"We recommend implementation of out-of-hospital 12-lead ECG diagnostic programs in urban and suburban EMS systems." Class I. (p. IV-91).

No change, still the highest classification.

"Routine use of 12-lead out-of-hospital ECG and advance notification is recommended for patients with signs and symptoms of ACS.' Class IIa. (p. IV-91)

Previously not classified.

The LIFENET® RS Receiving Station works together with the LIFEPAK® 12 defibrillator/monitor to identify suspected ST-elevated MI and transmit a diagnostic-quality ECG to the ED or directly to the cardiology department/cath lab.

"We recommend that out-of-hospital paramedics acquire and transmit either diagnostic-quality ECGs or their interpretation of them to the receiving hospital with advance notification of the arrival of a patient with ACS." Class IIa. (p. IV-91)

Previously not classified

The LIFENET RS Receiving Station works together with the LIFEPAK 12 defibrillator/monitor to identify suspected ST-elevated MI and transmit a diagnostic-quality ECG to the ED or directly to the cardiology department/cath lab.

EMS assessment, care and hospital preparation is now included in the Chest Pain Algorithm on page IV-90.

Previously, EMS assessment and care were only a side bar to the algorithm. It is now number 2 on the treatment algorithm with recognition of the value of early notification and triage to the correct facility.

Hospital goals remain at 30 minutes door-to-drug/needle time or 90 minutes door-to-balloon inflation.

Prep time to set up room and prepare patient is commonly 30-45 minutes and it may take 10-15 minutes to get the catheter in place for balloon inflation. A transmitted 12-Lead ECG can help hospitals meet the Guidelines related to "door to needle" and "door to balloon" times.

To view or order clinical studies showing how the LIFENET RS Receiving Station can be implemented, and how it helps reduce door-to-treatment times.5,6 To order a reprint of this abstract, click here. You will be routed to our request page; please type "Sekulic Study" and/or "Bradley Study" in the message box that appears.

"In summary, at this time there is inadequate evidence to recommend out-of-hospital triage to bypass non-PCI-capable hospitals to bring patients to a PCI center. (Class Indeterminate). Local protocols for EMS providers are appropriate to guide the destination of patients with suspected or confirmed STEMI." (p. IV-92)