Abstract 597: Feasibility of Pre-Hospital Activation of Cardiac Catheterization Laboratory Staff by Emergency Medical Services Personnel for ST Elevation Myocardial Infarction
Background: We initiated a program to empower Emergency Medical Services (EMS) personnel to mobilize the cardiac catheterization laboratory (CV lab) staff to attempt to reduce time to treatment with percutaneous coronary intervention (PCI) for patients with ST elevation myocardial infarction (STEMI).
Methods: EMS personnel from 18 different EMS organizations within a 60 mile radius of our institution participated in this pilot program. EMS personnel were trained to perform 12 lead ECG on-scene and taught to identify standard ECG patterns of acute STEMI. EMS activated the CV lab staff and the on-call interventional cardiologist through a central paging system, and then transported the patient directly to the CV lab without stopping at regional emergency departments (EDs) or our ED. Accuracy of EMS interpretation of abnormal ECGs were adjudicated by a panel of cardiovascular and emergency medicine MDs and compared to accuracy of physician ECG interpretation from referral EDs and our ED.
Results: In a 16 month period from January 2007 to April 2008, the CV lab was activated 431 times: EMS 145, referring hospital EDs 149, our ED 118, local primary clinics 17. No significant differences were detected comparing the rates of accuracy of ECG interpretation among the groups (EMS 78%, referring hospital ED 81%, our hospital ED 75%, local primary clinics 71%, p=NS.) Door to balloon time with EMS activation in the field (35 minutes) is significantly decreased compared to door to balloon time when the CV lab is activated through our ED (81 minutes) p<0.0001.
Conslusions: Pre-hospital EMS activation of CV lab staff is a promising strategy to reduce time to treatment in patients with STEMI. Accuracy of ECG interpretation by trained EMS personnel and, therefore, appropriateness of CV lab activation is the same whether initiated in the field or in the ED.