EASTERN WI MISSION LIFELINE: STEMI OVERTRIAGE FORM

The Eastern WI Mission Lifeline Team has created a resource to help identify and track false cath lab activations*. This tool will help facilities track false activation rates to help better understand where the gaps/barriers to practice are and how we can work to improve our STEMI system for the region. 2013 guidelines report the rate of false activations to be approx. 15% and “is more than balanced by earlier treatment times for the majority of patients for whom notification is appropriate.”

The definition agreed upon the Eastern WI Mission Lifeline team is “A false activation of the cath lab is for those patients who had the cath lab cancelled after being initiated by the ED or EMS.”

*The term “false activation” is used in this document to align with the universal wording of the AHA 2013 Mission Lifeline STEMI guidelines regarding cath lab activation. This term is not meant to be punitive or undermine providers clinical judgment, but to be used as a tool to help improve the quality of STEMI systems by tracking reasons why the cath lab was cancelled.

Term / Alternative descriptions/ / Field choices(chose all that applyfrom thefollowing / Definition
terms / choices)
Initial sourceof
activation /

a.Medical Control

b.Emergency Medical Technician

c.Emergency Room Physician
d.In-house STEMI / Thehealthcareprofessionwhomadetheinitial
decision to activate the catheterizationlaboratory. Generally, this is the first professional toevaluate the patient’ssymptomsandelectrocardiogram(ECG)on first medical contact.
ECG
interpretation method / a.EMS
b.Machine
c.Transmission/Physician
d.Other / The method of interpretingthe ECG regarding criteria
for STEMI during first medical contact.More than one option maybe selected.
Reason
catheterization laboratory cancelled. / a.The patientdidnot have ST segment elevation
(discordancein ECG interpretation)
b.Thepatientdidnot haveischemictypechestpain (discordanceinsymptom interpretation)
c.Resolution of chest painand/ or ST segment elevation
d.Death
e.Do not resuscitate status
f.Unwilling toundergo catheterization
g.Unabletoobtainconsentfortheprocedure
h.Severe dementia
i.Combative/ uncooperative patient
j.Active bleeding
k.Severe co-morbid or terminal illness
l.Protocol deviation
m.Other / Principalormostlikelyreasoncatheterization
laboratory was cancelled.
Positivecardiac
enzymes / a.Yes
b.No
c.Not available
d.Not applicable / Elevationofspecific markersformyocardialnecrosis
according to the ACC/ ESC definitions for type1 myocardialinfarctionincludingelevationofcreatine kinase-MBortroponinabovethe99thpercentile. Valuesexceedingindividualhospitalrangesare
sufficient and meet thecriteria for positivecardiac enzymes.
[J Am Coll Cardiol2000;36:959–69.]
Patient for whom
the catheterization laboratory should not be activated. / Inappropriatepatient for
catheterization / a.No
b.Not available
c.Not applicable / A patient for whomemergent catheterizationcannotbe
performed for reasons obvious to the health care professionalduringthefirstmedicalcontactincluding1) donotresuscitatestatus,2) unwillingtoundergo catheterization, 3) neither the patient nor their proxy are abletoconsentfortheprocedure,4) severedementia,
5)combative/ uncooperative patient, 6) active bleeding, 7) severe comorbid or terminal illness.