Project UPSTART -- STEMI BootCamp

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UVA Pre-hospital ECG Protocol for STEMI

Note: For situations where EMS personnel have obtained a pre-hospital ECG (PH ECG) suspicious for STEMI

  1. EMS personnel should immediately contact Med Com, clearly identify the incoming patient as a possible STEMI, and then request to talk directly with the attending ED physician. This step should occur for each suspected STEMI case -even if EMS is unable to transmit the ECG to UVA.
  2. ECG transmittal should always be combined with Med Com contact but is not a protocol requirement. If an ECG is transmitted, EMS must also talk directly to the attending in order for a STEMI Alert to occur; transmitting an ECG alone is not sufficient to call a STEMI Alert.
  3. Med Com will immediately notify the ED attending who will then perform direct medical command with EMS. This should occur each time EMS calls in with a suspected STEMI. Med Com will not attempt to weed out “non-STEMI” cases or refer the cases to residents.
  4. The ED attending will discuss the case directly with EMS and (if applicable) evaluate any ECG that has been transmitted. Based on available information the ED attending will then decide to either activate the cath lab prior to patient arrival (high probability of STEMI) or delay activation (diagnosis of STEMI uncertain) until the patient is reevaluated.
  5. The ED attending will then notify the ED Team Leader of the situation who will prepare the ED for a possible STEMI. Potential STEMI ALERT patients should be treated with highest priority and should be evaluated immediately on arrival by an ED attending or senior resident.
  6. Upon arrival, EMS should immediately notify ED staff that the patient is a possible STEMI ALERT and any pre-hospital ECG’s should be immediately shown to the attending physician and ED care team.
  7. All pre-hospital ECG’s (or a copy) should be given to the ED physician or nurse caring for the patient. This is vital for quality improvement purposes and feedback. EMS personnel are encouraged to seek feedback from the ED staff on each STEMI case.