1. No category

CEPCP EMS Policy Manual
6.6
STEMI Bypass
Created: January 2012
Revised: January 2014
Approved By: Dr. Vandersluis
1. PURPOSE
The policy provides the steps the paramedic may take when attending to a patient complaining of
continuous cardiac ischemic “chest pain” with a STEMI positive ECG.
2. SCOPE
This procedure applies to the Medical Direction area of the program. The application of this policy
applies to all paramedics (ACP and PCP) within the CEPCP catchment area, with destination
hospitals of Southlake Regional Health Centre, Rouge Valley Health System – Centenary site or
Peterborough Regional Heath Centre.
3. RELATED DOCUMENTS
ALS PCS
4. PROCEDURE

When presented with a patient meeting the indications and conditions of the Cardiac Ischemia
Medical Directive;
o
Complaint of continuous (defined as when the “pain” started and has not gone away)
cardiac ischemic “chest pain” or chest discomfort, and
o
Age ≥ 18 years of age, and
o
Unaltered LOAs
the paramedic will obtain a diagnostic 12 lead ECG.

A 15 lead ECG is to be performed when the 12 lead appears “normal” (posterior wall V8 and V9
to be evaluated), or demonstrates ST elevation in the inferior leads (V4R to be evaluated).

If the 12 or 15 lead ECG is indicative of a STEMI the patient is to be considered for STEMI
bypass.
o
ST elevation ≥ 1 mm in two (2) or more anatomically contiguous limb leads or
o
ST elevation ≥ 2 mm in two (2) or more anatomically contiguous precordial leads or

Bypass the closest Emergency Department and transport the patient to the closest facility
equipped with a Cardiac Catheterization lab (PCI lab) when:
o
The current episode of pain is < 12 hours in duration, and
o
The patient can be transported to the PCI Centre in less than 60 minutes from initial
patient contact.

The bypass is contraindicated if any of the following apply:
o
The systolic blood pressure is < 80mmHg (despite field interventions including fluid
bolus, inotropes or trans-cutaneous pacing), or
Central East Prehospital Care Program · 1 Hospital Court, Oshawa, ON L1G 2B9 · (905) 433-4370
CEPCP EMS Policy Manual
6.6
STEMI Bypass
Created: January 2012
Revised: January 2014
Approved By: Dr. Vandersluis
o
A STEMI imitator is present, specifically Left Bundle Branch Block (LBBB), Ventricular
paced rhythms, Left Ventricular Hypertrophy (LVH) or pericarditis are present, or
o
The airway is unsecured or the patient cannot be adequately ventilated, or
o
Advanced Directives are in place indicating a restriction in patient care

Where possible, intravenous initiation should be performed in the left arm to facilitate right radial
artery access at each of the receiving facilities.

Once the determination to bypass is made, a code STEMI is to be activated by calling the
receiving facility:
o
Southlake Regional Health Centre at 905-952-2466
o
Rouge Valley Health System – Centenary site at 416-287-8364
o
Peterborough Regional Health Centre at 705-743-2121 ext “0” (directly or via CACC) and
a patch to the Emergency Department should also be made.
o
And advising them:
 You are EMS (and which EMS service)
 ETA
 Patient age and gender and initials
 Whether the patient is or has been treated with an advanced airway,
defibrillation, inotropes or transcutaneous pacing.

 And any additional relevant information (remember this is an advisory notification
and not a patch and cannot violate confidentiality rules).
On arrival at the receiving facility:
o
Proceed directly to the Cardiac Catheterization lab without stopping in the Emergency
Department at Southlake Regional Health Centre or Rouge Valley – Centenary Site.
NOTE – outside of regular working hours, if the cath lab team has not arrived or is not yet
ready to accept the patient, proceed to the Coronary Care Unit. Whenever possible,
remain with the patient until transfer into the cath lab is completed.
o
Proceed to the Emergency Department and report to the receiving staff at Peterborough
Regional Health Centre and the staff will advise if Cardiac Catheterization lab is ready for
the patient.
Central East Prehospital Care Program · 1 Hospital Court, Oshawa, ON L1G 2B9 · (905) 433-4370