Assessment of the Safety and Effectiveness of Emergency Department STEMI Bypass by Defibrillation-only Emergency Medical Technicians/Primary Care Paramedics

Abstract

Substantial time savings may occur if EMT-Ds/PCPs bypass non-PCI center EDs with only a small predicted increase (about 7 minutes) in the transport time to the PCI center ED. EMT-P/ACP rendezvous does not appear to substantially increase transport time. Given the relatively low occurrence of clinically important events, our findings suggest that EMT-D/PCP bypass to a PCI center ED may be safe and effective for selected STEMI patients.

Relationship between Time-to-ROSC and Survival in Out-of-hospital Cardiac Arrest ECPR Candidates: When is the Best Time to Consider Transport to Hospital?

“…Furthermore, there are additional resource-intensive logistical factors that require planning, albeit for a relatively small number of patients who would be eligible. Experience gleaned from the development STEMI protocols in the recent years may have high yield for ECPR protocols, including the prehospital identification of eligible patients, prehospital ECPR team activation, and bypass of other hospitals to designated ECPR centers [38][39][40] In-hospital ECPR teams that could be rapidly mobilized would be required. These protocols would need to prioritize rapid arrest-to-ECMO times, however with the recognition that there would be a proportion of false positive prehospital activations for those who would achieve ROSC in the intervening time prior to actual cannulation.…”

Informing a Canadian paramedic profile: framing concepts, roles and crosscutting themes

“…Alternative disposition for patients (e.g., bypass protocols, referrals, treat and release programs) are increasingly common [13–16]. Even in more traditional models, innovative, specialized and expanding care programs are emerging [14, 17, 18]. These “non-traditional” practice settings have been effective in helping to manage acute and chronic conditions, reduce unplanned transfers to emergency departments, promote more health care touch points for patients and avoid or minimize admission and readmission rates [19].…”

Evaluation of a primary care paramedic STEMI bypass guideline

“…Eight (2.3%) patients experienced cardiac arrest of whom six presented with VF/VT. Lastly, Ross et al 8 reported that, in 89 PCP STEMI cases transported to the nearest hospital, the ischemic time could have been decreased by an estimated 50 minutes with direct transport to a PCI centre while only incurring a 7-minute increase in the transport interval. Three (3.3%) patients experienced prehospital cardiac arrest, all characterized by VF/VT.…”

“…Eleven of 361 patients (3.0%) experienced a sudden cardiac arrest. Reports suggest that this is predictable in 2% to 5% of cases, 8,10,15,16 most being stable prior to the arrest and presenting with VF. In our study, all patients with VF were resuscitated with one to three shocks, and none required intubation or other ACI.…”

“…Recent reports have suggested that hemodynamically stable STEMI patients infrequently require advanced care interventions (ACI) and that primary care paramedic (PCP) transport of these patients may be safe. [8][9][10] To add to the evidence, we evaluated a STEMI bypass guideline authorizing PCPs to perform a STEMI bypass for hemodynamically stable patients complemented by a consideration for advanced care paramedic (ACP) rendezvous/transport for hemodynamically unstable patients. Our objectives were to 1) assess PCP assignment of patients to PCP transport versus ACP-rendezvous according to stable versus unstable criteria, respectively, 2) compare the proportion of patients transported by PCPs having indications for an ACI with the proportion of patients receiving an ACI after ACP-rendezvous, 3) describe clinical aspects of patients who experienced cardiac arrest, and 4) compare transport intervals incurred by a PCP STEMI bypass, with or without ACP-rendezvous, with PCP transport intervals to the nearest ED.…”