Project UPSTART: the Use of Procedural Standardization to Reduce Recognition to Repferfusion (R2R) Time in ST-Elevation Myocardial Infarction (STEMI)

Training Tutorial 1.5

What Exactly is “Project UPSTART”?

UPSTART is an acronym short for “The Use of Procedural Standardization to Reduce Recognition to Reperfusion (R2R) Time in STEMI.”

What is “R2R”?

Recognition to Reperfusion: The interval between STEMI recognition and opening of the blocked artery.

Recognition may occur in the ED, in an EMS vehicle, at Grandma’s house - anywhere you can do an ECG!

Reperfusion occurs via the use of thrombolytic drugs or heart catheterization. The faster the better!

Regardless of how or where the two “R’s actually occur on each patient, we continually strive to bring them closer together: Early recognition followed by early reperfusion.

“Pulling the two R’s together requires a clear plan of action and quick decision making. When a STEMI is detected, everything should occur as if we do this all the time. However, STEMI is usually a rare event, which means that we don't have that many chances to practice! The secret to success, then, is to set up a carefully designed system in advance that has key decisions built into the process. Remember fire drills in elementary school? When a STEMI is identified, we can simply “sound the bell” and follow pre-established directions, avoiding wasting precious time on non-critical actions.

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