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 field activation of the hospital Cardiac Catheterisation Lab (CCL) where PCI takes place, as well as pre-hospital thrombolysis (PHT), 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 a model of paramedic initiated helivac of STEMI patients to a tertiary hospital for Primary Percutaneous Coronary Intervention (PPCI). This programme involves paramedics from St John Ambulance Service, New Zealand’s largest ambulance provider and occurs without physician oversight. It is also the first programme of its kind to be introduced within the country. We hypothesise that adopting such an approach will lead to improved patient outcomes, with reduced hospital admission times compared to previous physician authorised systems. Economic benefits are also likely.
Interventions
This proposed research will be an experimental study trialling a Whangarei-based programme of paramedic initiated helivac of STEMI patients to a tertiary hospital for Primary Percutaneous Coronary Intervention (PPCI) directly from the field. This will be compared to a previous programme where patients were firstly routed through the local receiving hospital's Emergency Department and the decision for patient helivac was made by the treating physician. This programme involves paramedics from St J
This proposed research will be an experimental study trialling a Whangarei-based programme of paramedic initiated helivac of STEMI patients to a tertiary hospital for Primary Percutaneous Coronary Intervention (PPCI) directly from the field. This will be compared to a previous programme where patients were firstly routed through the local receiving hospital's Emergency Department and the decision for patient helivac was made by the treating physician. This programme involves paramedics from St John Ambulance Service, New Zealand’s largest ambulance provider and occurs without physician oversight. It is also the first programme of its kind to be introduced within the country. We hypothesise that adopting such an approach will lead to improved patient outcomes, with reduced hospital admission times compared to previous physician authorised systems. Economic benefits are also likely. The inclusion criteria for paramedic initiated helivac of STEMI patients from the field to a tertiary hospital from PPCI include: 1. 12-lead ECG with persistent ST-elevation > 1mm in two or more contiguous limbs leads (I, II, III, aVL or aVF) OR ST-elevation > 2mm in two or more contiguous chest leads (V1-V6) including postyerior leads V7-V9. 2. Monitor interpretation indicates >>> Acute MI <<< OR ***ACUTE MI SUSPECTED*** on two consectutive ECGs 3. Normal QRS width (less than or equal to 0.12secs) OR Right Bundle Branch Block identified on 12-lead ECG 4. Symptoms consistent with myocardial ischemia of < 10 hours duration 5. Ambulance transport time from the patient's location to the helicopter base < 15 minutes. The exclusion criteria for this pathway includes: 1. Left Bundle Branch Block identified on 12-lead ECG 2. History of serious systemic disease e.g. advanced / terminal cancer, severe liver or kidney disease 3. Severe Dementia 4. Severe dependent living i.e. resident of an aged care facility requiring significant assistance with activities of daily living 5. Ongoing cardiac arrest requiring repeated CPR Note: those patients who are not candidates for helivac will continue to be transported by ambulance to the normal local receiving hospital which is not PCI capable. The overall intervention period for this study is 46 months.
Sponsors
Auckland University of Technology (AUT)
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Diagnosis
Eligibility
Sex/Gender
All
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
a) The retrospective cohort (n = 30) will include: all patients at/or greater than 18 years of age who were transported to Auckland City Hospital (ACH) CCL from Northland Base Hospital (NBH) ED via the Northland Emergency Services Trust (NEST) Helicopter Service for PPCI between the period May 1st 2010 and May 1st 2013 as part of the historic Code STEMI programme. b) The prospective cohort (n = 30) will include: all patients at/or greater than 18 years of age up to 85 years of age who have been transported to ACH-CCL from Whangarei via the NEST Helicopter Service for PPCI between the period December 23rd 2014 and December 23rd 2017 as part of the paramedic STEMI Bypass programme. The study will also investigate all patients transported by road-based paramedics to the NEST helicopter base over the same time period but who were re-directed to NBH-ED following re-assessment by the Flight Intensive Care Paramedic (ICP).
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