The most important thing a paramedic can do for a patient having a STEMI is to acquire a 12-lead on first patient contact and then if the 12-lead shows a STEMI, immediately call in a STEMI Alert to the ED of your local PCI hospital.
Don’t wait until you are approaching the ED to notify them. Don’t wait until you have done an IV and given ASA and NTG. Don’t wait until you have loaded the patient in the ambulance. Call NOW! From the patient’s side.
You are the dispatcher for the cath lab.
ASA, NTG, morphine, IVs, even 02 are not going to save this person’s life.
Getting them on the cath lab table and getting a wire into their coronary artery and clearing the deadly occlusion will.
As soon as you see your patient is having a STEMI, you need to get the cath lab team sliding down their bat poles.
On weekends and nights, most cath lab teams are on call with the goal on getting into the hospital within 20 minutes of activation. During the week, the cath lab tables may have elective patients scheduled on their tables, and they will need time to get them off so they can get your patient on.
The cath lab needs to be ready to take your patient onto their table the moment you hit the ED doors. If you provide adequate notice and your local PCI center has its act together, you should be going right to the cath lab with the patient still on your EMS stretcher.
Call in from 5 minutes out and your patient will have to wait in the ED for the cath lab to be readied and the team gathered.
Call in from 20 minutes out (call from the patient’s second floor bedroom) and you will likely have spared your patient fifteen minutes of dying heart.
Simple as that.
Also, after you have called in the STEMI Alert, make certain you have your defib pads on the patient. STEMI patients are at high risk of going into vfib and you will want to defibrillate right away rather than digging into your monitor and fumbling to pull the pads out and attach them.
I am the EMS coordinator at a PCI center and it amazing the number of STEMI patients who come in on death’s door and walk out two and three days later with minimal heart damage and the rest of their lives ahead of them.
EMS can make the difference. You can make the difference.
Early notification saves lives!