Harbor:Code STEMI

Background

Code STEMI is utilized to activate the cardiac catheterization laboratory for emergent revascularization in the setting of ST-elevation myocardial infarction.

Pre-Hospital Activation

The process for pre-hospital activation is dependent on existing procedures outlined in the Los Angeles County EMS Agency Prehospital Care Manual and proceeds along the following pathway:

Pre-Hospital 12-lead ECG

A pre-hospital 12-lead ECG is obtained in the following settings:

• Chief complaint of chest pain
• Alternative chief complaint suggestive of an acute cardiac event
• Relevant and significant medical history which increases the likelihood of an acute cardiac event
• New-onset dysrhythmia
• ROSC

Criteria for contact/transmission to STEMI Receiving Center (SRC)

• Good-quality 12-lead ECG with >1mm ST-segment elevation in greater than 2 contiguous leads.
• Computer analysis indicates ***ACUTE MI***or manufacturer equivalent.

Criteria for pre-hospital activation of Code STEMI

• ED physician agrees with STEMI impression
• Age 30-90
• Pain less than 12 hours
• Greater than 2mm S-T elevation in 2 or more contiguous leads
• QRS less than 0.12
• Heart Rate less than 120
• No paced rhythm
• No DNR
• Able to give informed consent
• Not intubated
• Paramedic confident in STEMI impression

If the requirements for pre-hospital activation are not met, the patient should undergo expedited evaluation upon arrival in the emergency department to determine appropriateness for Code STEMI activation.

Procedure

Code STEMI can be activated via the auto-paging order in Orchid FirstNet titled "Code STEMI". Relevant ECG's should be submitted via the STEMI email (open in the radio room).

See Also

• Harbor:Operations manual

References

Authors

Tom Fadial, Michael O'Brien, MD, Ross Donaldson, Neil Young