Milwaukee prehospital chest pain project — Phase I: Feasibility and accuracy of prehospital thrombolytic candidate selection

Aufderheide, Tom P.; Keelan, Michael H.; Hendley, Gail E; Robinson, Nancy; Hastings, Thomas; Lewin, Ruben F.; Hewes, Harvey F.; Daniel, Alan M.; Engle, David G.; Gimbel, Barry K.; Bortin, Kenneth R.; Clardy, David; Schmidt, Donald H.; Bajwa, Tanvir; Holzhauer, Peter; Dabrowski, Russell C.; Schuchard, Gregory H.; Teichman, Sam L.

doi:10.1016/0002-9149(92)90852-p

Cited by 82 publications

(20 citation statements)

References 17 publications

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“…These findings support the use of PH ECG for all EMS response patients experiencing chest pain. In particular, the clinically insignificant 18-s prolongation in scene time in our cohort is in contrast to previous reports demonstrating an average increase of 1.2 to 5.2 min in the on-scene time interval (21,(27)(28)(29)32). This difference may be a reflection of our EMS system design, which deploys paramedics on both fire first responders and ambulances and thereby increases the efficiency of rapid patient assessment.…”

Section: Discussioncontrasting

confidence: 90%

“…Currently, approximately 90% of EMS systems serving the 200 largest cities in the United States have PH 12-lead ECG capability (26). However, though the PH ECG helps in reducing the D2B time, some have suggested it may increase total ischemic time by prolonging the time obtaining an ECG at the scene and thus offsetting the reduction in D2B time (16,(27)(28)(29)(30).…”

mentioning

confidence: 99%

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Pre-Hospital Electrocardiography by Emergency Medical Personnel

Patel

Dunford

Aguilar

et al. 2012

Journal of the American College of Cardiology

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Section: Discussioncontrasting

confidence: 90%

mentioning

confidence: 99%

Pre-Hospital Electrocardiography by Emergency Medical Personnel

Patel

Dunford

Aguilar

et al. 2012

Journal of the American College of Cardiology

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“…In one survey, it was reported that 20% of all calls to the dispatch centre were the result of chest pain [4]. diagnosis of acute myocardial infarction and fewer than 10% had prehospital ECG signs of myocardial ischemia [7]. Among patients reached by a mobile coronary care unit in Gothenburg and Stockholm in Sweden due to chest pain or other symptoms raising a suspicion of an acute myocardial infarction, 31% were finally judged to have had an acute myocardial infarction and 29% myocardial ischemia [8].…”

Section: Prevalencementioning

confidence: 99%

Is pre-hospital treatment of chest pain optimal in acute coronary syndrome? The relief of both pain and anxiety is needed

Herlitz

Bång

Ömerovic

et al. 2011

International Journal of Cardiology

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“…5,15 The checklist helps to determine the presence of comorbid conditions for which fibrinolytic therapy may be contraindicated. Local protocols usually dictate the destination hospital for such patients.…”

Section: Ems Assessment Triage and Treatment Of Suspected Stemi Patmentioning

confidence: 99%

Development of Systems of Care for ST-Elevation Myocardial Infarction Patients

Moyer¹,

Ornato²,

Brady³

et al. 2007

Circulation

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Central to the development of systems and centers of care for ST-elevation myocardial infarction (STEMI) patients will be the key role played by emergency medical services (EMS) at entry into the system and within the system when emergency interhospital transport is required. Current System of Care Emergency Medical Services System DesignPrehospital EMS systems have 3 major components: emergency medical dispatch, public safety (fire and law enforcement) first response, and EMS ambulance response. Each of these operates within a broader emergency care system, which includes acute care facilities and regionalized healthcare services. In most states, an EMS regulatory entity within the state government oversees the emergency care system. Many states have regional EMS councils and advisory boards that function with varying levels of authority. Emergency Medical DispatchEarly access to EMS is promoted by a 9-1-1 system currently available to Ͼ95% of the US population. Enhanced 9-1-1 systems provide the caller's location and number to the dispatcher, which permits rapid dispatch of prehospital personnel to locations even if the caller is not capable of verbalizing or the dispatcher cannot understand the location and telephone number of the emergency. Although cellular phones have been problematic because they do not stay in a fixed location, new technology exists that allows triangulation of a cellular phone caller's location. This technology is being phased in throughout the country at a rapid pace.In most communities, law enforcement or public safety officials are responsible for operating 9-1-1 centers, because in most locations, 85% of calls are for police assistance, 10% are for EMS, and 5% are for fire-related emergencies. Dispatchers who staff 9-1-1 centers may have minimal medical training, be emergency medical technicians, or on occasion be paramedics trained and certified as emergency medical dispatchers. In any case, dispatchers operate under standardized, written (often computerized) protocols. Such protocols are developed nationally and then modified locally or nationally. The ideal system has intense quality improvement programs to ensure that dispatchers follow protocols and procedures correctly and consistently. This is particularly true for the prearrival instructions that are given to cardiac arrest bystanders to instruct them on how to perform cardiopulmonary resuscitation (CPR) while awaiting arrival of emergency personnel (telephone CPR). Emergency medical dispatchers can also prompt patients with symptoms suggestive of an acute STEMI to take aspirin while awaiting the arrival of EMS personnel. Public Safety First RespondersTo minimize time to lifesaving treatment, most communities have volunteer and/or paid firefighters and/or law enforceThe American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all me...

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Milwaukee prehospital chest pain project — Phase I: Feasibility and accuracy of prehospital thrombolytic candidate selection

Cited by 82 publications

References 17 publications

Pre-Hospital Electrocardiography by Emergency Medical Personnel

Pre-Hospital Electrocardiography by Emergency Medical Personnel

Is pre-hospital treatment of chest pain optimal in acute coronary syndrome? The relief of both pain and anxiety is needed

Development of Systems of Care for ST-Elevation Myocardial Infarction Patients

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