inform them that their decision may be harmful and attempt to convince them. If they insist, we have them sign an RMA and obey their wishes. If they are unstable, it would probably have to be approved by telemetry, but I don't really run into this issue. It's rare that someone will argue with me when I tell them, "that hospital can't treat xxxx condition"

[JPINFV]

Oh my... please tell me that your protocols don't tell you to provide treatment based on the machine's interpretation too.

· Cardiovascular Receiving Center (CRC) triage: If field 12-lead identifies ST-segment elevation MI (STEMI) – machine interpretation is “acute myocardial infarction suspected” report this to the base hospital for possible triage to a Cardiovascular Receiving Center.

http://www.ochealthinfo.com/docs/medical/e...delines/c15.pdf

Medics need a base hospital order for morphine and they currently aren't allowed to administer ASA.

[MeekoBB]

I voted "Yes, but I usually go to the closest ED anyway." because most of the hospitals around here have cath labs already. The few that don't also are capable of stabalizing the patient for a CC truck to transfer. I know of 2 hospitals that transfer out but they also have trucks on standby the second they get a cardiac patient in if they need to be transferred to another facility.

[flight-lp]

We have a Cath Alert protocol for our AMI and acute onset LBB pts. They all, regardless of location, go to the same hospital for immediate cath. The protocol calls for the usual AMI stuff (i.e MONA as required), followed by a Heparin bolus and Lopressor if indicated. Upon our interpretation of the 12 lead, the ER charge nurse is notified that we have a "Cath Alert" and in turns activates the cath team. We bypass the ER and head straight to the cath lab (unless its at night and the team hasn't arrived yet, then we'll deliver to the ER until they arrive). We are hoping to add some other facilities to this program to further reduce our transport time, but as we stand now, our current time from 911 call until revascularization is around 85 minutes. The national standard from ER door time to revascularization is 90 minutes, so I guess we aren't doing too darn bad!