All patients with symptoms and ECG findings indicative of a STEMI-type acute heart attack are treated according to the national STEMI protocol, which has been defined by the Acute Coronary Syndrome Clinical Programme, in accordance with international best practice. If patients can be transported to a primary PCI centre dedicated to 24/7 treatment of STEMIs within ninety minutes, then they go directly to that centre. If transport to a PCI centre within 90 minutes is not feasible, then STEMI patients are taken to the nearest emergency department where thrombolysis (administration of clot-busting drugs) can be given, to stabilise the patient before transport to the PCI centre. This is accepted international best practice for management of STEMI patients, particularly in remote areas. Unfortunately, STEMI incidents are extremely serious and some STEMI cases have poor outcomes, irrespective of treatment.
The national STEMI protocol was launched in Oct 2012. The National Ambulance Service, with by the Emergency Aeromedical Support Service helicopter and the Coast Guard, has been implementing this protocol and patients are managed according to the protocol. The PCI centre in the West of Ireland is the cardiology centre in University Hospital Galway (UHG). This unit has 2 cardiac catheter laboratories and a dedicated team of interventional cardiologists, nursing, technical and radiography staff on call 24/7. Based on international best practice, a unit such as this will serve the population of the west of Ireland for management of STEMI incidents. If transport to UHG within 90 minutes is not feasible, then STEMI patients are taken to the nearest emergency department (eg Mayo General or Portiuncula) for thrombolysis, to stabilise the patient before transport. They are then transferred to UHG for assessment as to whether further intervention is needed.