title: Clinical events and treatment in prehospital patients with ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  Little is known about clinically important events and advanced care treatment that patients with ST-segment elevation myocardial infarction (STEMI) encounter in the prehospital setting.
  
  
  OBJECTIVE
  We sought to determine the proportion of community patients with STEMI who experienced a clinically important event or received advanced care treatment prior to arrival at a designated percutaneous coronary intervention (PCI) laboratory or emergency department (ED).
  
  
  METHODS
  We reviewed 487 consecutive community patients with STEMI between May 2008 and June 2009. All patients were geographically within a single large "third-service" urban emergency medical services (EMS) system and were transported by paramedics with an advanced care scope of practice. We recorded predefined clinically important events and advanced care treatment that occurred in patients being transported directly to a PCI laboratory or ED (group 1) or interfacility transfer to a PCI laboratory (group 2).
  
  
  RESULTS
  One or more clinically important events occurred in 92 of 342 (26.9%) group 1 patients and nine of 145 (6.2%) group 2 patients. The most common were sinus bradycardia, hypotension, and cardiac arrest. Additionally, 33 of 342 (9.6%) group 1 and nine of 145 (6.2%) group 2 patients received one or more advanced care treatments. The most common were administration of morphine and administration of atropine. Eight group 1 patients and three group 2 patients received cardiopulmonary resuscitation (CPR) or defibrillation.
  
  
  CONCLUSIONS
  Clinically important events and advanced care treatment are common in community STEMI patients undergoing prehospital transport or interfacility transfer to a PCI center. Several patients required CPR or defibrillation. Further research is needed to define the clinical experience of STEMI patients during the out-of-hospital phase and the scope of practice required of EMS providers to safely manage these patients.
authors.affiliation: Division of Prehospital Care, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Damien
authors.initials: D
authors.lastname: Ryan
authors.forename: Alan M
authors.initials: AM
authors.lastname: Craig
authors.forename: Linda
authors.initials: L
authors.lastname: Turner
authors.forename: P Richard
authors.initials: PR
authors.lastname: Verbeek
mesh_terms: D000293:Adolescent; D000328:Adult; D022561:Advanced Cardiac Life Support / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001919:Bradycardia / Q000209:etiology / Q000628:therapy; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004634:Emergency Medical Technicians / Q000193:education; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000628:therapy*; D009864:Ontario; D010360:Patient Transfer; D024382:Professional Role; D012189:Retrospective Studies