STEMI Bypass in the Middle East
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Presentation at EMS Gathering 2017
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STEMI Bypass in the Middle East
- 2. Disclosures Faculty, Fanshawe College, ON, Canada Research Paramedic, National Ambulance, UAE Paramedic Educator, CPER, ON, Canada Faculty, Portland Community College, OR, USA Editor, Irish Journal of Paramedicine Vice-President, Irish College of Paramedics
- 5. Access
- 6. Logistics
- 7. Logistics
- 8. Personnel
- 10. Service delivery
- 11. Al Raha apartments, behind RAK bank building, in Khuzan area, off Sheikh Khalifa Street…
- 12. Service delivery
- 13. Service delivery
- 14. Male Female
- 17. Almost 40% of Emiratis are obese
- 18. 39% 16% 16% 21%
- 21. Prehospital ECG reduces mortality Reduces reperfusion times Accurate regardless of provider PCI activation accurate
- 23. ~15-25% GulfRACE 1,2,3 Abu Dhabi STEMI Network
- 25. Study design
- 26. Service delivery
- 27. Personnel
- 28. Logistics
- 29. Logistics
- 30. Data collection
- 31. Communication
- 32. Sheikh Khalifa Specialty Hospital
- 35. 6 15 3 5 0 2 4 6 8 10 12 14 16 Emirati Indian Asian Other Nationality
- 36. Past Medical History STEMI PMHx (any)
- 38. Pain STEMI Pain
- 39. Mortality
- 40. Major adverse cardiac event
- 41. Symptom onset to call Symptom onset to ECG EMS arrival to ECG EMS Dispatch to door
- 42. Door to balloon
- 43. So what?
Editor's Notes
- Arabian gulf Bordered by Saudi to West & South (nice buffer), Oman to East 9.7 million total. Around 1 million nationals. 2/3 of population live in Abu Dhabi and Dubai.
- NE Service area Emirates of Sharjah, Umm al-Quwain, Ras al-Khaimah, Fujairah, Ajman The geographic area 12,100 km2 population of approximately 4.7 million persons
- 998 direct.
- 24 ambulances across 14 stations and 25 standby points.
- Custom designed interior. Not all carried LP15 at the time
- 450 EMTs, 5 area managers. Mix of Filipino and Arabic crews, male and female. Mostly RNs with additional EMT experience and 1 year certificate of clinical practice.
- Broadly similar to PCP. No ALS backup as routine. Broader pharmacological options
- geographic area covers approximately 12,100 km2, and contains a population of approximately 4.7 million 35,000 emergency medical calls per annum
- Fleet of 4x4 sprinters and support vehicles
- ISC workers. Filipinos account for a smaller % but also have comorbidities and ++ risk
- Almost 40% of Emiratis obese
- Life expectancy 77 years. Main cause of death – cardiovascular diseases, trauma, malignancy.
- Lots of stuff is different But don’t worry…you can still get a Timmies!
- Life expectancy 77 years. Main cause of death – cardiovascular diseases, trauma, malignancy.
- GulfRACE-2 & 3 – EMS use
- Approx 3% of land – RAK Population 300,000 2 hospitals, one PCI capable
- Observational cohort –ethical considerations Allows for normal practice Evidence base already shows ECG and PCI work Inclusion criteria: anyone who had an ECG performed, >18yo Exclusion: children, cardiac arrest as initial presentation, RIP, outside RAK
- 998 app for geo-location
- Education – 8 hour training
- Phones, LifePak 15
- Detailed protocol and instructions
- Specific prehospital and hospital data collection forms Aligned with AD STEMI network to allow for population of national registry
- CSD
- SKSH
- Total 118 ECGs performed during pilot study after exclusion criteria applied (lack of data, pediatric, outside RAK etc.)
- We can state that in our dataset, a previous history of CAD or presence of CAD risk factors has no relationship with having a STEMI. The incidence of diabetes was 32.58% in the STEMI group and 37.93% in the non-STEMI group, and a history of hypertension was present in 48.31% of the STEMI group and 41.38% of the non-STEMI group.
- The 2 tests were not significant. In the sample of patients with dyspnoea, 15.73% did not have a STEMI and 13.79% did have a STEMI. Dyspnoea has no relationship with a STEMI presentation (2 (1, n=118) = 0.0635, p >0.05). In the sample of patients with nausea, 14.61% did not have a STEMI and 13.79% did have a STEMI. Nausea has no relationship with a STEMI presentation (2 (1, n=118) = 0.0117, p >0.05). In the sample of patients with weakness, 41.57% did not have a STEMI and 34.48% did have a STEMI. Weakness has no relationship with a STEMI presentation (2 (1, n=118) = 0.4588, p >0.05).
- There was a non-significant difference in the pain scores for non-STEMI (mean 3.584, SD 3.45) and STEMI (mean 4.5926, SD 3.15) presentations (t (100)= -1.33, p = 0.1859).
- One confirmed STEMI patient suffered a cardiac arrest en-route to SKSH, and in line with study protocol, was diverted to the nearest emergency department at Saif Hospital
- No patient suffered any major adverse cardiac event in the period post-PCI. MACE = CABG, arrest, bleed post-PCI, stroke, IABP, ECMO etc.
- STEMI Took longer to call 171 v 242 minutes STEMI took longer to have ECG from onset, explained by longer to call 268 v 173 STEMI took longer for EMS to get ECG on – why? 11 v 17 STEMI got to hospital quicker Median 57 mins from dispatch
- Median D2B 73 minutes (mean 77) 75% achieved D2B under 90 minutes Self presentations mean 113
- So what? Western evidence can work in Middle East STEMI bypass still works in the desert STEMI bypass still works with a novel population First study of it’s kind in UAE NE One of very few studies in ME Adds to AD STEMI network data One of very few studies internationally to use EMTs for 12 Lead ECG and PCI activation
- Northern Emirates do not have healthcare authorities unlike AD and Dubai