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S –T Elevation Myocardial Infarction Bypass & Percutaneous Coronary Intervention By:

S –T Elevation Myocardial Infarction Bypass & Percutaneous Coronary Intervention By: Andrew Robert Director, County of Simcoe Paramedic Services. Objectives Introduce Dr. M. Murray, Selma Mitchell, Maureen Sullivan. Discuss Heart attack treatment Introduce the Research Initiative.

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S –T Elevation Myocardial Infarction Bypass & Percutaneous Coronary Intervention By:

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  1. S –T Elevation Myocardial Infarction Bypass & Percutaneous Coronary Intervention By: Andrew Robert Director, County of Simcoe Paramedic Services County of Simcoe Paramedic Services

  2. Objectives Introduce Dr. M. Murray, Selma Mitchell, Maureen Sullivan. Discuss Heart attack treatment Introduce the Research Initiative. Discuss Bypass Protocol. Outline Paramedic Role. Illustrate Clinical Procedure. County of Simcoe Paramedic Services

  3. Percutaneous Coronary Intervention (PCI) vs. Thrombolysis (Clot Busters) Lower composite of death, reinfarction & stroke (8% versus 14%). County of Simcoe Paramedic Services

  4. The Research Initiative Collaboration between: County of Simcoe Paramedic Services. Southlake Regional Health Centre. Royal Victoria Hospital. Simcoe Muskoka Base Hospital Program. PCP vs. ACP County of Simcoe Paramedic Services

  5. Process Steering Committee Established: SRHC Staff, Physicians & Cardiologists. SMBHP Medical Director & Program Manager. CSPS Director. RVH Physicians and staff. CACC Policy Liaison Officer. Establish Proposed Practices. Research Ethics Boards Approval. County of Simcoe Paramedic Services

  6. Project Goals Provide Simcoe County with the current standard of practice for patients with STEMI. Identify candidates for hospital bypass. Timely transportation of patients from “field” or RVH to SRHC in maximum of 60 minutes (including assessment). Provide intervention when necessary. Collect data related to project. County of Simcoe Paramedic Services

  7. To Achieve Best Patient Outcomes Early identification of STEMI. Early deployment of the cath team. Bypassing the closest hospital. Direct transfer to the PCI Center. County of Simcoe Paramedic Services

  8. Plaque Build-Up in the Heart County of Simcoe Paramedic Services

  9. Left Main Coronary Artery Right Coronary Artery Left Anterior Descending County of Simcoe Paramedic Services

  10. An ECG Displaying a Normal Sinus Rhythm County of Simcoe Paramedic Services

  11. An Example of a Normal Cardiac Cycle with Labeling County of Simcoe Paramedic Services

  12. An Example of a ECG Showing ST Segment Elevation County of Simcoe Paramedic Services

  13. Placement of 12 Lead Electrodes on the Chest & Limbs County of Simcoe Paramedic Services

  14. An Example of an Acute Inferior MI. (The red line indicates where the ST Segment would normally be) County of Simcoe Paramedic Services

  15. Paramedic Role Patient assessment. Suspected cardiac patient. Symptom onset. Contraindications to Thrombolysis. 12 Lead ECG. ETA to SRHC. County of Simcoe Paramedic Services

  16. “CODE STEMI” to CACC. Patient Bypass to local hospital to SRHC. SRHC Internal Notifications. Patient arrival at SRHC. Bypass Emergency to Cath Lab. Review case & ECG with Cardiologist. PCI immediately, if indicated. Data gathering & analysis. County of Simcoe Paramedic Services

  17. County of Simcoe Paramedic Services

  18. PCI DVD County of Simcoe Paramedic Services

  19. Conclusion Increased collaboration of health care partners, enhancing patient care. “It is estimated that there would be 23 less deaths, 42 less non-fatal reinfarctions and 11 less strokes per 1,000 patients treated with primary PCI rather than a fibrinolytic”. County of Simcoe Paramedic Services

  20. Conclusion Cont’d Benefits of previous PS initiatives realized 12 Lead ECG Capture Capability 12 Lead ECG training CME Priorities County of Simcoe Paramedic Services

  21. Questions County of Simcoe Paramedic Services

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