CBRAC-U REGIONAL TRAUMA SYSTEM PLAN
BYPASS PROTOCOL FOR THE CONFIRMED ST
ELEVATION MYOCARDIAL INFARCTION
PATIENT
Goal: A ST elevation myocardial infarction (STEMI)
which is confirmed with a 12 lead electrocardiogram
will be quickly identified and transported to the
appropriate percutaneous coronary intervention
(PCI) capable chest pain accredited hospital in an
expeditious manner.
Decision Criteria: This bypass protocol is intended
to ensure that patients with a confirmed STEMI will
be transported directly to the appropriate chest pain
accredited PCI capable hospital. Exceptions to the
bypass protocol requiring the patient be transported
to the NEAREST facility are:
 Inability to establish and/or maintain an airway
or in the event of cardiac arrest, the patient will
be transported to the nearest acute care facility.
 Transport time to the indicated PCI facility
exceeds 30 minutes and EMS is unable to
handoff the patient to a higher level of prehospital care, the patient will be transported to
the nearest facility.
 Consideration to bypass the closest facility
based on exclusionary criteria for thrombolytics
will necessitate contact with that facility or
medical director for medical direction.
Patient Criteria for Activation of Bypass
Protocol for the Confirmed STEMI Patient
The activation of the Bypass Protocol for the
confirmed symptomatic STEMI patient will be
initiated upon the recognition of a confirmed STEMI
with 12 lead EKG.
Air Ambulance/Hand-Off
Hand off of the STEMI patient to advanced life
support (ALS)/mobile intensive care unit (MICU)/air
transport will be initiated in the following
circumstances:
 If the responding unit is the first/only responder
and is unable to leave the service area.
 Consider air handoff if transport time is greater
than thirty minutes.
Notes:
If there should be any questions regarding activation
of treatment protocol for the confirmed STEMI
patient, the receiving facility should be contacted for
decisions regarding treatment.
The receiving facility should be notified at the
earliest possible time by EMS to provide the facility
with the ability to activate a cardiac team response.
Patient’s rights, choices and best interest will be
respected in the determination of hospital
destination.
Thrombolytic Screening Exclusionary Criteria
 Active internal bleeding
 History of CVA
 Recent intracranial or intraspinal surgery or
trauma (2 months)
 Intracranial neoplasm, AVM, or aneurysm
 Known bleeding diathesis
 Uncontrolled hypertension (systolic > 185
mmHg and or diastolic > 110 mmHg)