Prehospital Electrocardiogram and Early Helicopter Dispatch to Expedite Interfacility Transfer for Percutaneous Coronary Intervention

Abstract

Care provision and benchmarking for patients with ST-elevation myocardial infarction (STEMI) have focused on streamlining time between initial hospital presentation and opening of theinfarct-related artery. In a Boston-area regional system already characterized by expedited advanced life support (ALS) dispatch and paramedic performance of prehospital electrocardiogram (EKG), a critical pathway was designed that allows for helicopter dispatch based on ground ALS providers' STEMI diagnosis. The pathway dictates that as soon as ALS crews make the diagnosis of STEMI from their 12-lead EKG, they will contact Boston MedFlight (BMF) and a helicopter will be immediately dispatched to the participating community hospital (Lawrence General Hospital [LGH]). Based on historical and predicted time patterns, it is expected that BMF will arrive at LGH soon after the ALS ambulance delivers the patient to the LGH emergency department (ED). The patient will then undergo BMF transport from the ED into central Boston with direct transfer into an awaiting cardiac catheterization suite (ie, bypassing the receiving hospital ED). The pathway minimizes the delay between patient arrival at LGH and BMF arrival for transport to the catheterization laboratory. It is hoped that implementation of the critical pathway will allow the region's patients with STEMI to achieve coronary arterial patency within 90 minutes of LGH presentation. If the pathway proves effective, it can serve as a model for other regions and programs with similar clinical and logistic situations and advance the concept of "diagnosis-to-balloon" time.

Ground Emergency Medical Services Requests for Helicopter Transfer of ST‐segment Elevation Myocardial Infarction Patients Decrease Medical Contact to Balloon Times in Rural and Suburban Settings

“…However, if transport time is expected to be lengthy (e.g., more than 30 minutes longer than transport to the closest hospital) alternative approaches may be needed. Some have proposed a “direct‐to‐scene” HEMS activation by ground EMS, analogous to the care of trauma patients 24 . Another alternative would be for ground EMS to rendezvous with HEMS at a local non–PCI‐capable facility for immediate transfer of the patient to a PCI‐capable facility.…”

Helicopter EMS Transport Outcomes Literature: Annotated Review of Articles Published 2007–2011

“…While the lack of identification of any health outcomes benefits is appropriately highlighted in the authors' discussion, it is hard to dispute the criticality of the STEMI care surrogate endpoints relating to time. Considering the lack of downside to the types of protocol changes that were adopted by the authors (and which have been previously described by other HEMS services) [6] there seems sufficient evidence to support broader application of these streamlining principles. In addition to the lack of mortality benefit, there were other limitations to the study.…”

Helicopter EMS: Research Endpoints and Potential Benefits

“…The aircraft thus arrives at the (non-PCI-capable) community hospital within minutes of the patient's arrival by ground EMS [90]. After the community hospital's ED physician quickly confirms the diagnosis based upon review of the prehospital 12-lead EKG, the tertiary center's cardiac catheterization laboratory activation is confirmed, and the helicopter (either already at, or very close to, the community hospital) completes rapid transport directly to the cath lab.…”