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March 4, 2008
Toronto EMS improves pre-hospital cardiac care to help save more heart attack patients
Toronto Emergency Medical Services is arming its Advanced Care Paramedics with leading-edge equipment and skills to reduce deaths and disability from heart attacks. Using 12-lead electrocardiogram (ECG) monitors in ambulances and in the community, Advanced Care Paramedics are now able to begin high-level cardiac diagnosis before a patient arrives at the hospital, speeding up access to life-saving drugs and medical procedures.

Effective immediately, Advanced Care Paramedics will perform 12-lead ECGs (Electrocardiograms) on patients with chest discomfort or other symptoms indicating a possible cardiac event. The ECG monitor will alert the paramedic if a specific type of heart attack, known as an “ST-elevated Myocardial Infarction,” or STEMI, is underway. STEMIs are caused by coronary artery blockages. They must be treated immediately, either with clot-busting drugs (thrombolytics) or PCI (Percutaneous Coronary Intervention) surgery, a procedure that requires a Cardiologist to re-inflate the affected artery by inserting a balloon stent with a catheter. If the cardiac monitor indicates a STEMI, the paramedics will run through a drug eligibility checklist and notify the receiving hospital so that hospital staff can prepare to administer medication or initiate PCI surgery immediately upon arrival.

Dr. Brian Schwartz, an emergency physician and Director of the Sunnybrook-Osler Centre for Prehospital Care, says when paramedics start STEMI diagnosis in the field before arriving at the hospital, they improve the patient’s chance of survival and recovery. “Once I know there is a 12-lead that indicates a STEMI, I can start getting a full team ready to assess and treat the patient when they arrive in the emergency department. I’ve saved 15 minutes on the ECG and another 10 minutes asking questions to determine drug eligibility. Then we save even more time because we’ve started to get the PCI lab ready. We’ve saved anywhere from 30-60 minutes because the 12-lead ECG has been done by paramedics. By treating patients more quickly, we can reduce their chances of dying significantly and we can save much more heart muscle so people can have a better quality of life.”

Research indicates that with early diagnosis and treatment of STEMI, mortality can decrease from 15 per cent to just 5 per cent. Paramedic 12-lead ECG use is now a key “best practice” of the American Heart Association, and has been proven to speed access to specialized in-hospital interventions to rapidly remove blockages to blood circulation within the heart.

“This is a great example of how more and more, paramedics are part of a seamless emergency healthcare system. It involves Emergency Medical Dispatchers, paramedics, nurses and physicians working together to give the patient the very best chance of surviving with a high quality of life,” said Toronto EMS Chief Bruce Farr.

This improvement in pre-hospital health care in Toronto will affect approximately 1,200 patients each year in Toronto who experience a STEMI. It will also help diagnose other serious cardiac events, allowing patients to get the appropriate, definitive care they need sooner.

Toronto is Canada’s largest city and sixth largest government, and home to a diverse population of about 2.6 million people. It is the economic engine of Canada and one of the greenest and most creative cities in North America. In the past three years, Toronto has won more than 70 awards for quality, innovation and efficiency in delivering public services. Toronto’s government is dedicated to prosperity, opportunity and liveability for all its residents.

Media contact:
Lyla Miller, Toronto EMS Media Relations, 416-392-2255, 416-708-8125 (cell),

Note: Photos and graphics available upon request



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