CTAS 1 and STEMI Bypass
Question# 784
I wanted to follow up on clarification of STEMI bypass and our CTAS level, in our companion documentation it shows a STEMI should be a CTAS 1 but our guide for bypass says a CTAS 1 is contraindicated and the paramedic cannot secure airway or ventilate. Is this pertaining to you can still go back on a CTAS 1 and bypass unless we as paramedics cannot secure the airway?
Answer:
In short, yes you are correct that a STEMI patient can be transported on a CTAS 1 to the PCI centre, provided all of the indications are met and there are no contraindications.
The contraindication you are referring to in the STEMI Hospital Bypass Protocol states, "CTAS 1 AND the PARAMEDIC is unable to secure the patient's airway or ventilate." A good example to use would be a post VSA-ROSC-STEMI patient who is now intubated however, they are being adequately ventilated. This is a CTAS 1 patient and the closest/more appropriate receiving facility would be the PCI centre, provided you are within 60 minutes. Take the same patient but who has a difficult airway to manage (copious amounts of vomit/blood), who is not intubated and the paramedics are not able to adequately ventilate, it would be appropriate and vital for the patient to stop at the closest emergency department. Once the ED has addressed the airway issue, the patient can be safely transferred to the PCI centre.
If there is an issue or concern with the patient's ABC's, it is critical to address them prior to other competing priorities, such as STEMI bypass.
The contraindication you are referring to in the STEMI Hospital Bypass Protocol states, "CTAS 1 AND the PARAMEDIC is unable to secure the patient's airway or ventilate." A good example to use would be a post VSA-ROSC-STEMI patient who is now intubated however, they are being adequately ventilated. This is a CTAS 1 patient and the closest/more appropriate receiving facility would be the PCI centre, provided you are within 60 minutes. Take the same patient but who has a difficult airway to manage (copious amounts of vomit/blood), who is not intubated and the paramedics are not able to adequately ventilate, it would be appropriate and vital for the patient to stop at the closest emergency department. Once the ED has addressed the airway issue, the patient can be safely transferred to the PCI centre.
If there is an issue or concern with the patient's ABC's, it is critical to address them prior to other competing priorities, such as STEMI bypass.
References
BLS PCS STEMI Hospital Bypass Protocol
OBHG Adult Prehospital CTAS
Prehospital CTAS Paramedic Guide
Published
06 February 2024
ALSPCS Version
5.2
Views
253
Please reference the MOST RECENT ALS PCS for updates and changes to these directives.