Prehospital diagnosis and triage of ST-elevation myocardial infarction by paramedics without advanced care training

Cantor, Warren J.; Hoogeveen, Paul; Robert, Andrew; Elliott, Karen; Goldman, Lorne; Sanderson, Erica; Planté, Sylvain; Prabhakar, Manu; Miner, Steven E.S.

doi:10.1016/j.ahj.2012.05.009

Cited by 38 publications

(39 citation statements)

References 20 publications

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“…Clark and colleagues compared the automated algorithms with human interpretation and found a 7% lower sensitivity for diagnosing STEMI [43]. Paramedics with 4-6 h of training may be able to identify classic STEMI, but one comparative study found a false negative rate for identification of anterior or lateral STEMI's of 25%-50% [44][45][46]. Still, even physicians will miss STEMI and only physicians with expert ECG knowledge seem to be able to identify STEMI with sufficient precision [47].…”

Section: Prehospital Ecg Diagnosis Of Patients With St Elevation Myocmentioning

confidence: 99%

Prehospital diagnosis of patients with acute myocardial infarction

et al. 2016

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Primary percutaneous intervention (PPCI) is the preferred treatment in patients with ST elevation myocardial infarction (STEMI) if this can be performed in a timely manner. The 2012 ESC Guidelines on management of AMI in patients presenting with ST-segment elevation advice that PPCI should be performed within 120 min of first medical contact. Prehospital diagnosis of patients with STEMI is performed to save time and make PPCI available to the majority of patients. Although diagnosing patients with STEMI is usually easy, there are important pitfalls and patients with STEMI are missed on occasion. In addition, it is well know that patients without ST elevation may also have a high-risk cardiac condition. The 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation stress the importance of urgent CAG in patients with high-risk non ST-segment elevation myocardial infarction (NSTEMI). Unfortunately, these patients are difficult to diagnose in the acute phase and important time may be spend establishing the correct diagnosis. Prehospital biomarker measurement has emerged as a method to gain important additional information. We review the evidence on prehospital diagnosis of patients with STEMI and, In addition, we present the current knowledge on the new diagnostic methods that could have a future role in prehospital rule-in and rule-out of cardiac disease.

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Section: Prehospital Ecg Diagnosis Of Patients With St Elevation Myocmentioning

confidence: 99%

Prehospital diagnosis of patients with acute myocardial infarction

et al. 2016

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“…All paramedics should be adequately trained to make the "time-sensitive" diagnosis of STEMI and triage the patients successfully as this has the potential to have major impact on patient outcome. (11) Ideally EMS should be mandated to promptly activate the cath lab team. (12) The finding that EMS is not routinely solicited by the public prompts urgent implementation of public awareness initiatives.…”

Section: Findings Relating To Emergency Medical Service (Ems) Provisionmentioning

confidence: 99%

Referral pathways for reperfusion of STEMI – developing strategies for appropriate intervention

Snyders

Delport

2017

SAHJ

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undergo PCI within 90 minutes of FMC, should be treated with fibrinolytic therapy within 30 minutes of hospital presentation, unless such therapy is contraindicated.A recent study in STEMI patients found that while p-PCI was performed in 60%, the majority of the interventions occurred later than 120 minutes, and that only 36% received fibrinolysis.(2) This high percentage of patients receiving angiographyand an invasive treatment strategy may be explained by the location of the participating centers in urban areas, almost all of which were private healthcare facilities.Early and appropriate pre-hospital diagnosis, as well as immediate transport, are of vital importance to avoid unnec- ABSTRACT

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“…Although this may have been useful as a direct comparator, this was not the population of interest for our study as it has been reported in previous studies. 5,6,14 We cannot completely exclude the selection of ACP versus PCP crew related to patient severity and not dispatch proximity without a direct comparison of ACP cases. However, in our EMS system, most STEMI cases come into dispatch as chest pain calls and therefore response is simply based on closest unit availability.…”

Section: Discussionmentioning

confidence: 99%

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

Mitchell

Dionne

Maloney

et al. 2018

CJEM

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CLINICIAN’S CAPSULEWhat is known about the topic?Transport of STEMI patients directly to the cath lab (STEMI bypass) by advanced care paramedics (ACPs) is common practice. The safety of this practice with primary care paramedics (PCPs) is unknown.What did this study ask?What is the prevalence and breakdown of events during PCP STEMI bypass?What did this study find?Clinically important events are common in STEMI bypass patients. A smaller proportion of events would be addressed differently by ACP compared to PCP protocols.Why does this study matter to clinicians?This study adds to the evidence that PCP STEMI bypass is safe.

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Prehospital diagnosis and triage of ST-elevation myocardial infarction by paramedics without advanced care training

Cited by 38 publications

References 20 publications

Prehospital diagnosis of patients with acute myocardial infarction

Prehospital diagnosis of patients with acute myocardial infarction

Referral pathways for reperfusion of STEMI – developing strategies for appropriate intervention

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

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