What does EMS look like in the ideal STEMI system of care?
Before answering that question, it's important to remember that there is no "one-size-fits-all" answer. A city swelling with residents presents different issues than a region where there is more wildlife or livestock than people. Providing emergency medical services to someone at the crest of a Colorado mountain poses another set of problems than transporting a STEMI patient from one Hawaiian isle to another for percutaneous coronary intervention (PCI).
Through Mission: Lifeline, the American Heart Association provides a set of guidelines that equip STEMI systems of care across the nation to improve timely access to appropriate medical treatment, ultimately saving lives.
In the ideal system for EMS and EDs, standardized point of entry protocols (created by state-based coalitions of EMS personnel, emergency physicians and cardiologists, and supported by payers and administrators) would establish which patients are transported to the nearest hospital and which patients are transported to the nearest STEMI-Receiving hospital. This will be based in part on the acquisition, interpretation and transmission of a pre-hospital 12-lead electrocardiogram (ECG).
The catheterization laboratory team would be activated by EMS personnel in the field or by emergency physicians after receiving the transmitted ECG. Patients transported to a STEMI Referring hospital by EMS would remain on the stretcher with EMS personnel in attendance until the decision about whether to transport to a STEMI-Receiving hospital is rendered.
For patients who transport themselves to a STEMI Referring hospital and require primary PCI, activation of EMS via a 9-1-1 system would occur. An ideal system would also foster a coordinated curriculum to teach EMS providers and ED staff to care for STEMI patients and provide feedback on performance and compliance with guidelines.
For a more detailed understanding of how an effective EMS operates within a STEMI system of care, read the strategies of an ideal EMS.