title: Prehospital diagnosis and triage of ST-elevation myocardial infarction by paramedics without advanced care training.
abstract: BACKGROUND
  Prehospital triage of ST-elevation myocardial infarction (STEMI) for primary percutaneous coronary intervention (PCI) reduces treatment times. Prehospital triage and transport of STEMI patients have traditionally been undertaken in emergency medical service systems with Advanced Care Paramedics (ACPs). However, ACPs are not available in many regions. A pilot study was conducted to determine the feasibility of prehospital STEMI triage in a region with only Primary Care Paramedics.
  
  
  METHODS
  Hemodynamically stable patients with chest pain and suspected STEMI were brought directly to a catheterization laboratory for primary PCI. End points included accuracy of prehospital STEMI identification, complications during transfer, and treatment times.
  
  
  RESULTS
  One hundred thirty-four consecutive patients with suspected STEMI were triaged for primary PCI. Only 1 patient developed complications during transport (rapid atrial flutter) that required ACP skills. One hundred thirty-three patients underwent urgent angiography, and 105 patients underwent PCI. Based on physician interpretation of the prehospital electrocardiogram, there was agreement with triage decision for 121 (90%) of the 134 cases. The final diagnosis based on the angiogram and cardiac markers was true STEMI for 106 patients and false positive for 28 patients. The median first medical contact to balloon time was 91 (81-115) minutes.
  
  
  CONCLUSIONS
  Hemodynamically stable patients with suspected STEMI can be safely and effectively transported directly for primary PCI by paramedics without advanced care training. Prehospital STEMI triage for primary PCI can be extended to regions that have few or no paramedics with advanced care training.
authors.affiliation: Southlake Regional Health Centre, Newmarket, Ontario, Canada. cantorw@rogers.com
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Cantor
authors.forename: Paul
authors.initials: P
authors.lastname: Hoogeveen
authors.forename: Andrew
authors.initials: A
authors.lastname: Robert
authors.forename: Karen
authors.initials: K
authors.lastname: Elliott
authors.forename: Lorne E
authors.initials: LE
authors.lastname: Goldman
authors.forename: Erica
authors.initials: E
authors.lastname: Sanderson
authors.forename: Sylvain
authors.initials: S
authors.lastname: Plante
authors.forename: Manu
authors.initials: M
authors.lastname: Prabhakar
authors.forename: Steven
authors.initials: S
authors.lastname: Miner
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians; D005240:Feasibility Studies; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy; D010865:Pilot Projects; D014218:Triage / Q000458:organization & administration*; D000078329:Workforce