In the ideal STEMI and cardiac resuscitation system of care, standardized point of entry protocols indicate that patients should be transported directly to a receiving (PCI-capable) center based on:

• Specific criteria for high mortality risk
• Contraindications to fibrinolysis in STEMI
• The proximity of the nearest PCI center
• Need for cardiology/neurology evaluation
• The ability of the receiving center to continue hypothermia
• Need for primary PCI or urgent revascularization

Those STEMI patients transported by EMS or who arrive via self-transport (or via family or friends) to a referral center are treated according to standardized triage and transfer protocols. Patients who suffer out of hospital cardiac arrest and arrive by EMS transport also demand a standardized process for treatment and transfer to the Receiving Center. Incentives are provided to rapidly:

• Treat patients in accordance with American Heart Association resuscitation guidelines and American College of Cardiology/American Heart Association STEMI guidelines
• Transfer STEMI and resuscitated patients to the receiving center for primary PCI using reperfusion checklists, standard pharmacological regimens and order sets, clinical pathways with attention to details such as eliminating continuous intravenous infusions and tubing
• Initiate therapeutic hypothermia as soon as possible, when indicated
• Transport patients resuscitated from cardiac arrest to the receiving center for to allow angiography of cath eligible/appropriate patients as soon as possible
• Promote efficient data transfer to the receiving center as well as integrate data collection and feedback into the system of care
• Integrate plans for return of the patient to the local community physician for follow-up care following discharge from the receiving center
• Provides CPR training to include signs and symptoms of heart attack, the need to activate the 911 EMS system and instruction on current CPR techniques
• Provides CPR and ACLS training for appropriate staff

Learn about strategies referral centers can use to achieve the ideal practice.

Refer to the Mission: Lifeline^® recommendations for quality improvement recognition and accreditation.