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* All patients being transported for chest pain should be managed as if the pain were ischemic in origin unless clear evidence to the contrary is established. * If available, an ALS unit should transport patients with hemodynamic instability or respiratory difficulty. * Prehospital notification by Emergency Medical Services (EMS) personnel should alert ED staff to the possibility of a patient with MI. EMS personnel should receive online medical advice for a patient with high-risk presentation. * The American Heart Association (AHA) protocol can be adopted for use by prehospital emergency personnel. This protocol recommends empirical treatment of patients with suspected STEMI with morphine, oxygen, nitroglycerin, and aspirin. * Specific prehospital care includes the following: * ** Intravenous access, supplemental oxygen, pulse oximetry ** Immediate administration of aspirin en route ** Nitroglycerin for active chest pain, given sublingually or by spray ** Telemetry and prehospital ECG, if available * EMS protocol should be formulated to strongly consider taking patients with suspected MI/ACS, and certainly patients with STEMI, to facilities capable of PCI if geographically possible. * Prehospital thrombolysis allows eligible patients to receive thrombolysis 30-60 minutes sooner than if treatment were given in the ED; however, prehospital thrombolysis is still under investigation. (source: emedicine.com)

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