Development of systems of care for ST-elevation myocardial infarction patients: the emergency medical services and emergency department perspective.

Central to the development of systems and centers of care for ST-elevation myocardial infarction (STEMI) patients will be the key role played by emergency medical services (EMS) at entry into the system and within the system when emergency interhospital transport is required. ### Emergency Medical Services System Design Prehospital EMS systems have 3 major components: emergency medical dispatch, public safety (fire and law enforcement) first response, and EMS ambulance response. Each of these operates within a broader emergency care system, which includes acute care facilities and regionalized healthcare services. In most states, an EMS regulatory entity within the state government oversees the emergency care system. Many states have regional EMS councils and advisory boards that function with varying levels of authority. #### Emergency Medical Dispatch Early access to EMS is promoted by a 9-1-1 system currently available to >95% of the US population. Enhanced 9-1-1 systems provide the caller’s location and number to the dispatcher, which permits rapid dispatch of prehospital personnel to locations even if the caller is not capable of verbalizing or the dispatcher cannot understand the location and telephone number of the emergency. Although cellular phones have been problematic because they do not stay in a fixed location, new technology exists that allows triangulation of a cellular phone caller’s location. This technology is being phased in throughout the country at a rapid pace. In most communities, law enforcement or public safety officials are responsible for operating 9-1-1 centers, because in most locations, 85% of calls are for police assistance, 10% are for EMS, and 5% are for fire-related emergencies. Dispatchers who staff 9-1-1 centers may have minimal medical training, be emergency medical technicians, or on occasion be paramedics trained and certified as emergency medical dispatchers. In any case, dispatchers operate under standardized, written (often computerized) protocols. Such protocols are developed nationally and then modified locally or nationally. …

[1]  P. Moyer,et al.  How Accurate Is Paramedic Identification of ST Segment Elevation Myocardial Infaction in the Prehospital Setting , 2005 .

[2]  R Roberts,et al.  Thrombolysis in Myocardial Infarction (TIMI) Trial, Phase I: A comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge. , 1987, Circulation.

[3]  Klaus Rasmussen,et al.  A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. , 2003, The New England journal of medicine.

[4]  S. Spinler,et al.  Prehospital-Initiated Thrombolysis , 1997, The Annals of pharmacotherapy.

[5]  E. Antman,et al.  Fibrinolysis for acute myocardial infarction: the future is here and now. , 2003, Circulation.

[6]  Johan Herlitz,et al.  Indications for fibrinolytic therapy in suspected acute myocardial infarction : collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients , 1994 .

[7]  C. Cannon,et al.  ER TIMI-19: testing the reality of prehospital thrombolysis. , 2000, The Journal of emergency medicine.

[8]  J P Ornato,et al.  Public-access Defibrillation and Survival after Out-of-hospital Cardiac Arrest Recommended Citation Public-access Defibrillation and Survival after Out-of-hospital Cardiac Arrest , 2022 .

[9]  Mary M Hand,et al.  Pre-hospital 12-lead electrocardiography programs: a call for implementation by emergency medical services systems providing advanced life support--National Heart Attack Alert Program (NHAAP) Coordinating Committee; National Heart, Lung, and Blood Institute (NHLBI); National Institutes of Health. , 2006, Journal of the American College of Cardiology.

[10]  W. Weaver,et al.  The prehospital electrocardiogram in acute myocardial infarction: is its full potential being realized? National Registry of Myocardial Infarction 2 Investigators. , 1997, Journal of the American College of Cardiology.

[11]  P. Touboul,et al.  Impact of Time to Treatment on Mortality After Prehospital Fibrinolysis or Primary Angioplasty: Data From the CAPTIM Randomized Clinical Trial , 2003, Circulation.

[12]  C. Pozner,et al.  Implications of the mechanical (PCI) vs thrombolytic controversy for ST segment elevation myocardial infarction on the organization of emergency medical services: the Boston EMS experience. , 2004, Critical pathways in cardiology.

[13]  Gruppo Italiano per lo Studio della Soprawivenza nell'Inf Miocardico.,et al.  EFFECTIVENESS OF INTRAVENOUS THROMBOLYTIC TREATMENT IN ACUTE MYOCARDIAL INFARCTION , 1986, The Lancet.

[14]  Y. Ohtsuki,et al.  ISOLATION OF HTLV-I FROM CEREBROSPINAL FLUID OF A PATIENT WITH MYELOPATHY , 1986, The Lancet.

[15]  G. Lamas,et al.  ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1999 guidelines for the management of patients wi , 2004, Journal of the American College of Cardiology.

[16]  J. Giglio,et al.  Clinical utility of CKMB isoform determinations in patients who present to the emergency department with continuous or resolved chest pain. , 2000, The Journal of emergency medicine.

[17]  Harlan M Krumholz,et al.  Achieving door-to-balloon times that meet quality guidelines: how do successful hospitals do it? , 2005, Journal of the American College of Cardiology.

[18]  Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 6: advanced cardiovascular life support: section 7: algorithm approach to ACLS emergencies: section 7A: principles and practice of ACLS. The American Heart Association in collaboration with the International Li , 2000, Circulation.

[19]  J. Ornato.  The earliest thrombolytic treatment of acute myocardial infarction: ambulance or emergency department? , 1990, Clinical cardiology.

[20]  J S Martin,et al.  Utility of the prehospital electrocardiogram in diagnosing acute coronary syndromes: the Myocardial Infarction Triage and Intervention (MITI) Project. , 1998, Journal of the American College of Cardiology.

[21]  Subcommittees.  2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. , 2005 .

[22]  B. Nallamothu,et al.  Percutaneous coronary intervention versus fibrinolytic therapy in acute myocardial infarction: is timing (almost) everything? , 2003, The American journal of cardiology.

[23]  C. Fry,et al.  Science of urinary incontinence Report of a Meeting of Physicians and Scientists, University College London , 1994, The Lancet.

[24]  Racht Em.  Prehospital 12-lead ECG. An evolving standard of care in EMS systems. , 2001 .

[25]  E. Pérez,et al.  Feasibility and Timing of Prehospital Administration of Reteplase in Patients with Acute Myocardial Infarction , 2002, Journal of Thrombosis and Thrombolysis.

[26]  W D Weaver,et al.  31st Bethesda Conference. Emergency Cardiac Care. Task force 2: Acute coronary syndromes: Section 2A--Prehospital issues. , 2000, Journal of the American College of Cardiology.

[27]  N. Terrin,et al.  Evaluation of technologies for identifying acute cardiac ischemia in emergency departments. , 2000, Evidence report/technology assessment.

[28]  Marian Vermeulen,et al.  Emergency department crowding and thrombolysis delays in acute myocardial infarction. , 2004, Annals of emergency medicine.

[29]  E. Bedrick,et al.  The prehospital 12-lead electrocardiogram's effect on time to initiation of reperfusion therapy: a systematic review and meta-analysis of existing literature. , 2005, The American journal of emergency medicine.

[30]  A. Werner.  Public-access defibrillation and survival after out-of-hospital cardiac arrest* , 2004 .

[31]  Dave Williams,et al.  2004 JEMS 200-city survey. , 2005, JEMS : a journal of emergency medical services.

[32]  Todd G Nick,et al.  Estimating the degree of emergency department overcrowding in academic medical centers: results of the National ED Overcrowding Study (NEDOCS). , 2004, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[33]  W. Weaver,et al.  Factors influencing the time to thrombolysis in acute myocardial infarction. Time to Thrombolysis Substudy of the National Registry of Myocardial Infarction-1. , 1997, Archives of internal medicine.

[34]  E. Racht.  Prehospital 12-lead ECG. An evolving standard of care in EMS systems. , 2001, Emergency medical services.

[35]  W. Rogers,et al.  Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the US from 1990 through 1999: the National Registry of Myocardial Infarction 1, 2 and 3. , 2000, Journal of the American College of Cardiology.

[36]  David M. Williams.  2005 JEMS 200-city survey. A benchmark for the EMS industry. , 2006, JEMS : a journal of emergency medical services.

[37]  I. Kakadiaris,et al.  Images in cardiovascular medicine. Detection of luminal-intimal border and coronary wall enhancement in intravascular ultrasound imaging after injection of microbubbles and simultaneous sonication with transthoracic echocardiography. , 2005, Circulation.

[38]  Fibrinolytic Therapy Trialists' Collaborative Group.  Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients , 1994, The Lancet.

[39]  W. Gibler,et al.  Prehospital diagnosis and treatment of acute myocardial infarction: a north-south perspective. The Cincinnati Heart Project and the Nashville Prehospital TPA Trial. , 1991, American heart journal.

[40]  J S Martin,et al.  Time delays in the diagnosis and treatment of acute myocardial infarction: a tale of eight cities. Report from the Pre-hospital Study Group and the Cincinnati Heart Project. , 1990, American heart journal.

[41]  Fibrinolytictherapytrialistsf.  Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients , 1994 .

[42]  Gervasio A. Lamas,et al.  ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1999 guidelines for the management of patients wi , 2004, Journal of the American College of Cardiology.

[43]  N. Rathlev,et al.  Potential diversion rates associated with prehospital acute myocardial infarction triage strategies. , 2004, The Journal of emergency medicine.

[44]  W. Gibler,et al.  Relative importance of emergency medical system transport and the prehospital electrocardiogram on reducing hospital time delay to therapy for acute myocardial infarction: a preliminary report from the Cincinnati Heart Project. , 1992, American heart journal.

[45]  T. Aufderheide,et al.  Milwaukee Prehospital Chest Pain Project--phase I: feasibility and accuracy of prehospital thrombolytic candidate selection. , 1992, The American journal of cardiology.

[46]  G. Tognoni,et al.  The GISSI Study: further analysis. Italian Group for the Study of Streptokinase in Myocardial Infarction (Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico, GISSI). , 1987, Circulation.

[47]  P. Kudenchuk,et al.  Myocardial Infarction Triage and Intervention Project--phase I: patient characteristics and feasibility of prehospital initiation of thrombolytic therapy. , 1990, Journal of the American College of Cardiology.