Cardiovascular STEMI Receiving Center System in a Large Metropolitan County

Background: Annually over one million Americans suffer acute myocardial infarction (AMI), 250,000 die within 60 minutes of symptoms, 375,000 die before reaching medical attention. 32% have ST-Segment Elevation Myocardial Infarction (STEMI). Locally over 11,000 9-1-1 transports are for cardiac chest pain, over 400 for STEMIs. Paramedics with the ability to perform field 12-lead ECG can play a key role in reducing this cause of morbidity and mortality. Methods: In January 2007, EMS launched a STEMI Receiving Center (SRC) system. In this system Prehospital ALS personnel have the ability to alert hospitals of an incoming STEMI patient. Thirteen of 20 EDs are SRC and submit data to EMS. Data collected includes demographics, interventions, date/time of interventions, length of hospitalizations, outcomes, and field ECGs. Results: Of 335 Prehospital activated STEMI patients 81% went to the cardiac catheterization lab for an intervention. A main measure of success is time from arrival at ED to intervention/balloon inflation (Door-To-Balloon time/DTB). Pre-system data showed DTB times to be within 90 minutes 85.7% and 88.7% after system implementation. Mean DTB time was 76 minutes for pre-system and 61 minutes after system implementation. Median DTB time was 64 minutes for pre-system and 56 minutes after system implementation. 70% of pre-system patients and 88% of after system implementation patients returned home. Conclusions: Although still new, the SRC system has shown that Prehospital STEMI notification plays a key role in triaging patients to appropriate facilities and reducing time to interventions.