Abstract
Patients with ST-elevation myocardial infarction (STEMI) identified in free-standing emergency centers (FSEC) present unique challenges in accomplishing time-based ACC/AHA recommended interventions not encountered by hospital-based emergency departments (HBED). Lack of on-site specialty services and geographic distance from a center capable of acute percutaneous coronary intervention contributes to the challenges. The ability to achieve door-to-balloon (d2B) time < 90 minutes in STEMI patients first identified at a free-standing emergency department mandates ED-directed coordination of rapid identification, efficient clinical care, preparation for percutaneous coronary intervention, and rapid transport directly to a percutaneous coronary intervention facility without reevaluation at a destination hospital-based emergency departments.
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