PMID- 29151401
OWN - NLM
STAT- MEDLINE
DCOM- 20190912
LR  - 20190912
IS  - 1481-8043 (Electronic)
IS  - 1481-8035 (Linking)
VI  - 20
IP  - 6
DP  - 2018 Nov
TI  - Evaluation of a primary care paramedic STEMI bypass guideline.
PG  - 850-856
LID - 10.1017/cem.2017.415 [doi]
AB  - OBJECTIVE: Limited evidence supports primary care paramedic (PCP) direct 
      transport of ST-segment elevation myocardial infarction (STEMI) patients for 
      percutaneous coronary intervention (PCI). The goal of this study was to evaluate 
      an urban-based PCP STEMI bypass guideline. METHODS: We reviewed consecutive 
      Toronto Paramedic Services call reports between April 7, 2015, and May 31, 2016, 
      regarding STEMI patients identified by PCPs. The primary outcome was patient 
      assignment (stable versus unstable) according to guideline criteria. Secondary 
      outcomes were the proportion of PCP-transported patients who had an indication 
      for an advanced care intervention (ACI) or who received an ACI when PCPs 
      rendezvoused with an advanced care paramedic (ACP). Lastly, we reviewed 
      prehospital outcomes of cardiac arrest patients and calculated the difference in 
      transport intervals between direct PCP bypass and a PCI-centre and predicted 
      transport interval to the closest emergency department (ED). RESULTS: Of 361 
      patients, 232 were PCP transports and 129 were ACP-rendezvous transports. There 
      was a significant difference in the distribution of stable and unstable patients 
      between PCPs and ACPs (p<0.001). For PCP patients, 21/232 (9.1%) had indications 
      for an ACI, whereas 34/129 (26.4%) ACP patients received an ACI. Eleven patients 
      experienced cardiac arrest; 10 were successfully resuscitated (5 of these by 
      PCPs). The median difference between direct PCP bypass and a PCI-centre versus 
      transport to the closest ED was 5.53 minutes (IQR=6.71). CONCLUSIONS: We found a 
      significant difference in the distribution of stable and unstable patients and 
      fewer patients with indications for an ACI in PCP patients. This PCP STEMI bypass 
      guideline appears feasible.
FAU - Kwong, Jonathan L
AU  - Kwong JL
AD  - *Department of Medicine.
FAU - Ross, Garry
AU  - Ross G
AD  - double daggerSunnybrook Centre for Prehospital Medicine,University of Toronto,Toronto,ON.
FAU - Turner, Linda
AU  - Turner L
AD  - double daggerSunnybrook Centre for Prehospital Medicine,University of Toronto,Toronto,ON.
FAU - Olynyk, Chris
AU  - Olynyk C
AD  -  section signToronto Paramedic Services,Toronto,ON.
FAU - Cheskes, Sheldon
AU  - Cheskes S
AD  - daggerDepartment of Family and Community Medicine,Division of Emergency 
      Medicine,University of Toronto,Toronto,ON.
FAU - Thurston, Adam
AU  - Thurston A
AD  -  section signToronto Paramedic Services,Toronto,ON.
FAU - Verbeek, P Richard
AU  - Verbeek PR
AD  - double daggerSunnybrook Centre for Prehospital Medicine,University of Toronto,Toronto,ON.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20171120
PL  - England
TA  - CJEM
JT  - CJEM
JID - 100893237
SB  - IM
MH  - Aged
MH  - Canada
MH  - Electrocardiography
MH  - Emergency Medical Services/*standards
MH  - Emergency Medical Technicians/*standards
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Percutaneous Coronary Intervention
MH  - *Practice Guidelines as Topic
MH  - Primary Health Care/*standards
MH  - Retrospective Studies
MH  - ST Elevation Myocardial Infarction/*therapy
MH  - Time Factors
MH  - Transportation of Patients/*methods
OTO - NOTNLM
OT  - ST-segment elevation myocardial infarction
OT  - STEMI bypass
OT  - emergency medical services
OT  - percutaneous coronary intervention
OT  - prehospital emergency care
EDAT- 2017/11/21 06:00
MHDA- 2019/09/13 06:00
CRDT- 2017/11/21 06:00
PHST- 2017/11/21 06:00 [pubmed]
PHST- 2019/09/13 06:00 [medline]
PHST- 2017/11/21 06:00 [entrez]
AID - S1481803517004158 [pii]
AID - 10.1017/cem.2017.415 [doi]
PST - ppublish
SO  - CJEM. 2018 Nov;20(6):850-856. doi: 10.1017/cem.2017.415. Epub 2017 Nov 20.