Williamson County EMS

Transcription

1 Williamson County EMS STEMI Protocol

2 History Williamson County EMS implemented 12 lead ECG to SOCs in Every paramedic had to be personally cleared by Dr. Benold prior to putting into practice Almost every monthly shift track involves some 12 - lead review/new material New staff spend 16 hours with Dr. Benold learning and practicing 12 -lead acquisition and interpretation prior to release to FTO for field training

3 Ongoing Reviews Every STEMI activation in the field is reviewed by Dr. Benold and Clinical Practices staff Clinical Practices meets with every county hospital once a month to review STEMI, Stroke, and Trauma alerts Re-education occurs immediately after false negatives and false positives are identified Interesting/ Difficult strips are used in shift tracks

4 Scope of Care -Assessment ALS (FRP, P) The paramedic utilizes the following additional assessment aids based on patient presentation. ECG Monitoring Required for all patients with a cardiovascular complaint or cardiovascular condition Required for Pharmacologic Assisted Intubation May be utilized for other patients if indicated based on assessment findings 12 Lead ECG Acquisition & Interpretation Required for all patients with suspected myocardial ischemia regardless of transport time (printed 12 lead ECG) Acquisition time of initial 12 lead ECG should be documented in epcr activity log Repeat 12 Lead ECGs must be performed for all suspected ACS patients approximately every 10 minutes unless all providers are busy performing critical therapies Print a 12 lead ECG and provide to the receiving hospital Dynamic 12 lead ECG (on screen) shall not be used for diagnostic purposes Required prior to EMS administration of Zofran for patients who have recently (past 12 hrs) received Zofran in order to assess for a prolonged QTc interval (> 0.45 sec) Should be used for patients with a complaint or event associated with syncope or near syncope, altered mental status, respiratory difficulty, stroke, cardiotoxic poisonings, irregular heartbeat, chest discomfort or palpitations Confirm all 12 lead interpretations with partner

5 Scope of Care Cardiac Patients ALS(FRP, P) 12-lead ECG PRIOR to beginning transport if at all possible Advise the receiving ED of a Code STEMI (if diagnostic) When calling a Code STEMI, request to speak to the ED physician. Code STEMI notifications should occur prior to transport if at all possible. For non-stemi ECGs, DO NOT notify the receiving ED with a possible Code STEMI (use terms such as acute coronary syndrome ). A Code STEMI is defined as a patient with signs/symptoms of acute myocardial ischemia AND: > 1 mm ST elevation in 2 or more anatomically contiguous leads. No imitators/imposters for ST segment changes are present. V1 and V2 alone are not used to determine a Code STEMI. Attempt to collect a green top blood sample for all suspected ACS patients. Fentanyl 1-2 mcg/kg IV every 10 minutes if SBP 90 mmhg until pain relieved or until hypotension or respiratory depression present. (P) May repeat NTG tablet/spray at same dosing if effective (pain resolved) and pain then reoccurs

6 Scope of Care -Transport HOSPITAL SELECTION(FRP, P) Hospital selection should be made by the patients or caregiver if at all possible (consent). The following outlines the methods used to determine hospital selection in order of priority. Patient s or caregiver s choice of hospital If patient s condition dictates a specific facility is required due to the specific medical needs, the paramedic will inform the patient or caregiver of the most appropriate hospital for transport. Every effort will be made to obtain patient consent for transport to the more appropriate hospital. If the patient s or caregiver s choice of hospital is reasonable but not ideal, the paramedic may explain options to the patient or caregiver. The patient or caregiver must make the final decision. Closest hospital capable of managing the patient s condition If the patient or caregiver is unable to provide his/her choice of hospital, the paramedic crew will transport to the closest hospital capable of managing the patient s condition. (For STEMI, ROSC, Stroke, and Trauma patients, see #3 below) Any time the patient s condition is significantly unstable, the paramedic may choose to divert to a closer hospital ED staffed by a physician.

7 Scope of Care -Transport Patients with a clinical presentation and 12-lead ECG diagnostic for an acute ST-elevation MI (STEMI) OR if patient is successfully resuscitated and has a return of spontaneous circulation (ROSC) Transport to closest facility with emergent PCI capability (Round Rock Medical Center, North Austin Medical Center, Scott and White University Hospital Round Rock, Scott and White Temple, and Seton Williamson) Provide early notification to the receiving ER If patient requests transport to another cardiac catheterization capable hospital, discuss risks and benefits of transport to hospital with longer transport time

8 epcr Documentation

9 epcr Documentation

10 epcr Documentation

11 epcr Documentation

12 epcr Documentation

13 Additional Documentation New software will be added to Phillips monitors to allow data from monitor to EMS charts Physicians are able to access EMS Charts Physicians can leave patient follow-up information on epcr

14 AMI Database Currently under construction

15 2010 CPR Statistics 2010 Statistics -Gathered by Dr. Benold January 1 June 30, 2010 Cardiac arrests worked 49 Witnessed 39 Shockable Rhythm 20 Witnessed and Shockable 12 Discharged alive from hospital 9 CPR Success % of all arrests 18% % of witness 23% % of shockable rhythms 45% % of witnessed and shockable 75%

16 2010 CPR Statistics July 1 December 31, 2010 Cardiac Arrests Worked 65 Witnessed 28 Shockable Rhythm 18 Witnessed and Shockable 11 Discharged alive from hospital CPR Success % of all arrests % of all witnessed % of shockable rhythms % of witnessed and shockable