Question: For STEMI Bypass, what is the delay in extending the bypass into all of the services that would meet the transport criteria? Originally I was told it was an issue of having an IV established, now with the increasing number of service providers with autonomous PCP IVs this would no longer seem to be an issue. I never understood the initial rationale since say Glencoe is 50km from UH and St Thomas is roughly 20km closer. Yet Glencoe could bypass and St. Thomas couldn't. Thanks in advance.

 Great question! The 2010 AHA Guidelines state that "it is reasonable to transport patients directly to the nearest PCI facility, bypassing closer EDs as necessary, in systems where time intervals between first medical contact and balloon times are < 90min and transport times are relatively short (ie, < 30min) (ClassIIa, LOE B)." (O'Connor et al, Part 10: Acute Coronary Syndromes)

Your point is very well taken. There are areas within each municipality from which a patient can be transported to the PCI capable centre and still meet the time guidelines. As you correctly point out, not all of these municipalities currently participate in a STEMI bypass agreement. That being said, the boundaries of municipalities and EMS services vary and are not (unfortunately) built around the PCI centre. That would certainly make a lot of our work so much easier!

In the example above, yes, there are areas of Elgin County from which a patient could be but also would not be able (most likely) to be transported to the PCI capable centre within the time lines set forth from the AHA Guidelines. Compounding this is the background work that is required with each hospital in the creation of repatriation agreements for admission beds, bypass agreements with government officials and MOHLTC-EHS branch, training of paramedic staff on varying bypass protocols, not to mention the ongoing evolution of the literature that surrounds STEMI Bypass as our experience with this grows.

Bottom line: Your point is well taken. We are in fact actively working behind the scenes aggressively both locally and provincially with multiple stakeholders (cardiac care network (CCN), cath lab leadership, interventional cardiologists, MOHLTC-EHS officials, multiple local hospitals €“maybe even yours!) in attempting to expand our current STEMI bypass agreement to the maximal benefit for as many patients as safely as possible. Stay tuned. This is an area (similar to Stroke Bypass 10 years ago) of tremendous interest and growth.

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