The Safety of Bypass to Percutaneous Coronary Intervention Facility by Basic Life Support Providers in Patients with ST-Elevation Myocardial Infarction in Prehospital Setting

Froats, Mark; Reed, Andrew J.; Dionne, Richard; Maloney, Justin; Duncan, Susan L.; Burns, R. R.; Sinclair, Julie E; Austin, Michael

doi:10.1016/j.jemermed.2018.09.006

Cited by 3 publications

(3 citation statements)

References 28 publications

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“…While doubtless further programmatic analysis is required for many of the specific programmes described, the current practices show promise. In the case of bypass to alternate care destinations, there is evidence for safe and effective bypass by paramedics to alternate care destinations for conditions such as heart attacks (STEMI) (Cheskes et al, 2011;Froats et al, 2018) and stroke (Stiell et al 2017). While crisis response teams vary in their format and require further study, there has been some study of such teams and indication that an interagency response model has potential to be preferable for crisis response (Boscarato et al, 2014;Choi et al, 2019;Watson & Compton, 2019).…”

Section: Tensions Between Frontline Work and System Level Interventionmentioning

confidence: 99%

Filling the gap: Mental health and psychosocial paramedicine programming in Ontario, Canada

Ford-Jones

Daly

2020

Health Social Care Comm

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Paramedics respond to acute medical and trauma emergencies in the community and transport patients to emergency departments (ED). In some cases, paramedics are not only attending calls for mental health and psychosocial care but are also connecting individuals with more appropriate services to address their needs. This study qualitatively explores to what extent there are promising practices to be learned from paramedic services that are connecting patients to mental health and psychosocial programming. The study is organised as follows. In terms of the methods, we conducted a critical ethnographic case study of mental health and psychosocial care within paramedic services in Ontario, Canada. Interviews were conducted with frontline paramedics (n = 31), paramedic services management (n = 5), educators at paramedic college programmes (n = 5) and Base Hospital physicians/directors (n = 5).Work observations were also performed in three paramedic services, with multiple crews across different shifts (n ~90 hr). The study findings outline three promising practices: diversion programmes that transfer patients to a destination other than the ED; crisis response teams that attend calls identified as involving mental health and community paramedicine programmes including referral programmes. We outline the social, political and economic conditions in which these programmes were established and are provided. We also describe the conditions required to enable connecting patients to non-ED supports. The benefits of implementing specific programming for mental health-related calls within paramedic services are discussed, as well as the importance of reaching beyond the prehospital and mental healthcare system to comprehensively and preventatively address mental health needs.Tensions are explored related to running programmatic interventions for mental health by paramedic services. We conclude by noting some public policy-level challenges including the need to focus more broadly on prevention and address the social determinants of health to aid the de-escalation of distress.

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Section: Tensions Between Frontline Work and System Level Interventionmentioning

confidence: 99%

Filling the gap: Mental health and psychosocial paramedicine programming in Ontario, Canada

Ford-Jones

Daly

2020

Health Social Care Comm

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“…7,8 Additionally, other studies rely on the monitor's analysis of the 12L-ECG, 6,8 whereas this county-wide program utilizes the real-time transmission of the 12L-ECG to a physician, which although more vulnerable to techni-cal difficulties, allows for greater interpretational nuance than most software programs. 9 Despite these operational challenges, this is the largest study published to date, [6][7][8] and the only one which uses a single physician, blinded to patient outcome, to evaluate the diagnostic quality of the transmitted 12L-ECGs. 6,7 Of the 12L-ECGs acquired by EMTs, 96% of those available for review were of diagnostic quality.…”

Section: Discussionmentioning

confidence: 99%

“…5 After a search for peer-reviewed, published literature describing EMT acquisition of 12L-ECGs, it seems that qualifying research is limited to two feasibility studies 6,7 and an evaluation of the safety of EMTs bypassing local community hospitals for a PCI-center in rural Canada. 8 Therefore, the objective of this retrospective observational study was to describe the impact of EMT-acquired 12L-ECGs in Suffolk County, New York, both in terms of the diagnostic quality of the transmitted 12L-ECGs and the number of prehospital PCI-center notifications made as a result of transmitted 12L-ECGs demonstrating a STEMI.…”

Section: Introductionmentioning

confidence: 99%

12-Lead Electrocardiograms Acquired and Transmitted by Emergency Medical Technicians are of Diagnostic Quality and Positively Impact Patient Care

Kotelnik

Pesce

Masterton

et al. 2020

Prehosp. Disaster med.

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Introduction: Existing peer-reviewed literature describing emergency medical technician (EMT) acquisition and transmission of 12-lead electrocardiograms (12L-ECGs), in the absence of a paramedic, is largely limited to feasibility studies. Study Objective: The objective of this retrospective observational study was to describe the impact of EMT-acquired 12L-ECGs in Suffolk County, New York (USA), both in terms of the diagnostic quality of the transmitted 12L-ECGs and the number of prehospital percutaneous coronary intervention (PCI)-center notifications made as a result of transmitted 12L-ECGs demonstrating a ST-elevation myocardial infarction (STEMI). Methods: A pre-existing database was queried for Emergency Medical Services (EMS) calls on which an EMT acquired a 12L-ECG from program initiation (January 2017) through December 31, 2019. Scanned copies of the 12L-ECGs were requested in order to be reviewed by a blinded emergency physician. Results: Of the 665 calls, 99 had no 12L-ECG available within the database. For 543 (96%) of the available 12L-ECGs, the quality was sufficient to diagnose the presence or absence of a STEMI. Eighteen notifications were made to PCI-centers about a concern for STEMI. The median time spent on scene and transporting to the hospital were 18 and 11 minutes, respectively. The median time from PCI-center notification to EMS arrival at the emergency department (ED) was seven minutes (IQR 5-14). Conclusion: In the event a cardiac monitor is available, after a limited educational intervention, EMTs are capable of acquiring a diagnostically useful 12L-ECG and transmitting it to a remote medical control physician for interpretation. This allows for prehospital PCI-center activation for a concern of a 12L-ECG with a STEMI, in the event that a paramedic is not available to care for the patient.

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Safety and Adverse Events During Primary Care Paramedic Interfacility Transfer of Stable STEMI Patients

Feldman,

Bahaidarah,

Rahimi

et al. 2024

Prehospital Emergency Care

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The Safety of Bypass to Percutaneous Coronary Intervention Facility by Basic Life Support Providers in Patients with ST-Elevation Myocardial Infarction in Prehospital Setting

Cited by 3 publications

References 28 publications

Filling the gap: Mental health and psychosocial paramedicine programming in Ontario, Canada

Filling the gap: Mental health and psychosocial paramedicine programming in Ontario, Canada

12-Lead Electrocardiograms Acquired and Transmitted by Emergency Medical Technicians are of Diagnostic Quality and Positively Impact Patient Care

Safety and Adverse Events During Primary Care Paramedic Interfacility Transfer of Stable STEMI Patients

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