STEMI transfers

[cruiseforever]

When we started to do STEMI transfers many years ago. It was normal practice to hang a Nitro drip, Heparin drip. Over the last few months they have disappeared on most of our transfers. Now the ER gives a bolus of Heparin and have us give Nitro as needed. Their goal is to have the pt. on the road in less than 30 minutes. The last one I did, a pt. walked into the ER.. 20 minutes later was on the road.

It sure makes the transfer to stretcher and then back to cath. lab table easier. Our transport time is approx. 30 minutes by ground. Wondering what is happening in your area.

 

[DesertMedic66]

All 3 of our hospitals are STEMI centers so we don't do transports. If for some reason they needed to transport a patient on nitro or heparin drip it would be a CCT or air ambulance call or the patient would have to be DCed from those for an ALS transport.

 

[Tigger]

Your ALS cannot take those drips? I guess I often forget how much CCT differs in California with having RNs on board and whatnot.

Most of our STEMIs still go down on heparin and a fair few have nitro running as well. Our hospital could be quicker, but I don't think it's the drips that are slowing them down, I think they're just useless. We usually take their pump to speed things up though our ambulances all have their own MiniMed pumps on them as we initiate our own nitro drips in the field for STEMIs.

 

[DesertMedic66]

Your ALS cannot take those drips? I guess I often forget how much CCT differs in California with having RNs on board and whatnot.

Most of our STEMIs still go down on heparin and a fair few have nitro running as well. Our hospital could be quicker, but I don't think it's the drips that are slowing them down, I think they're just useless. We usually take their pump to speed things up though our ambulances all have their own MiniMed pumps on them as we initiate our own nitro drips in the field for STEMIs.

These are the only medications that ALS can monitor during transport:
i. Intropin (Dopamine)
ii. Isoproterenol (Isuprel)
iii. KCl of < 40mEq/1000cc
iv. Morphine Sulfate
v. Xylocaine HCL (Lidocaine)

 

[TRSpeed]

It's county specific because where I work in CA we can Transport Heparin or Nitro drips.

 

[DesertMedic66]

It's county specific because where I work in CA we can Transport Heparin or Nitro drips.

For CA those medications are listed under CCP medications however your LEMSA is able to put in a request to allow normal medics to give those meds.

 

[Angel]

we have to be cct trained to take those drips. and since there arent any classes....

 

[Handsome Robb]

The only time we do STEMI transfers are from our LII satellite center to their main hospital, from the VA or one other small hospital in the area if it's something more complex than a simple single stent placement. We can take NTG and heparin infusions on standing orders though. Any ground medic here can take SCT transfers. We can take amiodarone, dope, epi, heparin, hydroxocolbalamin, ABx, lidocaine, NTG, KCl, TPN and versed.

The scary ones are the ones from the small, non satellite hospital where you get a RN a IABP and an RN plus a slap on the *** and "drive like the wind, champ. The only one I've had was a patient who ended up with a spiraled LAD at the small hospital and they arrested during transport. I had to prompt the RN to change the IABP to a pressure trigger rather than the ECG trigger.

 

[Sunburn]

We don't have heparin for prehospital care in the whole country. When I get a call for STEMI all I can do is basic MONA (morphine, oxygen, nitro and ASA) therapy and hightail it to the hospital. Which is a tad more than 2 hrs away.

 

[Carlos Danger]

These are the only medications that ALS can monitor during transport:
i. Intropin (Dopamine)
ii. Isoproterenol (Isuprel)
iii. KCl of < 40mEq/1000cc
iv. Morphine Sulfate
v. Xylocaine HCL (Lidocaine)

That seems like an odd list?

 

[CANMAN]

Cath labs could care less about if the Heparin and Integrilin get transferred/are running upon arrival to the cath lab. Most times they are D/C'ed and tossed in the trash prior to patient even being draped.

Our goal bedside times for STEMI flights is 10minutes or less bedside time. Aircraft stays running we go inside to get patient. One provider gets paperwork signatures and quick report, second provider packages patient, places them on monitor, and obtained brief HPI from patient. Heparin and Integrilin will get pulled and we will take with and restart in the aircraft if we have time. Tridil we will transfer at bedside. All our referral hospitals normally have the paperwork together when they call and I would stay we meet our goal time 90% of the time.

If we do a STEMI scene flight, local provider's transmit the 12 lead, and we will go straight to the lab from the field.

 

[DesertMedic66]

That seems like an odd list?

Well I am in SoCal...

Those medications are in addition to the normal NS, D10, etc

 

[Carlos Danger]

Well I am in SoCal..

Oh I understand.

But whoever is writing those regs....why would they allow dopamine but not norepi or dobutamine? Potassium but not magnesium? Morphine but not fentanyl? Lidocaine but not amiodarone? I wonder what their rationale is.

Are they actually using Isuprel out there?

 

[Carlos Danger]

double post

 

[CANMAN]

Oh I understand.

But whoever is writing those regs....why would they allow dopamine but not norepi or dobutamine? Potassium but not magnesium? Morphine but not fentanyl? Lidocaine but not amiodarone? I wonder what their rationale is.

Are they actually using Isuprel out there?

Agree 110% Maryland is the same way man for single medic ground provider's. Makes no sense.

 

[DesertMedic66]

Oh I understand.

But whoever is writing those regs....why would they allow dopamine but not norepi or dobutamine? Potassium but not magnesium? Morphine but not fentanyl? Lidocaine but not amiodarone? I wonder what their rationale is.

Are they actually using Isuprel out there?

Honestly can't answer that. I'm in a very isolated part of the county. The only drips I have ever seen medics with out here are your normal NS (which BLS can do in out area). It makes no sense at all

 

[Smash]

We don't have heparin for prehospital care in the whole country. When I get a call for STEMI all I can do is basic MONA (morphine, oxygen, nitro and ASA) therapy and hightail it to the hospital. Which is a tad more than 2 hrs away.

Why are you not thrombolysing with that sort of prehospital time?

 

[Tigger]

How many here are able to transport thrombolytic agents? It is our hope to begin doing so in the next year though we generally only have a 40 minutes transport time from community hospital to cath lab.

 

[Smash]

How many here are able to transport thrombolytic agents? It is our hope to begin doing so in the next year though we generally only have a 40 minutes transport time from community hospital to cath lab.

We thrombolyse in rural areas. Metro areas generally have plenty of access to PCI in short timeframes.

 

[drl]

In my IFT service, we do STEMI transfers fairly often, and they're almost always CCT with heparin running, and often nitro as well.