title: Clinical pathway: helicopter scene STEMI protocol to facilitate long-distance transfer for primary PCI.
abstract: BACKGROUND
  The latest American College of Cardiology/American Heart Association guidelines recommend primary percutaneous coronary intervention (PCI) in acute ST-elevation myocardial infarction (STEMI) patients within 90 minutes from presentation to the emergency room. For interhospital transfers, the most recent PCI guidelines recommend first medical contact-to-device times ≤120 minutes. Although PCI-capable hospitals have improved door-to-balloon times, many patients present to non-PCI-capable facilities and have been excluded from national quality measures.
  
  
  METHODS
  In our acute myocardial infarction network, not only do we enable non-PCI hospitals to transfer STEMI patients but empower outside emergency medical services (EMS) to activate the catheterization laboratory team with a burst page and transfer STEMI patients directly from the scene. Data on patient characteristics, outcomes, and time elements were collected for "scene STEMI" patients who circumvented outlying rural non-PCI hospitals and are presented in this case series.
  
  
  RESULTS
  From December 2007 to November 2010, 22 STEMI patients with higher than average acuity were transported by helicopter directly to our medical center for primary PCI. Median distance from the scene to our medical center was 47 miles [25th to 75th interquartile range (IQR) = 39-71 miles]. Median EMS-to-balloon time was 120 minutes (IQR = 111-134 minutes). There were no false activations by EMS. In comparison, our median time for interhospital STEMI transfers (N = 335) was 145 minutes (IQR = 121-186 minutes) from 2007 to 2009.
  
  
  CONCLUSIONS
  In our single-center experience, 22 scene STEMI patients were diagnosed and appropriately triaged by EMS to our center for primary PCI. Our data show feasibility of an EMS-activated STEMI network over long distances with good reperfusion times.
authors.affiliation: Vanderbilt Heart and Vascular Institute, 1215 21st Avenue South, Nashville, TN 37232, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Huang
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Thomassee
authors.forename: Jae Yoon
authors.initials: JY
authors.lastname: Park
authors.forename: Carol
authors.initials: C
authors.lastname: Scott
authors.forename: David J
authors.initials: DJ
authors.lastname: Maron
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Fredi
mesh_terms: D000368:Aged; D017732:Air Ambulances; D015415:Biomarkers / Q000032:analysis; D019091:Critical Pathways; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D010360:Patient Transfer / Q000706:statistics & numerical data*; D062645:Percutaneous Coronary Intervention; D012307:Risk Factors; D012424:Rural Population; D013714:Tennessee; D013997:Time Factors; D016896:Treatment Outcome; D014218:Triage
chemical_list: D015415:Biomarkers