Kentucky EMS protocols,
in your pocket.

• Administer aspirin and obtain IV access
• ✓ Perform a STAT 12-lead EKG at the scene
• Immediately transport to the closest PCI-capable hospital
• Notify the receiving hospital of a possible STEMI

The protocol clearly states that the first step upon encountering chest pain or equivalent symptoms suggestive of ischemia is a 'STAT 12-lead EKG at scene,' performed at the site of first medical contact (FMC). This is required before any destination or treatment decisions are made.

• Transport to the closest non-PCI hospital and administer fibrinolytic therapy within 30 minutes
• Transport to the closest, most-appropriate facility regardless of PCI capability
• ✓ Transport to the closest PCI-capable hospital
• Consider fibrinolytic therapy and transport to the closest facility

Per the protocol algorithm, if the patient has ST elevation consistent with STEMI, stable hemodynamics and airway, AND a PCI-capable hospital is within 45 minutes of ground or air EMS transport, the correct action is to transport to the closest PCI-capable hospital. The 40-minute transport time falls within the 45-minute threshold.

• Proceed with EJ access, as STEMI is not listed as an exclusion criterion.
• Obtain bilateral EJ access simultaneously to maximize flow rates.
• ✓ Use caution because a neck hematoma may complicate care, and consider IO as an alternative.
• Contact medical control before making any attempt at EJ access in a STEMI patient.

The protocol states that caution should be used in patients who may receive thrombolytics or anticoagulation (such as STEMI patients) because a neck hematoma may complicate care, and directs providers to consider IO as an alternative in these patients.

• Transport to the closest PCI-capable hospital regardless of travel time
• ✓ Transport to the closest, most-appropriate facility and consider fibrinolytic therapy within 30 minutes
• Administer fibrinolytic therapy on scene before transport
• Wait on scene for air transport to become available

When the PCI-capable hospital is NOT within 45 minutes of ground or air transport and the patient has no contraindications to fibrinolytics, the algorithm directs transport to the closest, most-appropriate facility with consideration of fibrinolytic therapy within 30 minutes. The protocol notes fibrinolytic therapy should be considered when FMC-to-device time at a PCI-capable hospital would exceed 120 minutes.

• Less than 60 minutes
• ✓ Less than 90 minutes
• Less than 120 minutes
• Less than 180 minutes

The protocol explicitly states: 'EMS transport directly to a PCI-capable hospital for primary PCI is the recommended treatment strategy for patients with a STEMI, with an ideal FMC-to-device time system goal of < 90 minutes (Class I, LOE: A).' The 120-minute goal applies only to patients initially transported to or arriving at a non-PCI-capable hospital.

• This indicates cardiac arrest; begin CPR immediately.
• ✓ Cardiac patients may have absent pulses in some limbs and may be chronically hypoxic or have hypoxic spells.
• The absent pulse confirms severe hemorrhagic shock and IV fluid resuscitation should begin.
• Absent pulses are abnormal in cardiac patients and indicate a new acute occlusion requiring immediate intervention.

The protocol states: 'Cardiac patients may have absent pulses in some limbs. They may be chronically hypoxic or have hypoxic spells.' This warns providers not to misinterpret an absent limb pulse as a new emergency finding without considering the patient's baseline.