In 2015, St John and Nelson Marlborough Health (NMH), jointly developed a STEMI treatment pathway used primarily by ambulance, medical and nursing staff in the out-of-hospital setting. This involves ambulance staff using an electrocardiogram (ECG) to confirm a STEMI.
This is sent to the closest hospital with a heart centre (either Nelson or Wellington) where an on-call cardiologist reviews the ECG reading and prepares the operating theatre (cath lab) and heart team.If the cath lab is unavailable or the patient cannot be transported within 60 minutes, paramedics will administer thrombolysis (clot busting drugs) in the field to ‘dissolve’ blood clots within a patient’s heart. Patients are then transported to a heart centre for expert assessment and stent surgery if required.
Before the STEMI pathway was developed angioplasty was not available for around two million New Zealanders due to the time it took to transport them to the closest hospital with a heart centre.The STEMI pathway proved so successful in the Nelson Marlborough region it has been introduced nationwide.
NMH consultant interventional cardiologist, Dr Nick Fisher says the roll out of the pathway is particularly good news for patients in rural areas, as it will ensure they get the care they need in optimal time. When you suffer a heart attack an artery blocks within your heart. If this artery isn’t opened within two hours, heart muscle will die. The most lethal type of heart attack is STEMI or ST segment elevation myocardial infarction. STEMI is identified by electrocardiogram (ECG) and ideally the blocked coronary artery is unblocked by angioplasty or ‘percutaneous coronary intervention’ (PCI), which means having a stent inserted.This procedure is 99 per cent successful if patients having a STEMI are treated within two hours.
Video: Dr Nick Fisher, Interventional Cardiologist describes a pathway, developed in Nelson, which enhances the chances of survival for patients having a STEMI heart attack: https://www.youtube.com/watch?v=OwVvWBygWgI&feature=youtu.beInvite to the New Zealand STEMI Team Facebook pageThe St John National Patient Pathways Team is inviting all clinicians involved in STEMI care to join the New Zealand STEMI Team Facebook page. This is a closed group that was established to share anonymised STEMI case studies, ECGs and patient stories; share examples of excellent clinical practice, disseminate lessons learned and share STEMI pathway news.
This is also a forum to give feedback about the national development of the STEMI pathway. Search ‘New Zealand STEMI Team’ on Facebook, and when you request to join, please indicate your involvement in STEMI care so that your membership can be approved. Participants in the group agree to maintain patient confidentiality and abide by the social media policy of their respective organisation(s).
For more information on STEMI in New Zealand, the following link will take you to a presentation entitled ‘The New Zealand Out-of-Hospital STEMI Pathway – why do we need it?’ delivered by Dr Tammy Pegg (Consultant Cardiologist, Nelson Marlborough DHB) and Mr Kris Gagliardi (National Patient Pathways Manager, St John) at the recent Council of Ambulance Authorities conference in Auckland: https://www.youtube.com/watch?v=SSZfKFm1R30