STEMI Bypass: From time of first +ve 12-Lead or Pt. Contact?
A few of us seem to remember CME indicating STEMI bypass can occur if you can get to the PCI center within 60 minutes of a +ve STEMI reading on a 12-lead. The BLS PCS has the follwoing Contraindication: Transport to PCI centre >60 from Patient Contact.
Is it 60 minutes from +ve 12lead or patient contact?
Thank you for your MedicAsk inquiry.
We appreciate your diligence in determining the best treatment course for these individuals.
STEMI+ patients are a unique cohort that benefit from highly specialized timely care. The BLS Standards' patient priority system uses standard algorithms based on validated prehospital tools and best evidence based on risk/benefit scenarios, as identified and determined by both provincial and local bypass agreements.
Some Paramedic Services have tailored PPS agreements locally in addition to the provincial guidelines. Your paramedic service would be the best authority to review and evaluate the efficacy of these bypass agreements and the local nuances of facilities in the region.
In addition to the generic field triage tools specified in the PPS, the Base Hospital Physicians are always happy to discuss individual cases, help weigh the risks and benefits to make sure we are continually providing the safest, most appropriate patient-centered care. Do not hesitate to patch in future to consult on patient disposition and optimal destination decisions.
The key things to remember here are:
The goal for time to 12-lead ECG should be less than 10 minutes where possible (as per the ALS PCS), and
You do in fact require a STEMI+ 12-lead in order to transport to a PCI centre (or equivalent)
We hope this helps and are happy to discuss these concepts in more detail, should you have any further questions/concerns. Please don't hesitate to reach out.
Have a safe shift!
Patient Care Standards