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MP36: Safety and clinically important events in PCP-initiated STEMI bypass in Ottawa: a health record review

Published online by Cambridge University Press:  15 May 2017

S. Mitchell*
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
R. Dionne
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
J. Maloney
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
M.A. Austin
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
G. Mok
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
J.E. Sinclair
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
C. Cox
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
M. Le May
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
C. Vaillancourt
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
*
*Corresponding authors

Abstract

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Introduction: In Ottawa, STEMI patients are transported directly to percutaneous coronary intervention (PCI) by advanced care paramedics (ACPs), primary care paramedics (PCPs), or transferred from PCP to ACP crew (ACP-intercept). PCPs have a limited skill set to address complications during transport.The objective of this study was to determine what clinically important events (CIEs) occurred in STEMI patients transported for primary PCI via a PCP crew, and what proportion of such events could only be treated by ACP protocols. Methods: We conducted a health record review of STEMI patients transported for primary PCI from Jan 1, 2011-Dec 21, 2015. Ottawa has a single PCI center and its EMS system employs both PCP and ACP paramedics. We identified consecutive STEMI bypass patients transported by PCP-only and ACP-intercept using the dispatch database. A data extraction form was piloted and used to extract patient demographics, transport times, and primary outcomes: CIEs and interventions performed during transport, and secondary outcomes: hospital diagnosis, and mortality. CIEs were reviewed by two investigators to determine if they would be treated differently by ACP protocols. We present descriptive statistics. Results: We identified 967 STEMI bypass cases among which 214 (118 PCP-only and 96 ACP-intercept) met all inclusion criteria. Characteristics were: mean age 61.4 years, 78% male, 31.8% anterior and 44.4% inferior infarcts, mean response time 6 min, total paramedic contact time 29 min, and in cases of ACP-intercept 7 min of PCP-only contact time.A CIE occurred in 127 (59%) of cases: SBP<90 mmHg 26.2%, HR<60 30.4%, HR>100 20.6%, malignant arrhythmias 7.5%, altered mental status 6.5%, airway intervention 2.3%, 2 patients (0.9%) arrested, both survived. Of the CIE identified, 54 (42.5%) could be addressed differently by ACP vs PCP protocols (25.2% of total cases). The majority related to fluid boluses for hypotension (44 cases; 35% of CIE). ACP intervention for CIEs within the ACP intercept group was 51.6%. There were 6 in-hospital deaths (2.8%) with no difference in transport crew type. Conclusion: CIEs are common in STEMI bypass patients however a smaller proportion of such CIE would be addressed differently by ACP protocols compared to PCP protocols. The vast majority of CIE appeared to be transient and of limited clinical significance.

Type
Moderated Poster Presentations
Copyright
Copyright © Canadian Association of Emergency Physicians 2017