Abstract 235: Prehospital STEMI Protocol Administering Aspirin, Ticagrelor, and Heparin Reduces Reperfusion Times

Abstract

Background: Emergency Medical Service (EMS) agencies serving large rural areas have not traditionally administered Ticagrelor or Heparin IV in the pre-hospital setting for STEMI patients who are ultimately transferred for Primary PCI. A recent international study demonstrated the safety of administering Ticagrelor by EMS. We hypothesized that allowing EMS to administer medications normally given in the hospital setting could be beneficial. A protocol was implemented with the goal being that if the ECG is Positive, give Aspirin, Ticagrelor, and Heparin, also known as (EPATH). Methods: Data was collected on 31 consecutive STEMI activations from a large rural area, from both the regional hospital and by the local EMS agency, prior to implementation of the EPATH Protocol, and 31 consecutive STEMI activations after implementing the EPATH Protocol. Data was stored on a Microsoft Excel spreadsheet, and analyzed using the calculation functions available within the database. Findings: Multiple STEMI performance Metrics improved, including the following: The median first EMS contact to Percutaneous Coronary Intervention (PCI) time was reduced by 28 minutes. The median 911 call to PCI time was reduced by 21 minutes. The rural referral hospital median door to PCI time was reduced by 22 minutes. Conclusion: After implementing the EPATH protocol in a large rural area, which allowed EMS to administer Prehospital Aspirin, Ticagrelor, and Heparin for STEMI, we observed an improvement in multiple STEMI performance metrics, including a 28 minute median reduction in first EMS contact to PCI time. Further research is warranted.