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.


Harbor - UCLA is a STEMI Center, with 24/7 cardiac catheterization availability. STEMI activations are often called in from the field. If a STEMI activations is called in from the field or from another hospital (IFT) please ask the providers to advance transmit the field ECG for review. This ECG should be downloaded by the MICN and brought to the Attending physician. Per the request of our colleagues in Interventional Cardiology, you should get the report from the MICN, paramedics, or transferring Emergency physician, review the transmitted ECG and if you agree with the STEMI interpretation have the clerk/MICN page the STEMI out. The Interventional Cardiologist on-call will review the ECG as well and cancel the STEMI activation if they disagree. If you cannot access the transmitted field or outside hospital ECG, you may call the Cardiology Fellow or Attending to access (if available). However, if the transferring hospital or reporting paramedic does not advance 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.

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 inform you that they are transferring a STEMI via 9-1-1 activation. 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 without a formal transfer process. We generally accept these without question. You should ONLY accept these calls on the recorded line in the Radio Room at (310) 328-1800. This is for your (and Harbor’s) protection, as these transfers are considered complex EMTALA matters and are being monitored closely by the County. If you receive a call regarding STEMI transfer to your Spectra (cordless) phone, please ask the caller to call the Radio Room and go there to answer. If you do not remember the number there, ask them to call the AED clerk (main number) and state that they are calling for a STEMI transfer (IFT). The clerks are aware of this process and should be able to transfer the call to the Radio Room. This is not necessary if the call is coming through the MAC (which records all calls).

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[1]

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

References

  1. Patel, D. (2016, January). Base Hospital Physician Course [PDF]. Torrance: Harbor-UCLA.