I’ve been working on a STEMI Alert protocol for my fire department. Basically, this is how we will notify our receiving hospital of a possible STEMI.

At present, a STEMI Alert will not have the force of a Code STEMI which is the term the ED physicians use to activate the cath lab.

The STEMI Alert will get a time stamp, and our goal is to start tracking the accuracy of paramedic-initiated STEMI Alert when compared with ED physician-initiated Code STEMI. We will also track the time interval between the STEMI Alert and Code STEMI.

This should empower our organization to target continuing education and training to paramedics who fail to call a STEMI Alert when appropriate (false negatives) and paramedics who call a STEMI Alert when they shouldn’t (false positives).

I suspect this will yeild some interesting case studies. I am particularly interested in ECGs that result in false positive cath lab activations. I’ve seen some fascinating STE-mimics from the RACE program in North Carolina. They’re great ECGs to learn from!

The beauty of our proposed STEMI Alert program is that it will give us the safety net of the ED physicians until such time that our STEMI Alerts are in-line with their Code STEMIs.

The process will probably end up looking something like this:

According to this flow chart, patients for whom the GE-Marquette 12SL interpretive algorithm fails to give the ***ACUTE MI SUSPECTED*** message will only get a STEMI Alert when the QRS duration is less than 120 ms and reciprocal changes are present.

It remains to be seen whether or not this will lead to a significant number of false negatives. I suspect the opposite will occur and the flow chart will significantly limit the number of false positives.

I’d love to hear what you guys are doing around the country! What do your protocols look like?

*** Update 12/12/09 ***

The training PowerPoint for our STEMI Alert protocol is now complete. Here is version 1.0 (there have subsequently been minor updates).