View source for Harbor:Code STEMI

==Background==
Code STEMI is utilized to activate the cardiac catheterization laboratory for emergent revascularization in the setting of ST-elevation myocardial infarction.<br>
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Harbor - UCLA is a STEMI Center, with 24/7 cardiac catheterization availability. STEMI activations are often called in from the field, and many patients are transferred from outside hospitals for STEMI treatment. <br>
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==Accepting STEMI Transfers from Outside Hosptials==

Not all hospitals in our area are STEMI receiving centers; a hospital that is not a STEMI Center may call you in the emergency department to request transfer of a STEMI via 911 EMS response. This countywide protocol allows hospitals that are not STEMI centers to call 911 to emergently transfer a patient in their Emergency Department (not inpatients) to a STEMI Center for emergent cardiac catheterization. The process for accepting a STEMI 911 IFT is as follows:<br>
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1) Only Attending Base Hospital Physicians can accept a STEMI 911-IFT. <br>
2) Only STEMIs should be transferred by 911-IFT. This process should NOT be used for NSTEMIs or "concerning history"<br>
3) These calls should be answered on the recorded line in the Radio Room at (310) 328-1800. If you receive a STEMI transfer call to your Spectra phone, please ask the caller to call the Radio Room and go there to answer. <br>
4) The transferring hospital must transmit their ECG to you & there must be a Doc-to-Doc conversation to confirm that both of you see ST elevations on the ECG.<br>
5) If you don't see a STEMI, but the transferring physician reasonably believes that he/she does, please accept the patient and re-evaluate in our ED. <br>
6) If you do not see STEMI and the transferring physician reports concern for NSTEMI changes or troponin abnormalities, please advise them that we “would be happy to accept the patient for transfer via the Medical Alert Center; but at this time we are only supposed to accept STEMI 911-IFTs if they meet ECG criteria for emergent cardiac catheterization.” <br>
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More information on STEMI patients and Interfacility Transfer of STEMI patients can be found on the Harbor-UCLA Intranet under DEM Policies and Procedures.

(See also "TRANSFERS")

Dir OPS 1/9/17

==Pre-Hospital Activation<ref>Patel, D. (2016, January). Base Hospital Physician Course [PDF]. Torrance: Harbor-UCLA.</ref>==
If a STEMI is reported in from the field or from another hospital (IFT) ask the providers to transmit the ECG for review (if not already done). The ECG should be printed by the MICN and brought to the Attending physician AND the physician should speak to the paramedics or transferring physician to get their clinical assessment. Per the request of our colleagues in Interventional Cardiology, if you agree that the transmitted ECG and clinical history is consistent with STEMI, you should page out the STEMI as soon as possible. DO NOT wait for patient to arrive before placing the page, regardless of time of day. The Interventional Cardiologist on-call will review the ECG as well and cancel the STEMI activation if they disagree. However, if the transferring hospital or reporting paramedic cannot or does not transmit the ECG, you should delay activation until the patient arrives in the emergency department and you have a chance to review the field or outside hospital ECG, or have performed one in our emergency department.<br>

The process for pre-hospital activation is dependent on existing procedures outlined in the Los Angeles County EMS Agency Prehospital Care Manual and proceeds along the following pathway:
===Pre-Hospital 12-lead ECG===
A pre-hospital 12-lead ECG is obtained in the following settings:
*Chief complaint of chest pain
*Alternative chief complaint suggestive of an acute cardiac event
*Relevant and significant medical history which increases the likelihood of an acute cardiac event
*New-onset dysrhythmia
*ROSC
===Criteria for contact/transmission to STEMI Receiving Center (SRC)===
*Good-quality 12-lead ECG with >1mm ST-segment elevation in greater than 2 contiguous leads.
*Computer analysis indicates ***ACUTE MI***or manufacturer equivalent. 
===Criteria for pre-hospital activation of Code STEMI===
*ED physician agrees with STEMI impression
*Age 30-90
*Pain less than 12 hours
*Greater than 2mm S-T elevation in 2 or more contiguous leads
*QRS less than 0.12
*Heart Rate less than 120
*No paced rhythm
*No DNR
*Able to give informed consent
*Not intubated
*Paramedic confident in STEMI impression

If the requirements for pre-hospital activation are not met, the patient should undergo expedited evaluation upon arrival in the emergency department to determine appropriateness for Code STEMI activation.

==Procedure==
Code STEMI can be activated via the auto-paging order in Orchid FirstNet titled "Code STEMI". Relevant ECG's should be submitted via the STEMI email (open in the radio room).

==See Also==
*[[Harbor:Main]]
*[[Harbor:EKG STEMI Screening]]

==References==
<references/>


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