Welcome to EMSAC's new home on the internet. After a bit of a hiatus, it's good to be back online. We are planning many things for this website and are completely open to suggestions from readers around the area. Here you will see a comprehensive collection of clinical and educational resources, as well as news from around the local and State EMS scenes. Some of the offerings we will have include:
- Notes from the Medical Director, written by Dr. Feicht
- An "Ask the MCP" column to address protocol and practice issues
- "Dear Dave", an advice column hosted by David Nutter, EMS Liason for EMSAC
- "EMSAC Online" Protocol and Protocol Review section
- Area Announcements - a bulletin board for local departments to post upcoming functions
- ER/ICU Notes - Feedback and updates from Genesis' critical care areas pertaining to EMS
- "Pharmacy Notes" - updates on medications and stocking & storage guidance
- Educational Opportunites - A calendar of classes put on by EMSAC and other entities
Featured Article
STEMI - Reducing Door to Procedure Time
Genesis HealthCare system has been operating as an accredited Chest Pain Center for a while now and one of their Performance Improvement Criteria focuses on critical times. Intervals such as time of 911 access to 12 lead electrocardiogram (ECG) and Door-to-Procedure times are watched closely in order to ensure the best care in the most expedient fashion possible. Starting with a goal of 90 minutes for door-to-balloon time, the subject of April’s STEMI Study was a 68 year-old male with a presenting complaint of chest pain, nausea and diaphoresis. The patient’s past medical includes Coronary Artery Disease with stenting, hypertension, dyslipidemia and is a smoker. The patient received routine EMS care including a 12 lead ECG from-which a CODE STEMI was called at Genesis Good Samaritan Hospital. Upon arrival to the ED, a repeat ECG was completed within one minute of the patient’s arrival and Interventional Cardiology Service confirmed Inferior wall STEMI. The patient arrived in the Cardiac Cath Lab 23 minutes after arriving at the hospital and Balloon catheterization was begun within 45 minutes. Total elapsed time from EMS’ arrival at the scene was 66 minutes.
Upon fluoroscopic examination, the patient was found to have 100% occlusion of the left circumflex artery as evidenced by corresponding S-T segment elevation in leads II, III and aVF on the ECG.
The patient subsequently had a good outcome with optimal preservation of Cardiac function on subsequent Echocardiogram.
This outlines the importance of rapid recognition of STEMI in the field and expeditious treatment and transport in order to minimize door to procedure time. The advent of 12 lead ECG’s in the pre-hospital setting, along with transmission to the hospital for interpretation and mobilization of the Cath Lab Team means that more patients are surviving with fewer deficits following Acute Coronary Syndrome.