Tuesday August 18, 2020
A new pathway for out-of-hospital STEMI has been developed by St John and the Midland Cardiac Network, and is now up and running in BOP. See links below for primary care-specific information.
In a nutshell, if the patient can reach Tauranga Hospital within 90 min of the diagnosis being made (should always be the case for the Western Bay) and will arrive between 0800-1500 Mon, Wed or Fri, the treatment is almost always Primary PCI in the cath lab. If the general practice team have identified STEMI and the ambulance hasn’t yet arrived, it’s no problem for the doctor or nurse to phone cardiology as the more notice the cath lab team have, the better.
Outside the days/hours that the cath lab is available, the treatment will always be fibrinolytic therapy (administered by ambulance personnel) unless contraindicated. In this circumstance, the GP teams don’t need to phone cardiology because the destination hospital will usually be Waikato in case rescue PCI is required. If the patient can’t be transported to Waikato (adverse weather preventing helicopter transport etc) then the destination would be Tauranga. Even then, the GP team calling cardiology is less of a priority because treatment would already have been administered pre-hospital and therefore giving cardiology a heap of notice is less important than if urgent treatment is required on arrival at ED.
For non-STEMI cardiac issues that require transport to hospital, usual practice should apply, i.e. request an ambulance and notify cardiology in the usual way. If an ECG is unable to be obtained or the GP team is uncertain of the interpretation, request an ambulance and phone cardiology in the usual way. If it turns out to be STEMI on arrival of ambulance personnel and the destination hospital changes to Waikato (for example), the GP team can always give the hospital a call back to say the patient isn’t coming. If cardiology are expecting a patient that doesn’t turn up, they are pretty good at getting in contact with St John to see where the patient is, and both ED and Cardiology are aware of the new pathway which should help.