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Every year, almost 400,000 people experience ST-Elevation Myocardial Infarction or a STEMI, the deadliest type of heart attack. Unfortunately, a significant number don't receive prompt reperfusion therapy, which is critical in restoring blood flow. Worse yet, 30 percent of STEMI victims don't receive reperfusion treatment at all.
(AHA Mission Lifeline)
The Mission Statement of the EMSI STEMI Committee is to improve the pre-hospital care of the STEMI patient within the 10 county EMSI region. This can be achieved by education, upgrading and improvement of ECG and transmission/receiving equipment, and a STEMI Regional Protocol and Guidelines for our EMS Providers to follow.
Equipment
There is a need for upgrading and improvement of the STEMI infrastructure in the EMSI region. This includes ECG and transmission equipment. Equipment needs vary for each EMS agency. Some are in need of cables, modems, cellular phones and service as well as upgrades to the ECG heart monitors itself. On the medical command/hospital side are needs for receiving stations, computers, and upgrades in software. In a recent STEMI survey done by the region, it was found that 26% of the heart monitors do not have 12 lead capabilities or need additional equipment in order to acquire and transmit a 12 lead. There is more analysis to be done to determine the needs of medical command systems and hospitals to receive 12 lead ECG’s from field EMS.
Education
The EMSI region will offer education in 12 lead acquisition, interpretation, and transmission using the regional and state STEMI protocols. There are several 12 lead presentations that are available to EMS agencies in the region. The STEMI Committee agreed to offer a regional STEMI educational component for those who are in need. In a recent STEMI survey done by the region, it was found that 27% of the EMS agencies would like the regional counsil to offer 12 lead/STEMI education. 64% state they would use their own programs as long as they met the criteria established by the STEMI Committee. Implemenation of the educational component are being discusses at this time.
STEMI Regional Protocol/Guidelines
The EMSI region has defined the standard of care for the potential STEMI patient. The standard is to follow PA protocol #5001 Acute Coronary Syndrome Protocol. Combining the state protocol along with the EMSI Regional STEMI Protocol and Guideline will be the standard. The Regional STEMI protocol says that a 12 leads must be done on every potential STEMI patient. Upon obtaining the 12 lead, EMS must transmit preferably on scene to medical command for interpretation or for further orders. The 12 lead should be sent to the receiving PCI hospital or hospital PCI referral center as soon as possible to activate the system of care of rapid reperfusion of an occluded coronary artery (PCI Center or Referral Center) and EMS should rapidly transport the STEMI patient to that chosen PCI facility. If transmission is not possible, EMS must interpret to the best of their ability the 12 lead ECG, communicate their findings to medical command so an intelligent decision can be made to transport the STEMI patient to the appropriate facility.
In a recent STEMI survey done by the region, it was found that over 21% of the EMS agencies do not transmit 12 lead ECG’s for various reasons. The EMSI STEMI committee understands that not only does it need to address equipment deficiencies and education deficiencies to correct this problem, but also answer misperceptions as to how important the EMS providers role is in positive outcome of the STEMI patient by acquisition and transmission of a 12 lead ECG following the regional guideline.
The EMSI Medical Directors Committee has agreed in principle to follow the recommendations of the AHA Mission Lifeline. The EMSI STEMI Committee has drafted a regional protocol and guideline that also follows these principles. The regional protocol understands that the region has EMS agencies that are already acquiring, interpreting, and transmitting 12 lead ECGs and quickly transporting the STEMI patient to the appropriate PCI locations.
On the opposite side, the STEMI Committee has identified a number of reasons why 12 lead ECG’s are not being done within the region. By offering education, improvements in equipment and a more definitive STEMI guidelines to follow, the EMSI Region and the STEMI committee can and will improve STEMI patient outcomes.