Pre-Hospital Algorithm for Anticoagulation Therapy in ST-Segment Elevation Myocardial Infarction

For a number of years the emphasis has been placed on the in hospital care of patients with acute myocardial infarction, a trend that was strengthened by the inception of coronary care units. In the past several years, however, increased attention has been focused on the pre-hospital phase. Recent studies indicate that two thirds of the deaths from acute myocardial infarction occur outside the hospital, and nearly one half of these deaths are sudden and unexpected, occurring within 2 hours after the onset of symptoms. One major reason for the high incidence of death is attributed to delay in medical care by patients, providers, transportation and or receiving facilities. In order to substantially reduce this high mortality the primary goal of treatment in ST-elevation myocardial infarction (STEMI) is to reduce time to reperfusion. Thus, accurate and timely diagnosis of acute coronary syndrome and subsequent initiation of guideline/algorithm-based therapy are critical in providing excellent pre-hospital care. The purpose of this project was to develop an algorithm that will help emergency medical service (EMS) providers treat patients with STEMI according to the 2013 America College of Cardiology/American Heart Association Guidelines for the Management of STEMI and help reduce patient morbidity and mortality. This project included the following: identification of existing literature and clinical algorithms for treatment of STEMI; development of an algorithm for quality improvement in the area of pre-hospital anticoagulation therapy in STEMI; presentation of pre-hospital anticoagulation algorithm to EMS providers within a rural Utah community; and submission of an abstract for poster presentation.