Background  

In late 2016, the New Zealand Out-of-Hospital STEMI Pathway was signed off by the National Cardiac Network.

The aim of the STEMI pathway is to reduce the time it takes for patients to receive reperfusion therapy, provide a consistent approach to which reperfusion therapy patients receive and ensure patients are transported to the most appropriate hospital, first time.

During the last two years, St John has worked with the Regional Cardiac Networks and DHBs to develop an Out-of-Hospital STEMI Pathway for each area. This includes ambulance personnel transporting patients for primary PCI when the patient can clearly reach a PCI capable hospital within 90 minutes of the diagnosis being made or administering fibrinolytic therapy (unless contraindicated) then the patient cannot clearly reach a PCI-capable hospital with 90 minutes of the diagnosis, followed by direct transport to a PCI capable hospital.

Key messages for primary care personnel when treating a patient with STEMI are:

  • When encountering a patient with STEMI, an ambulance should be arranged as soon as possible as per current practice.
  • Wherever feasible, a 12-lead ECG should be acquired before requesting an ambulance. If you suspect the patient has a STEMI, please let us know when you request an ambulance as this will determine what ambulance is sent.
  • Road and air ambulances staffed by Paramedics and Intensive Care Paramedics (ICPs) are now equipped with a fibrinolytic kit containing clopidogrel, tenecteplase, heparin, enoxaparin and metoprolol.
  • As part of the STEMI Pathway, Paramedics and ICPs will administer fibrinolytic therapy ASAP, if the patient cannot reach a PCI capable hospital within 90 minutes. Depending on the preferences of the treating primary care clinician and the clinical circumstances, fibrinolysis can be administered in either the primary care facility or in the ambulance.
  • Primary care clinicians are not expected to be proficient in the administration of fibrinolytic therapy, but are encouraged to assist Paramedics and ICPs (who have all received specific training) in administering the therapy. We are aware that some primary care clinicians across New Zealand administer fibrinolytic therapy and this is still encouraged.
  • Following the administration of fibrinolytic therapy, ambulance personnel will transport the patient to a PCI capable hospital.
  • Because patients with STEMI will not always be transported to the nearest hospital, primary care clinicians are not required to phone a clinician at the hospital prior to ambulance arrival to arrange admission or have the patient accepted.

Questions 

If you have any questions regarding the STEMI pathway, please email clinical.excellence@stjohn.org.nz

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