Paramedic Myocardial Infarction Care with Fibrinolytics: a Process Map and Hazard Analysis

Jensen, Jan; Walker, Mark S.; Denike, Doug; Matthews, V. O.; Boudreau, Christopher; Hill, W I; Travers, Andrew H.

doi:10.3109/10903127.2013.804136

Cited by 6 publications

(5 citation statements)

References 18 publications

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“…Several studies reported positive findings in hospital resulting from ‘advanced paramedic’ skills but these had only been applied during the pre-hospital phase such as clinical diagnoses of ST elevation MI [ 30 – 32 ] and paramedic-administered morphine or atropine [ 40 ] and fibrinolytic treatment [ 41 , 42 ].…”

Section: Resultsmentioning

confidence: 99%

A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients

et al. 2016

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BackgroundAmbulance paramedics play a critical role expediting patient access to emergency treatments. Standardised handover communication frameworks have led to improvements in accuracy and speed of information transfer but their impact upon time-critical scenarios is unclear. Patient outcomes might be improved by paramedics staying for a limited time after handover to assist with shared patient care. We aimed to categorize and synthesise data from studies describing development/extension of the ambulance-based paramedic role during and after handover for time-critical conditions (trauma, stroke and myocardial infarction).MethodsWe conducted an electronic search of published literature (Jan 1990 to Sep 2016) by applying a structured strategy to eight bibliographic databases. Two reviewers independently assessed eligible studies of paramedics, emergency medical (or ambulance) technicians that reported on the development, evaluation or implementation of (i) generic or specific structured handovers applied to trauma, stroke or myocardial infarction (MI) patients; or (ii) paramedic-initiated care processes at handover or post-handover clinical activity directly related to patient care in secondary care for trauma, stroke and MI. Eligible studies had to report changes in health outcomes.ResultsWe did not identify any studies that evaluated the health impact of an emergency ambulance paramedic intervention following arrival at hospital. A narrative review was undertaken of 36 studies shortlisted at the full text stage which reported data relevant to time-critical clinical scenarios on structured handover tools/protocols; protocols/enhanced paramedic skills to improve handover; or protocols/enhanced paramedic skills leading to a change in in-hospital transfer location. These studies reported that (i) enhanced paramedic skills (diagnosis, clinical decision making and administration of treatment) might supplement handover information; (ii) structured handover tools and feedback on handover performance can impact positively on paramedic behaviour during clinical communication; and (iii) additional roles of paramedics after arrival at hospital was limited to ‘direct transportation’ of patients to imaging/specialist care facilities.ConclusionsThere is insufficient published evidence to make a recommendation regarding condition-specific handovers or extending the ambulance paramedic role across the secondary/tertiary care threshold to improve health outcomes. However, previous studies have reported non-clinical outcomes which suggest that structured handovers and enhanced paramedic actions after hospital arrival might be beneficial for time-critical conditions and further investigation is required.

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Section: Resultsmentioning

confidence: 99%

A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients

et al. 2016

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“…A previously published process map of Nova Scotia PHF identified all the actions and decisions required, and identified those which could be a risk. 7 This work provided insight into potential mitigation strategies. To date, system outcomes from this provincial cardiac reperfusion strategy have yet to be published.…”

Section: Introductionmentioning

confidence: 98%

Outcomes of a Provincial Myocardial Infarction Reperfusion Strategy: A Population-Based, Retrospective Cohort Study

Cook

Carter

Goldstein

et al. 2020

Prehosp. Disaster med.

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Abstract Background: Fibrinolysis is an acceptable treatment for acute ST-segment elevation myocardial infarction (STEMI) when primary percutaneous coronary intervention (PCI) cannot be performed within 120 minutes. The American Heart Association has recommended Emergency Medical Services (EMS) interventions such as prehospital fibrinolysis (PHF), prehospital electrocardiogram (ECG), and hospital bypass direct to PCI center. Nova Scotia, Canada has incorporated these interventions into a unique province-wide approach to STEMI care. A retrospective cohort analysis comparing the primary outcome of 30-day mortality for patients receiving either prehospital or emergency department (ED) fibrinolysis (EDF) to patients transported directly by EMS from community or regional ED for primary PCI was conducted. Methods: This retrospective, population-based cohort study included all STEMI patients in Nova Scotia who survived to hospital admission from July 2011 through July 2013. Three provincial databases were used to collect demographic, 30-day mortality, hospital readmission, and rescue PCI data. The results were grouped and compared according to reperfusion strategy received: PHF, EDF, patients brought by ambulance via EMS direct to PCI (EMS to PCI), and ED to PCI (ED to PCI). Results: There were 1,071 STEMI patients included with 145 PHF, 606 EDF, 98 EMS to PCI, and 222 ED to PCI. There were no significant differences in 30-day mortality across groups (n, %): PHF 5(3); EDF 36(6); EHS to PCI <5(2); and ED to PCI 10(4); P = .28. There was no significant difference in patients receiving fibrinolysis who underwent rescue PCI. Conclusions: Prehospital fibrinolysis incorporated into a province-wide approach to STEMI treatment is feasible with no observed difference in patient 30-day mortality outcomes observed.

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“…Traditionally, paramedics transported patients to medical care, usually the closest emergency department. However, patient disposition options now include programs for critical care bypass of multiple trauma, acute cardiac and stroke patients (23)(24)(25)(26)(27)(28)(29)(30)(31)(32), treat and release (22,15,17,33) and referral to other health and social service providers (15,18,33).…”

Section: Introductionmentioning

confidence: 99%

Four Dimensions of Paramedic Practice in Canada: Defining and Describing the Profession

Bowles

Beek²,

Andérson

2017

Australasian Journal of Paramedicine

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IntroductionThis article presents a framework for describing four dimensions of paramedic practice: Practitioners, Practice Setting, Care and Patient Disposition. The framework emerged from a qualitative study conducted to identify potential research directions and opportunities to advance paramedicine and paramedic education at Justice Institute of British Columbia in Canada. MethodsResearchers conducted semi-structured interviews with 17 stakeholders in Canadian paramedicine to explore the current state and emerging expectations of paramedic practice and paramedic education. ResultsThe study found no consensus, and little agreement, on what term or terms best describe the profession. Participants agreed that the core of paramedic practice involves an advanced care paramedic responding by ambulance to the patient’s side in an emergency to assess and treat urgent medical and traumatic conditions, then transport the patient to further medical care – most often an emergency physician at an emergency department. However, participants also described paramedics as healthcare providers who are increasingly taking on varied operational roles to improve patient care and address gaps in an evolving and stressed healthcare system. Four dimensions emerged for describing key characteristics of paramedic practice: the Practitioners, Practice Settings, Care and Patient Disposition. DiscussionThe framework described in this article may be useful for examining and better understanding both traditional and evolving paramedic roles. This, in turn, informs the efforts of paramedic educators, regulators, employers, and professional associations to support practitioners in the field. The article uses the framework to contrast two distinctly different community paramedic programs.

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Paramedic Myocardial Infarction Care with Fibrinolytics: a Process Map and Hazard Analysis

Cited by 6 publications

References 18 publications

A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients

A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients

Outcomes of a Provincial Myocardial Infarction Reperfusion Strategy: A Population-Based, Retrospective Cohort Study

Four Dimensions of Paramedic Practice in Canada: Defining and Describing the Profession

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