Paramedic PapersHome Cardiac (non-arrest) STEMI deaths now mostly prehospital
Cardiac (non-arrest)
STEMI deaths now mostly prehospital
Optimizing US Prehospital Care of ST-Segment–Elevation Myocardial Infarction Because Time Is Life, Not Just Muscle
Circulation · 2026-10-27 · Added 4 November 2026
A US Circulation viewpoint argues that because most STEMI deaths now occur out of hospital, the biggest gains lie in shortening symptom-onset-to-reperfusion, and sets out five recommendations spanning patient education, prehospital pharmaceuticals and reimbursement reform.
- Study type
- Other
- Design
- Perspective/viewpoint article
- Participants
- Not applicable
- Main finding
- Five recommendations to shorten symptom onset to reperfusion: patient education, prehospital glycoprotein IIb/IIIa inhibitors or thrombolytics, rapid PCI access, and changes to prehospital care reimbursement
- Caveat
- Opinion piece with no new data, and the prehospital-drug recommendations assume a system that doesn't exist in every Australian service
- Bottom line
- Context only
Why it matters in Australia (Medium relevance). The funding machinery is American, but the central argument — most STEMI deaths are prehospital — applies here, and thrombolytics are carried by a handful of Australian services while most don't.
Learning goal
Recognise the patient and system factors that delay reperfusion in Australian STEMI care.
More
- Topic: Cardiac (non-arrest)
- Daily scan: 4 November 2026
Related papers on Cardiac (non-arrest)
-
Roadside capillary troponin for chest pain
A French prospective multicentre diagnostic accuracy study (VALIDATE) tested prehospital capillary high-sensitivity troponin I on a point-of-care device against NSTEMI at hospital discharge in adults with acute chest pain, with treating clinicians blinded to results.
-
Mapping chest pain risk tools in ambulance care
A scoping review of 27 articles mapped eight chest-pain risk-stratification tools used or trialled in ambulance settings, finding the HEART score and derivatives most studied but with varying and incomplete validation for ambulance use.
-
Electrical capture uncommon in prehospital transcutaneous pacing
A US EMS agency reviewed continuous monitor ECGs from 56 patients given prehospital transcutaneous pacing between 2017 and 2024 and found electrical capture in only 32%, often intermittent, with clinician-verbalised pulses coinciding with capture in just 15% of instances.
-
Overdrive pacing for refractory pVT prehospital
A prehospital case report describes transcutaneous overdrive pacing used as rescue therapy for refractory polymorphic ventricular tachycardia after cardiac arrest, highlighting the gap between guideline options and what ambulances actually carry.