Protocol 2-220-50 - Chest Pain - STEMI Destination Matrix

CMH EMS & MIH Protocols

This matrix was developed using geographical analysis of designated facilities and historical ambulance transport statistics. It also follows Missouri regulations found in 19 CSR 30-40.790 (Transport protocol for trauma, stroke, and STEMI patients).

These are guidelines only. Scene or patient conditions may influence an alternate destination determination.

Patients have the right to refuse transport to the recommended destination. If the patient refuses recommended destination, document "transport / refused care" and have patient sign refusal.

When initial transport from the scene would be prolonged, the patient may be transported to the nearest appropriate facility.

Refer to ECG Interpretation Guide.

Consider transporting to the closest STEMI center for any one the following criteria:

ST elevation of one or more mm (1 mm) in two leads in the following areas:

Anterior (V3 and V4),
Inferior (II, III, and/or aVF),
Lateral Left (I, aVL, V5, and/or V6), OR
Septal (V1 and V2).

ST elevation of ½ or more mm (0.5 mm) in the following areas:

Lateral Right (V4R), OR
Posterior (V8 and V9)

New onset LBBB,

Sgarbossa criteria,

DeWinters syndrome, OR

Wellens syndrome.

Location	Destination	STEMI Designation	Notes
Bolivar	Citizens Memorial	Level II	If cardiogenic shock: Transport to Level I STEMI center
Osage Beach	Lake Regional	Level II

Location

Destination

STEMI Designation

Notes

Bolivar

Citizens Memorial

Level II

If cardiogenic shock: Transport to Level I STEMI center

Osage Beach

Lake Regional

Level II

Consider transporting to the closest Level I STEMI center for any one the following criteria:

Any criteria above, and/or

Any of the following:

Cardiogenic shock OR
Three Vessel Disease.

Location	Destination	STEMI Designation	Notes
Aircraft	Aircraft crew determination	NA	If over 45 min drive time: Utilize aircraft
Springfield	Cox South	Level I
Mercy	Level I
Kansas City	Research	Level I
St. Luke's	Level I

Location

Destination

STEMI Designation

Notes

Aircraft

Aircraft crew determination

If over 45 min drive time: Utilize aircraft

Springfield

Cox South

Level I

Mercy

Level I

Kansas City

Research

Level I

St. Luke's

Level I

NEMSIS Protocol: 9914117 - Medical-Cardiac Chest Pain

Citations:

Protocol 9-010 - References
Care Flight Collective, 2014
Chapter 190 - Emergency services, 2012
Citizens Memorial Hospital, 2014
Clemency, Thompson, Tundo, & Lindstrom, 2013
Cooper, 2015
Designated hospitals, n.d.
Missouri Department of Health & Senior Services, 2019
Missouri EMS Regional Committee - Southwest Region, 2013
NASEMSO Medical Directors Council, 2017
National Association of Emergency Medical Technicians, 2019
Proposed regulations, 2010
Zacher, 2017

Change Log:

Date	Link to previous version	Description of change
11/17/15	pdf	Added northern destinations that might be closer to Ellett’s response area. Modified quickest transportation mode definition to 35 minutes.
07/22/16	pdf	Added comment than BLS truck with ALS patient shall transport to closest ER or CMH.
08/24/17	pdf	Streamlined flowchart with a comment to follow aircraft protocol when flying patient.
07/23/19	pdf	Verified designated STEMI centers with BEMS website.
11/27/19	pdf	Changed format from flowchart to something more easily utilized.
07/12/20	pdf	Moved this section from 2-220created a new page.
06/06/21	pdf	Moved to emsprotocols.online
10/14/21	pdf	Renumbered from 2-220-01 to 2-220-50.
10/14/21		Added link to 1-100 aircraft.
11/05/21		Fixed typo where table indicated TRAUMA destination but should have been STEMI destination.

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