New York City
Direct Referral to Catheterization Lab
STEMI Notification
& Transportation Protocol
What is Mission: Lifeline?
•
Mission: Lifeline is the American Heart Association's systems-based approach to
improving emergency cardiac care for all Americans.
•
M:L implements quality improvement strategies based on evidence-based guidelines
and forms partnerships across the system of care:
– community
– emergency medical service
– emergency department (referral and receiving centers)
– inpatient care
– post-discharge
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©2012, American Heart Association
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Ideal System of Care
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New York City Mission: Lifeline
TIMELINE
• New York City chosen as one of 20
sites nationwide to participate in
pilot project with Duke Clinical
Research Institute and the
American Heart Association
• Project Timeline:
July 2012-December 2013
PROJECT OBJECTIVES
• Establish regional standards for
emergency cardiovascular care
• Lower mortality by improving timely
treatment for STEMI patients
• Create sustainable system for
treating cardiovascular
emergencies including STEMI,
cardiac arrest, stroke, aortic
dissection
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Purpose of Protocol
Direct notification to receiving hospital ED and direct delivery of
certain STEMI patients to receiving hospital catheterization labs in order
to expedite PCI treatment and continue to provide the highest level of
care and transportation.
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Direct to Cath Lab Criteria
INCLUSION CRITERIA
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EXCLUSION CRITERIA
Ongoing chest discomfort or upper
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LBBB
body discomfort felt to be ischemic in
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Intubated
origin
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Respiratory failure or CHF requiring
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Symptom duration of <12 hours
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ST elevation of at least 2 mm in two or
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Cardiac arrest
more contiguous leads
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DNR/DNI
Absence of other issues believed to
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On-going Hospice care
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Obvious active severe bleeding
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Head or other serious trauma (meets
•
require further evaluation and treatment
(see exclusions)
intubation
trauma center criteria)
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Direct to Cath Lab Protocol
EMS
1. EMS transmits ECG to OLMC MD
FDNY OLMC
2. OLMC MD confirms ST elevation and verifies direct
referral criteria with EMS
3. OLMC notifies and transmits ECG and patient
demographic info to PCI center ED
Receiving Hospital ED
(Meet, greet, and escort EMS)
4. ED activates STEMI pager, including information
that patient is Direct Referral to Cath Lab and ETA
5. Cath lab calls ED to confirm availability to proceed
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Cath Lab
6. Fellow, resident, or member of cath lab team
greets EMS and patient at ED entrance and escorts
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them to cath lab
Pre-Notification Protocol
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FDNY will transmit the ECG and make a phone call (providing the necessary demographic
information to allow for preregistration) for all patients with ischemic type chest discomfort
and ST segment elevation >1mm.
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For all cases with >2 mm ST segment elevation who meet the agreed upon criteria
for “direct referral to the cath lab” FDNY will use specific language stating that the patient
qualifies for “direct transport to the cath lab”.
•
Hospitals will then preactivate the cath lab and follow their procedures on how to expedite
the patient to the cath lab.
Note: If the field ECG cannot be transmitted from the field to the hospital, FDNY will still call a
“direct referral to the cath lab” if the patient meets the criteria. (Note: the field EMS personnel
will still communicate verbally with FDNY On-Line Medical Control MDs who will make the
determination on the case).
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Notes
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The hospital needs to escort EMS to the hospital’s Cath Lab on the EMS stretcher. EMS
will not take any patient directly from the field to a PCI Center’s cath lab.
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Hospital staff must meet EMS within five minutes of arrival and the total time spent
awaiting an escort is not to exceed ten minutes.
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If no staff is available within 10 minutes, the patient shall be delivered to ED staff.
•
With the availability of the transmitted field or hard copy ECG, time should not be wasted to
obtain an ECG at the time of arrival.
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If the cath lab is closed, the patient will then reside in the ED.
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Hospital “arrival time” is the time the patient is brought to the ED by EMS.
• If the field ECG cannot be transmitted, FDNY will still call a “direct referral to the cath lab”
if the patient meets the criteria.
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Questions?
Zainab Magdon-Ismail, Ed.M., MPH
Vice President, Quality Improvement Initiatives
American Heart Association
518-229-5483 (cell)
Zainab.Magdon@heart.org
Glenn Asaeda, MD
Chief Medical Director
Fire Department of New York
asaedag@fdny.nyc.gov
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