ST-Elevation Myocardial Infarction (STEMI) is a clinical syndrome defined by characteristic symptoms of myocardial infarction or acute myocardial infarction, commonly known as a heart attack. A heart attack occurs when blood stops flowing properly to part of the heart, injuring the heart muscle due to lack of oxygen. The most common way to determine if a person has had a myocardial infarction is through electrocardiograms (ECGs) that trace the electrical signals in the heart. ECG testing is used to differentiate between two types of myocardial infarctions based on the shape of the tracing. An ST section of the tracing that is higher than the baseline is considered to be a STEMI. A STEMI usually requires aggressive treatment in a timely manner to prevent permanent heart damage.

STEMI is treated by restoring circulation to the heart, called reperfusion therapy, and typical methods are angioplasty, where the arteries are pushed open, and thrombolysis, where the blockage is removed using medications.



The Early Management of Adults with STEMI

The EMS Authority staff participated in a STEMI Work Group co-convened by the American Heart Association and the California Department of Public Health, STEMI & Stroke Prevention Program. The work group developed the STEMI guidelines titled “Recommendations for the Early Management of Adults with ST–Elevation Myocardial Infarction (STEMI)”.

Local STEMI Systems

Some local EMS agencies have developed STEMI Systems. The systems vary among local EMS agencies. The American Heart Association/American Stroke Association is conducting a detailed survey on STEMI system approaches.  The EMS Authority has identified the following local EMS agencies as developing/implementing a STEMI System of Care Program: Alameda, Coastal Valleys, Contra Costa, El Dorado, Inland Counties, Kern, Los Angeles, Marin, Merced, Monterey, Mountain Valley, Napa, Orange, Riverside, Sacramento, San Diego, San Francisco, San Joaquin, San Luis Obispo, San Mateo, Santa Barbara, Santa Clara, Santa Cruz, Sierra-Sacramento Valley, Solano, Tuolumne and Ventura EMS.

STEMI Regulations

California statute mandates the EMS Authority to adopt necessary regulations to carry out the coordination and integration of all state activities concerning EMS (Health and Safety Code § 1797.107).

In addition, the statute allows the EMS Authority to establish guidelines for hospital facilities, in cooperation with affected medical organizations, according to critical care capabilities (Health and Safety Code § 1798.150).

As a result of these statutes, the EMS Authority established a multidisciplinary taskforce for the development of STEMI System of Care Regulations for California.

The key areas to be addressed within the regulatory recommendations are: hospital designation criteria, data collection and quality improvement processes, time-critical intervention values and pre-hospital EMS policies. The overall goal of the regulations is to reduce morbidity and mortality from acute cardiac disease by improving the delivery of emergency medical care within local communities in California.

STEMI Critical Care System Regulations

For Questions Contact

Farid Nasr, MD
Specialty Care Systems Specialist
(916) 322-4336 ext. 424