Important Update: Clinical Strategy in Acute Coronary Syndrome

Emergency Medical Services
300 North San Antonio Road  Santa Barbara, CA 93110-1316
805/681-5274  FAX 805/681-5142
Takashi M. Wada, MD, MPH Director
Suzanne Jacobson, CPA Chief Financial Officer
Susan Klein-Rothschild, MSW Deputy Director
Angela Gonzalez, MHA Deputy Director
Polly Baldwin, MD, MPH Medical Director
Charity Dean, MD, MPH Health Officer
John H. Eaglesham EMS Agency Director
Angelo Salvucci, MD EMS Agency Medical Director
May 20, 2015
Important Update: Clinical Strategy in Acute Coronary Syndrome
Dear Physicians and Providers:
In 2010, the Santa Barbara County Emergency Medical Services (EMS) Agency started our Countywide
ST-Segment Elevation Myocardial Infarction (STEMI) System. Paramedics perform 12-lead ECGs and
transport all patients with a STEMI directly to one of our two STEMI ReceivingCenters – Marian Regional
Medical Center and Santa Barbara Cottage Hospital - for immediate treatment.
First Medical Contact-to-Device Activation (reperfusion of coronary artery) is the standard of clinical
performance in National STEMI care. The target is 90 minutes or less.
In 2013,
93% of Santa Barbara County patients for whom 911 was called had FMC-to-reperfusion of 90
minutes or less.
Since STEMI System inception, improvements in all target measures have been seen.
IN THE CLINIC, OFFICE, OR URGENT CARE, WE RECOMMEND THE FOLLOWING - IN AN EFFORT TO
MINIMIZE TIME TO REPERFUSION:
1. Immediately call 9-1-1 for symptoms suggestive of ACS (note that 1/3 of patients with AMI experience
symptoms other than chest pain).
2. Consider calling 9-1-1 early in the evaluation. In the past year there have been several cases of a
prolonged time to reperfusion because of a more extensive pre-hospital evaluation/observation.
3. Ensure that all symptomatic persons are transported and cared for by EMS. For patients calling
in, consider advising them to call 9-1-1.
• ~ 1 in every 300 patients will suffer cardiac arrest en route to the ED.
• Arrival by ambulance = earlier reperfusion.
Thank you for helping to improve our STEMI System of Care!
For further information, please contact:
 Michele Combs, RN, BSN, Cardiac Programs Coordinator
Michele.combs@sbcphd.org
 Angelo Salvucci, MD, Medical Director of Emergency Medical Services
angelo.salvucci@sbcphd.org
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