STEMI transfers

Smash said:
Why are you not thrombolysing with that sort of prehospital time?
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It's very different between US and Cro. None of us have thrombolysing agents in our vehicle, since EU guidelines prefer PCI anyway. Our goal in pre-hospital is to save border areas of AMI heart by using nitro and morphine and prevent thrombus from growing by using ASA as anti-platelet therapy.
Trust me, there's a huge difference in our and your funding since we are government owned public service.
 
Here in Mass, we can transport 3 infusions running at once. Anything over 3 turns the call into a CCT, but if the crew/company is comfortable its fair game to leave it ALS
 
In my area we're able to transport any IV medication that we're comfortable with. We carry TNK on all the ALS trucks, and use it fairly often, as we have limited PCI resources. We also have IV nitro, and access to Plavix, Brilinta and Enoxaparin. Generally we take the hospital's pumps if they're running multiple infusions.

One of our limitations is that not all of our trucks are ventilator-equipped or have the ability to monitor arterial lines. So we sometimes have to call for additional resources in those situations.
 
I work in a very rural area with the closest cardiac cath lab 2 and a half hours away. So you can say I have a lot of time in the back with STEMI transfers. Mostly here they are on heparin drip with nitropaste very rarely will I have a nitro drip.
 
We have a hospital here that cannot do interventional caths so we get called from time to time to take STEMI patients to one of the other hospitals. We treat it like a scene call... come in code 3, tell them they better have paperwork ready in one minute and then swoop them up and out the door we go. They usually have enough time to slap some nitro paste on, give them some heparin and lovenox and aspirin by the time we roll out, but we try to keep our time in the ED to 5 minutes or less. They know the drill now, so it's a pretty streamlined process. We had several this last year that had times of less than 30 minutes from first EKG to being on the cath lab table across town.
 
STEMIs that come in by EMS don't even come off the EMS stretcher at the rural hospitals where I am. They get a PO dose of Brillinta, a heparin bolus and SL nitro prn while waiting for a call back from the cardiologist. This keeps our door to door time usually under 20 minutes. The EMS crews in this area can transport all sorts of drips but the cardiologists don't want to waste time setting up the drips since what they need is a cath lab.
 
ERDoc said:
STEMIs that come in by EMS don't even come off the EMS stretcher at the rural hospitals where I am. They get a PO dose of Brillinta, a heparin bolus and SL nitro prn while waiting for a call back from the cardiologist. This keeps our door to door time usually under 20 minutes. The EMS crews in this area can transport all sorts of drips but the cardiologists don't want to waste time setting up the drips since what they need is a cath lab.
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Why not just bypass the local hospital and transport directly to a STEM receiving center?
 
I ask the same thing every day.
 
Apparently not. Our cath lab is about 30-45 minutes away with L&S.
 
My current employer has pumps and we can take literally whatever's running on them if we need to, to include blood and thrombolytics. However, we are about an hour from metropolitan Houston and generally fly our CVA and STEMI patients due to the lack of a local cath lab.

My recent employer used a CCT truck for STEMI transfers whenever possible. When not available, we could either call our Texas medical control via on-duty supervisor and get permission to transport (slow) or DC and sprint (fast). Guess which one happened more?
 
One of the dumbest system designs I ever worked in required us to bring STEMI patients to our base hospital regardless of whether or not they were closer to the Las Cruces cath lab cluster due to an interpretation of EMTALA and "we can start thrombolytics". T or C to LC is about 50 minutes, but add in glacier-slow transfer paperwork and we're at 2 hours minimum...
 
Anyone ever transported a STEMI from a non-PCI hospital past one or more PCI hospital to a PCI hospital that is contracted or affiliated with the original hospital? Is that legal? I have done it.
 
medicaltransient said:
Anyone ever transported a STEMI from a non-PCI hospital past one or more PCI hospital to a PCI hospital that is contracted or affiliated with the original hospital? Is that legal? I have done it.
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Done it many times.
 
medicaltransient said:
Anyone ever transported a STEMI from a non-PCI hospital past one or more PCI hospital to a PCI hospital that is contracted or affiliated with the original hospital? Is that legal? I have done it.
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What law would a physician ordered transfer violate?
 
medicaltransient said:
Anyone ever transported a STEMI from a non-PCI hospital past one or more PCI hospital to a PCI hospital that is contracted or affiliated with the original hospital? Is that legal? I have done it.
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Unfortunately I have as well. My region's understanding is that if the patient becomes unstable (or less stable at any time), we can divert to the "closest appropriate" facility. Of course, OLMC should be involved, if at all possible...

As hospital consortia grow, and EMRs grow more fragmented, sometimes this makes sense, for continuity of care... sometimes.
 
Brandon O said:
Well, EMTALA, potentially.
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Have you personally encountered a transfer in which a patient hasn't been stabilized within the sending facility's capability and gets sent out for insurance repatriation?

It's something we all hypothesize happens, but I've never experienced it.
 
It's more of a regulatory thing than the classic dumping situation. Things get tricky when you're not transferring appropriately and needfully. Don't know how this sort of thing would apply, but it's quite possible bypassing a legitimate destination would be considered a violation. [not a lawyer]
 
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