Evaluation of a primary care paramedic STEMI bypass guideline

Abstract

We found a significant difference in the distribution of stable and unstable patients and fewer patients with indications for an ACI in PCP patients. This PCP STEMI bypass guideline appears feasible.

Safety and clinically important events in PCP-initiated STEMI bypass in Ottawa

“…Of note, the study by Kwong et al also found that the most common ACP intervention was a fluid bolus for hypotension, and they found that the median volume infused was only 300 ml. 8 Most importantly, in our population other more serious and advanced interventions were infrequent. While the majority of the clinically important events observed were related to hypotension, these are arguably the patients that would benefit most from urgent PCI and STEMI bypass.…”

“…Previous studies have shown an arrest rate of roughly 2% to 3% within similar EMS systems. 5,6,8 PCP paramedics have the skill to rapidly recognize cardiac arrest and deploy an AED and basic airway skills.…”

“…Furthermore, our study is independently in agreement with two recent studies supporting the safety of PCP-only STEMI bypass, therefore adding to the mounting evidence of safety for PCP-only STEMI bypass. 7,8 Finally, we believe that our inclusion of an ACP-intercept cohort allows some determination of actual ACP intervention in the setting of encountered clinically important events.…”

“…5,6 Two recent studies have been published in this journal examining PCP STEMI bypass. 7,8 Bussières et al looked at a PCP STEMI bypass in a rural setting in a PCP-only EMS system, whereas Kwong et al evaluated a PCP STEMI bypass guideline in a dense urban environment with both PCP and ACP care. Our study adds to the existing literature examining the safety of a PCP STEMI bypass by examining its use in a different setting.…”

ST-segment elevation myocardial infarction (STEMI) bypass: The importance of paramedics in an integrated STEMI system of care

“…Kwong et al recently presented data from an urban paramedic service. 5 One year of data included 232 PCP-only STEMI bypass, of which 21/232 (9.1%) had indications for an ACP intervention. Eleven patients experienced cardiac arrest; 10 were successfully resuscitated (5 of these by PCPs).…”