Re: Important Comment on Angioplasty vs. Fibrinolytics

[Guest guest]

Mike,

Interesting. When I referenced use of helos, I was referring to our

situation here in the boondocks. For us, the question would be whether or not

to use

the Abilene hospitals which are 40 minutes away, or, if is sometimes the case,

they do not have cathlab availability, to send our patient to Fort Worth, a

2.5 hour drive Code 3. The helo would be our choice there. For you, it

should not be a consideration.

GG

In a message dated 4/21/2004 12:30:51 PM Central Daylight Time,

hatfield@... writes:

This is actually where we stand now, we are in the development stages of

an MI bypass protocol which will give us the ability to decide where our

patients need to go, while we are not at the 'all MI patients go to cath

lab' yet, we are nearing the point where after answering questions

relative to candidacy for thrombo's, if the patient is not a candidate,

we bypass the nearest hospital in favor for a facility with catheter

capabilities.

We have a couple of hospitals to choose from, and a few we have to

bypass, needless to say that the ones we bypass would be excited that we

intend to intentionally pass them up, those with cath labs are unhappy

that we could potentially pass two ER's just to get to them.

The ultimate goal is the definitive needs of the patient, " Time is

muscle " .

We utilize our trauma bypass protocol well, and there is no doubt that

an MI bypass protocol will be used just as much if not more.

For HELO, if you take into account the amount of time for HELO to

activate, arrive, load and transport, we can be there just as quickly.

W. Hatfield EMT-P

" Si hoc legere scis nimium eruditiones habes "

Mark your calendars now!!! EMStock 2004!!!

Booming Midlothian, Texas!!! May 21-23, 2004!!!

www.EMStock.com

From: wegandy1938@...

Are any of y'all talking to your target destination hospitals re

availability

of cathlab and considering alternative destinations based on cathlab

availability?

, is this ONE situation that might suggest transport out of area

by

helo to a hospital with available cathlab?

Anybody?

Gene

[Guest guest]

This is actually where we stand now, we are in the development stages of

an MI bypass protocol which will give us the ability to decide where our

patients need to go, while we are not at the 'all MI patients go to cath

lab' yet, we are nearing the point where after answering questions

relative to candidacy for thrombo's, if the patient is not a candidate,

we bypass the nearest hospital in favor for a facility with catheter

capabilities.

We have a couple of hospitals to choose from, and a few we have to

bypass, needless to say that the ones we bypass would be excited that we

intend to intentionally pass them up, those with cath labs are unhappy

that we could potentially pass two ER's just to get to them.

The ultimate goal is the definitive needs of the patient, " Time is

muscle " .

We utilize our trauma bypass protocol well, and there is no doubt that

an MI bypass protocol will be used just as much if not more.

For HELO, if you take into account the amount of time for HELO to

activate, arrive, load and transport, we can be there just as quickly.

W. Hatfield EMT-P

" Si hoc legere scis nimium eruditiones habes "

Mark your calendars now!!! EMStock 2004!!!

Booming Midlothian, Texas!!! May 21-23, 2004!!!

www.EMStock.com

From: wegandy1938@...

Are any of y'all talking to your target destination hospitals re

availability

of cathlab and considering alternative destinations based on cathlab

availability?

, is this ONE situation that might suggest transport out of area

by

helo to a hospital with available cathlab?

Anybody?

Gene

[Guest guest]

This is actually where we stand now, we are in the development stages of

an MI bypass protocol which will give us the ability to decide where our

patients need to go, while we are not at the 'all MI patients go to cath

lab' yet, we are nearing the point where after answering questions

relative to candidacy for thrombo's, if the patient is not a candidate,

we bypass the nearest hospital in favor for a facility with catheter

capabilities.

We have a couple of hospitals to choose from, and a few we have to

bypass, needless to say that the ones we bypass would be excited that we

intend to intentionally pass them up, those with cath labs are unhappy

that we could potentially pass two ER's just to get to them.

The ultimate goal is the definitive needs of the patient, " Time is

muscle " .

We utilize our trauma bypass protocol well, and there is no doubt that

an MI bypass protocol will be used just as much if not more.

For HELO, if you take into account the amount of time for HELO to

activate, arrive, load and transport, we can be there just as quickly.

W. Hatfield EMT-P

" Si hoc legere scis nimium eruditiones habes "

Mark your calendars now!!! EMStock 2004!!!

Booming Midlothian, Texas!!! May 21-23, 2004!!!

www.EMStock.com

From: wegandy1938@...

Are any of y'all talking to your target destination hospitals re

availability

of cathlab and considering alternative destinations based on cathlab

availability?

, is this ONE situation that might suggest transport out of area

by

helo to a hospital with available cathlab?

Anybody?

Gene

[Guest guest]

In a message dated 4/21/2004 12:30:29 Central Daylight Time,

hatfield@... writes:

> For HELO, if you take into account the amount of time for HELO to

> activate, arrive, load and transport, we can be there just as quickly.

>

Depends on where you are, no doubt.

For many providers, Mike's statement above is exactly right. In my last job

in Beaumont, there was pretty much NO place we responded where it made sense

to use a helo for a non-entrapped patient....certainly not for a sick heart.

Where I work now, there are lots of places in the counties around us where it

would be very beneficial to have the helo come out and take the patient

straight to the " right " hospital.

Each region needs to evaluate this issue carefully and do a couple things:

1. Commit that the EMS system should triage active cardiac ischemia

patients to hospitals that are truly capable of managing the problem (that ain't

happening now!)

2. Provide clear and useful guidelines for the field personnel as to

where and how to send the patient.

Really important, current issue. So glad to see it discussed here.

Stay safe,

, BS, LP

Director of Prehospital Services

and White Hospital

2401 South 31st Street

Temple, Texas 76508

voice

fax

[Guest guest]

A couple of weeks late joining this thread, but Austin/ County EMS

recommends that ground providers request helo transport for AMI patients

that are a " considerable distance " from the hospital (read: town, Lago

Vista, et al.). I would imagine that STARFlight would transport to a

facility capable of emergent catheterization.

Mike

Important Comment on Angioplasty vs. Fibrinolytics

I'm posting parts of a comment from a cardiologist from another list. It

concerns the efficacy of emergency angioplasty vs. clot busters. As you may

know, angioplasty is emerging as the procedure of choice, and this comment

illustrates some of the considerations. For those unfamiliar with the term,

TNK

refers to TNKase (tenecteplase), the fibrinolytic that can be given in one

bolus

and is now being widely used.

Here's the message:

" We had a 56 year old man with STEMI taken to a local hospital and " lysed " .

About an hour after the TNK was given, he developed altered mental status

and

did not reprofuse. He was intubated and emergently shipped to us for a

cath/angioplasty. His ECG showed ST elevation in 2,3,and F, with

reciprocial ST

depression in V1 through V4, with 1 mm of ST elevation in V5 and 6. On

initial

look at the 12 lead, I was already reaching for the right sided catheter,

JR4. "

Question: Do any of you automatically do right sided leads in the field

when

you see ST elevation in the inferior leads? If not, why not?

" We ended up opening and stenting his proximal circ, after using an angiojet

to suck the clot out of the affected artery first. All things considered,

if

he had gone to a lab first, he might not have stroked. The result from our

end was very successful, the net result was not nearly so. "

" For my money, if the possibility of angioplasty is available, it is my AMI

treatment of choice. Now that we are in the era of drug eluding stents, the

chance of restenosis is rather small (about 5-7%) and well worth the

possible

complication involved in opening up an artery.

Signature: Cardiololgist "

Are any of y'all talking to your target destination hospitals re

availability

of cathlab and considering alternative destinations based on cathlab

availability?

, is this ONE situation that might suggest transport out of area by

helo to a hospital with available cathlab?

Anybody?

Gene