Emergency Medical Services Management of ST-Elevation Myocardial Infarction

Millin, Michael G.; Brooks, Steven C.; Travers, Andrew H.; Megargel, Ross E.; Colella, M. Riccardo; Rosenbaum, R. A.; Aufderheide, Tom P.

doi:10.1080/10903120802099310

Cited by 13 publications

(3 citation statements)

References 94 publications

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“…13 Traditional EMS performance measures have focused on response times, [14][15][16][17][18] appropriate patient selection for prehospital rapidsequence intubation (RSI) 19 and air versus ground transportation, 20 and out-of-hospital cardiac arrest survival. 21,22 Newer efforts are expanding EMS benchmarks for various clinical entities encountered by EMS systems, such as ST-segment elevation myocardial infarction (STEMI), [23][24][25] acute stroke, 26 pulmonary edema, asthma, and seizures. 27 Examples of disaster response-based metrics that are currently being studied include appropriateness of triage level, transportation to a hospital with suitable treatment capability, and time-dependent mortality of victims.…”

Section: Development Of Performance Metricsmentioning

confidence: 99%

Role of Emergency Medical Services in Disaster Response: Resource Document for the National Association of EMS Physicians Position Statement

Catlett

Jenkins

Millin

2011

Prehospital Emergency Care

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The National Association of EMS Physicians (NAEMSP) advocates for a strong emergency medical services (EMS) role in all phases of disaster management-preparedness, response, and recovery. Emergency medical services administrators and medical directors should play a leadership role in preparedness activities such as training and education, development of performance metrics, establishment of memoranda of understanding (MOUs), and planning for licensure and liability issues. During both the planning and response phases, EMS leadership should advocate for participation in unified command, modified scope of practice appropriate for providers and the event, and expanded roles in community and federal response efforts. To enhance recovery, EMS leadership should strongly advocate for national recognition for EMS efforts and further research into strategies that foster healthy coping techniques and resiliency in the EMS workforce. This resource document will outline the basis for the corresponding NAEMSP position statement on the role of

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Section: Development Of Performance Metricsmentioning

confidence: 99%

Role of Emergency Medical Services in Disaster Response: Resource Document for the National Association of EMS Physicians Position Statement

Catlett

Jenkins

Millin

2011

Prehospital Emergency Care

Self Cite

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“…2,3,8) Aspirin is an inexpensive and easily accessible medicine that can be administered quickly, with minimal side effects, even in a pretransfer setting. 8,10,11) However, clinical data demonstrating the benefits of pretransfer aspirin use in patients with STEMI before PCI remain lacking. 8,9) In the present study, pretransfer aspirin administration was not directly associated with decreased infarct size and 30-day mortality.…”

Section: Discussionmentioning

confidence: 99%

Pretransfer Aspirin Administration and Its Impact on Angiographic Outcomes for Patients with ST-Elevation Myocardial Infarction

Yamada,

Horikoshi,

Nakamura

et al. 2024

Int. Heart J.

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Although guidelines recommend early aspirin administration after diagnosis of ST-elevation myocardial infarction (STEMI), the decision of pretransfer aspirin administration is at the discretion of the primary physicians. Therefore, this study aimed to determine whether pretransfer aspirin administration was associated with better angiographical outcomes in patients with STEMI. This study compared the angiographic findings of thrombolysis in myocardial infarction (TIMI) flow grade in the infarct-related artery before percutaneous coronary intervention (PCI) between patients who received pretransfer aspirin and those who did not. In total, 28 patients (11.2%) were administered aspirin before transfer and 219 (88.8%) were administered aspirin upon arrival at the hospital. Propensity score matching yielded 135 patients [27 patients (20%) who were administered aspirin before transfer and 108 patients (80%) who were administered aspirin upon arrival at the hospital]. Patients who received pretransfer aspirin had a higher rate of TIMI-3 flow before PCI compared to those who did not receive pretransfer aspirin [8 (28.6%) versus 15 (6.8%), P < 0.01, in all study patients; 8 (26.6%) versus 7 (6.5%), P < 0.01, in propensity-score-matched patients]. Multivariable logistic regression analysis revealed that pretransfer aspirin administration was significantly associated with the presence of TIMI-3 flow before PCI, independent of age, gender, transfer time, and statin use (OR: 5.43, 95% CI: 1.94-15.2, P < 0.01, in all study patients; OR: 6.17, 95% CI: 1.86-20.46, P < 0.01, in propensity-score-matched patients). Pretransfer aspirin administration could lead to the early restoration of coronary blood flow in patients with STEMI, supporting its active use in STEMI care.

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“…Delays in activation of 911 often account for the largest delay from symptom onset to definitive care. 50 Average delays to hospital arrival for STEMI patients have been shown to be between 1.5 and six hours from symptom onset. 51 Furthermore, once a patient decides to seek medical care, a substantial number of patients with concerning symptoms do not utilize 911.…”

Section: Barriers To Implementationmentioning

confidence: 99%

The Role of EMS in Regionalized Systems of Care

Drennan

Verbeek

2015

CJEM

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The parallel advancement of prehospital and in-hospital patient care has provided impetus for the development and implementation of regionalized systems of health care for patients suffering from acute, life-threatening injury and illness. Regardless of the patient's clinical condition, regionalized systems of care revolve around the premise of providing the right care to the right patient at the right time. Current regionalization strategies have shown improvements in the time to patient treatment and in patient outcome, with the incorporation of emergency medical services (EMS) bypass as a key component of the system of care. This article discusses the emerging role of EMS as a critical component of regionalized systems essential to ensure effective and efficient use of resources to improve patient outcome. We also examine some of the benefits and barriers to implementation of regionalized systems of care and avenues for future research.

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Emergency Medical Services Management of ST-Elevation Myocardial Infarction

Cited by 13 publications

References 94 publications

Role of Emergency Medical Services in Disaster Response: Resource Document for the National Association of EMS Physicians Position Statement

Role of Emergency Medical Services in Disaster Response: Resource Document for the National Association of EMS Physicians Position Statement

Pretransfer Aspirin Administration and Its Impact on Angiographic Outcomes for Patients with ST-Elevation Myocardial Infarction

The Role of EMS in Regionalized Systems of Care

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