The ALS PCS 4.5 STEMI directive follows the BLS V3.0.1 criteria and no longer has a pulse rate of <50 as a contraindication for bypass. Does this mean a bradycardic patient with a pulse in the 40s can now be transported on a STEMI bypass? In the past medics where taught differing regions would have slightly different STEMI receiving acceptance criteria. Are there any considerations we as medics should consider for STEMI receiving hospitals in our governing region?
First off to clarify, STEMI Bypass is not part of the ALS PCS, but rather is a standard found in the BLS PCS. The STEMI Hospital Bypass Protocol lists Contraindications under the STEMI Hospital Bypass as 4./5. Patient is experiencing a complication requiring PCP/ACP diversion** which includes, b. Hemodynamic instability or symptomatic SBP <90mmHg at any point. With the asterisk being, **The interventional cardiology program may still permit the transport to the PCI center. based on their local destination agreements. Each individual cardiac program has the ability to set local parameters as to the types of patients they are willing to accept directly versus ones that require ED stabilization first. Please familiarize yourself with your local policies.
SWORBHP recognizes that each case has to be taken on its own merits including time, distance, weather, crew experience and comfort. SWORBHP would support a paramedics decision to transport to the closest hospital if they felt the bradycardia was making the patient unstable. In situations where uncertainty exists, SWORBHPs Medical Directors encourage a BHP patch to discuss the case.