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Cardiac Care

The 2011 Focus EMS Conference will feature the co-themes of “Cardiac Care” and “Pediatrics.”  As EMS providers, we regularly experience responding for patients suffering chest pain.  Although these calls occur quite frequently and most of us have the chest pain protocols memorized, the latest research has and is changing the way we provide care to these patients prehospitaly. The American Heart Association’s (AHA) 2010 guidelines were only recently introduced to many services, which makes this theme of “Cardiac Care” so relevant for the Institute’s annual conference.

History on Cardiac Care in the United States
Prehospital cardiac care has changed drastically since Dr. Frank Pantridge published A mobile intensive-care unit in the management of myocardial infarction in 1967.ⁱ   Dr. Pantridge recognized that mortality caused by a myocardial infarction could be reduced substantially by prehospital interventions. Within three years of the implementation of this ambulance system in Ireland, the United States followed suit.

Now, over 40 years later, prehospital emergency cardiac care includes the ability to diagnose ST-segment elevation in the prehospital setting, allowing EMS services to quickly activate the receiving hospital’s catheterization laboratory.  The American College of Cardiology “Door-to-Balloon” time Alliance target is to have the “Door-to-Balloon”  < 90 minutes,  >75% of the time.  Rokos et al. revealed in a study of 10 regional STEMI systems that “Door-to-Balloon” time drastically decreased when STEMI patients received an ECG, paramedic diagnosis, and hospital activation (of the 2,712 STEMI patients diagnosed prehospitaly, 2,053 received a primary percutaneous (PPCI) 86% were within 90 minutes of arrival).ⁱⁱ   The United States implemented standards to establish primary PCI within 90 minutes of “first medical contact,” defined as the moment EMS arrives on scene.ⁱⁱⁱ

Statistics

1. According to the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) registry, the “door-to-reperfusion” time decreased for the 27% of patients that received a prehospital ECG (median time to percutaneous coronary intervention (PCI): 61 minutes with prehospital ECG versus 75 minutes, P<0.001).  The patients that received a prehospital ECG also had a lower mortality rate (adjusted odds ratio: 0.80, 95% confidence interval: 0.63 to 1.01)^iv  
2. In the 2011 Statistical Update, the AHA reported that approximately 1 in 6 deaths in the United States was caused by coronary heart disease in 2007.^v

Focus EMS 2011 has been approved for Maine, New Hampshire, Massachusetts and Vermont CEUs. To learn about continuing education and Focus EMS click here.