None listed
Conditions
Brief summary
Heart disease is the second leading cause of death in New Zealand, after cancer. At the acute end of the spectrum of this disease is ST-elevation myocardial Infarction (STEMI), a common type of heart attack and the most severe. However, specific treatments are available for STEMI patients, which have high rates of success, especially if they are performed early, within the first hours of symptom onset. Two such treatments are Percutaneous Coronary Intervention (PCI), a mechanical procedure, and thrombolysis, a drug therapy. Both treatments are time-dependent, with early provision conferring the greatest clinical benefits and results. Paramedics are able to play a key strategic role in achieving this objective, as they are often the first healthcare professionals to encounter the STEMI patient. Internationally, autonomous paramedic-delivered pre-hospital thrombolysis (PHT) and field activation of the hospital Cardiac Catheterisation Lab (CCL) where PCI takes place, have both proven to be the most effective strategies in facilitating expedited delivery of these two treatment modalities. However, within New Zealand ambulance services have been slow to adopt and/or refine such paramedic-based approaches. Current New Zealand models rely on physician authorised telemetry-based systems which have proved problematic, particularly due to technological failings. This proposed research will be an experimental study trialling an autonomous paramedic model for field activation of the CCL within St John Ambulance Service, New Zealand’s largest ambulance provider, without physician oversight and authorisation. We hypothesise that adopting such an approach will lead to improved patient outcomes, with reduced hospital admission times compared to the existing physician authorised systems. Economic benefits are also likely.
Interventions
This proposed research will be an experimental study trialling an autonomous paramedic model for field activation of the cardiac catheterisation lab (CCL) within St John Ambulance Service, New Zealand’s largest ambulance provider, without physician oversight and authorisation. We hypothesise that adopting such an approach will lead to improved patient outcomes, with reduced hospital admission times compared to the existing physician authorised systems. Economic benefits are also likely.
The cri
This proposed research will be an experimental study trialling an autonomous paramedic model for field activation of the cardiac catheterisation lab (CCL) within St John Ambulance Service, New Zealand’s largest ambulance provider, without physician oversight and authorisation. We hypothesise that adopting such an approach will lead to improved patient outcomes, with reduced hospital admission times compared to the existing physician authorised systems. Economic benefits are also likely. The criteria for autonomous paramedic CCL activation include: 1. DEFINITE STEMI ONLY: Paramedic and heart monitor interpretation of STEMI (>>> Acute MI <<<) 2. ST elevation equal to or greater than 1mm in two or more limbs leads (I, II, III, aVL or aVF) or 3. ST elevation equal to or greater than 2mm in two or more contiguous chest leads (V1-V6) AND 4. Symptoms consistent with myocardial ischemia of less than 12hrs duration AND 5. Transport time to hospital less than 60 minutes from time of diagnosis The exclusion criteria include: *Severe Dementia *Severe dependent living *On-going cardiac arrest requiring repeated or continual CPR/ACLS (go to ED). Can proceed on STEMI Bypass if a single shock is required to obtain ROSC. CCL Activation Procedure: *Provide an early radio call to the receiving Coronary Care Unit from the scene prior to transport. *Ensure to provide your approximate ETA and the patients NHI number if known. *Minimise scene time (GOAL Scene Time <15 minutes) *Continue to manage patient as per the Clinical Practice Guidelines The overall duration of the intervention period is 20 months.
Sponsors
Auckland University of Technology (AUT)
Study design
Allocation
Non-randomised trial
Primary purpose
Diagnosis
Eligibility
Sex/Gender
All
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
a) The retrospective cohort (n = 72) will include: all patients at/or greater than 18 years of age who were transported to Auckland City Hospital Emergency Department via an ambulance paramedic crew over the last two years; who received an Emergency Department diagnosis of STEMI; and who received primary PCI. b) The prospective cohort (n = 72) will include all patients at/or greater than 18 years of age transported to Auckland City Hospital CCL following autonomous paramedic CCL activation over a prospective 20 month period in-line with protocol criteria. The study will also investigate all patients transported by paramedics to Auckland City Hospital without autonomous paramedic CCL activation, but who went on to receive primary PCI following an Emergency Department diagnosis of STEMI, during the same 20 month period.
Exclusion criteria
Key patient exclusion criteria is essentially those that do not meet our inclusion criteria for either the historic or prospective cohort.
Outcome results
None listed