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Paramedic Prompt Card for STEMI Hospital Bypass Protocol

This prompt card provides a quick reference of the STEMI Hospital Bypass Protocol contained in the Basic Life Support Patient Care Standards (BLS PCS). Please refer to the BLS PCS for the full protocol.

Indications under the STEMI Hospital Bypass Protocol

Transport to a PCI centre will be considered for patients who meet ALL of the following:

  1. ≥18 years of age.
  2. Chest pain or equivalent consistent with cardiac ischemia/myocardial infarction.
  3. Time from onset of current episode of pain <12 hours.
  4. 12-lead ECG indicates an acute AMI/STEMI*:
    1. At least 2 mm ST-elevation in leads V1-V3 in at least two contiguous leads; OR
    2. At least 1 mm ST-elevation in at least two other anatomically contiguous leads; OR
    3. 12-lead ECG computer interpretation of STEMI and paramedic agrees.

*Once activated, continue to follow the STEMI Hospital Bypass Protocol even if the ECG normalizes

Contraindications under the STEMI Hospital Bypass Protocol

ANY of the following exclude a patient from being transported under the STEMI Hospital Bypass Protocol:

  1. CTAS 1 and the paramedic is unable to secure patient’s airway or ventilate.
  2. 12-lead ECG is consistent with a LBBB, ventricular paced rhythm, or any other STEMI imitator.
  3. Transport to a PCI centre ≥60 minutes from patient contact.**
  4. Patient is experiencing a complication requiring PCP diversion:**
    1. Moderate to severe respiratory distress or use of CPAP.
    2. Hemodynamic instability or symptomatic SBP <90 mmHg at any point.
    3. VSA without ROSC.
  5. Patient is experiencing a complication requiring ACP diversion:**
    1. Ventilation inadequate despite assistance.
    2. Hemodynamic instability unresponsive/not amenable to ACP treatment/management.
    3. VSA without ROSC.

**The interventional cardiology program may still permit the transport to the PCI centre.

CACC/ACS will authorize the transport once notified of the patient’s need for bypass under the STEMI Hospital Bypass Protocol.

Contact

Ministry of Health and Long-Term Care
5700 Yonge Street, 6th Floor
Toronto, ON M2M 4K5

416-327-7900

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