For patients who have ECG evidence of STEMI, it is reasonable that paramedics review a reperfusion checklist and relay the ECG and checklist findings to a predetermined medical control facility and/or receiving hospital.It appears reasonable to expect that if fibrinolytic therapy could be started at the time of prehospital evaluation, a greater number of lives could be saved.Patients with possible symptoms of STEMI should be transported to the hospital by ambulance rather than by friends or relatives because there is a significant association between arrival at the emergency department (ED) by ambulance and early reperfusion therapy.
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Prehospital fibrinolysis is reasonable in those settings in which physicians are present in the ambulance or prehospital transport times are more than 60 minutes in high-volume (more than 25,000 runs per year) EMS systems.
Other considerations for implementing a prehospital fibrinolytic service include the ability to transmit ECGs, paramedic initial and ongoing training in ECG interpretation and myocardial infarction (MI) treatment, online medical command, a medical director with training/experience in management of STEMI, and full-time paramedics. Options for transportation of STEMI patients and initial reperfusion treatment.
The purpose of the present guideline is to focus on the numerous advances in the diagnosis and management of patients with STEMI since 1999.
This is reflected in the changed name of the guideline: “ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction.” The final recommendations for indications for a diagnostic procedure, a particular therapy, or an intervention in patients with STEMI summarize both clinical evidence and expert opinion (Table 1).
These goals should not be understood as ideal times but rather as the longest times that should be considered acceptable for a given system. 2003;133–7.25: Reperfusion in patients with STEMI can be accomplished by the pharmacological (fibrinolysis) or catheter-based (primary PCI) approaches.
Systems that are able to achieve even more rapid times for treatment of patients with STEMI should be encouraged. Implementation of these strategies varies based on the mode of transportation of the patient and capabilities at the receiving hospital.
Patients with STEMI who have contraindications to fibrinolytic therapy should be brought immediately or secondarily transferred promptly (ie, primary-receiving hospital door-to-departure time less than 30 minutes) to facilities capable of cardiac catheterization and rapid revascularization (PCI or CABG).
Regardless of the approach used, all patients presenting to the ED with chest discomfort or other symptoms suggestive of STEMI or unstable angina should be considered high-priority triage cases and should be evaluated and treated based on a predetermined, institution-specific chest pain protocol.
Early access to EMS is promoted by a 9-1-1 system currently available to more than 90% of the US population.