Jason Buick
Doctorate
Doctorate Title: Predictors of Clinically Important Events in Patients with Prehospital ST-Elevation Acute Myocardial Infarction: A Clinical Prediction Model for Paramedics
Doctorate Description: Acute myocardial infarction (AMI) affects more than 70,000 people each year in Canada, with one-third being classified as a ST-elevation acute myocardial infarction (STEMI). This type of medical emergency is often referred to by the saying, “Time is heart muscle”, which indicates that every minute of delay to definitive therapy (typically percutaneous coronary intervention or PCI) leads to higher mortality. Acute myocardial infarction represents nearly 3% of all 911 medical emergencies: more than cardiac arrest, severe trauma or stroke. The Canadian Cardiovascular Society guidelines recommend that paramedics transport patients directly to a hospital capable of reperfusion by PCI, bypassing other hospitals. Despite these recommendations, due to geographical limitations, long transfer times, provincial policies, and resource constraints, many patients are not transported directly from the field to a PCI-capable center. In many jurisdictions, prehospital STEMI bypass is almost exclusively limited to paramedics with Advanced Life Support (ALS) training, as 10-30% of patients will experience a clinical deterioration and potentially need an ALS intervention during transport. However, the majority of prehospital providers in North America are at the basic life support (BLS) level, which mandates that patients are transported to non-PCI capable centers if there is no ALS provider available. Naturally this increases time to initiation of reperfusion therapy. Given these limitations, it would be optimal to identify which patients could be transported safely to a PCI-center by BLS paramedics, and which patients are at high-risk of deterioration during transport and would benefit from ALS care. Currently there is little evidence to identify which patients will potentially deteriorate and therefore require ALS care, and no validated clinical decision rule exists to support paramedic decision making. Therefore, the objective is to derive and subsequently validate a clinical decision rule that predicts patient deterioration among prehospital STEMI patients using information available at the time of evaluation by a paramedic. This study will build a clinical prediction tool that can help support paramedic decision-making in patients with out-of-hospital STEMI, and ultimately prevent deaths in this high-risk population in whom time is heart muscle. It also has implications for resource allocation, utilization and paramedic deployment.
Details:
Type: PhD
University: University of Toronto
Primary Supervisor: Dr Clare Atzema
Category: Cardiology & Respiratory
Funding: None
Start Date: 2017
End Date: 2023
Status: Ongoing
Thesis
Awaiting
Research Interests
Publications
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