Unified Recommendations Issued by the National Chest Pain Protocol Launch Conference and Roundtable Meeting
Unified Recommendations Issued by the National Chest Pain Protocol Launch Conference and Roundtable Meeting
Based on the outcomes of the conference and the roundtable meeting, we recommend the following:
1. Adopt a unified national protocol for the diagnosis and treatment of Acute Coronary Syndromes (ACS), encompassing emergency departments, ambulance services, and cardiac centers, to be endorsed by all relevant official entities.
2. Perform an electrocardiogram (ECG) within the first 10 minutes of initial medical contact or upon the patient’s arrival at the emergency department. Emphasize the necessity of repeating the ECG every 10–30 minutes if chest pain persists or symptoms change, or after the resolution of pain if no significant changes were observed in the initial ECG.
3. Do not delay the activation of STEMI protocols or the transfer of the patient to the catheterization lab when clear clinical evidence is present (e.g., ECG changes), even if troponin results are not yet available.
4. Ensure the availability of a defibrillator (DC) during any internal or external transfer of a patient with ACS to guarantee immediate response to sudden cardiac arrest.
5. Recognize STEMI and its equivalents as top-priority medical emergencies requiring rapid assessment, transfer, and intervention from the moment of suspicion until the reopening of the occluded coronary artery.
6. Implement a fast-track administrative pathway to ensure timely transfer of patients from non-PCI-capable hospitals to PCI centers without administrative delays or unnecessary waiting.
As part of this pathway, establish a national STEMI Coordination Unit to oversee the unified digital system, connecting emergency departments, on-call physicians, and catheterization centers, with a real-time dashboard displaying bed availability, catheterization lab status, and staff readiness, utilizing secure and rapid communication channels.
The conference and roundtable also recommended establishing a unified national administrative coordination system for the referral and transfer of acute myocardial infarction (STEMI) cases between hospitals, linking all healthcare sectors (Ministry of Health, Royal Medical Services, private sector), managed by a central STEMI Coordination Unit.
1. Operation of a Unified Digital Information System (Real-Time Dashboard):
• Objective: Enable stakeholders (emergency departments, ambulance services, coordination unit) to identify the appropriate hospital for patient transfer immediately, without the need for manual calls to each hospital.
• Implementation:
• Develop a centralized electronic system (secure website or application) supervised by the STEMI Unit, featuring an automatically updated dashboard.
• Each catheterization center records daily:
• Number of available beds.
• Catheterization lab status (ready/occupied/out of service).
• Name and contact information of the on-call physician.
• This system is accessible to emergency and ambulance teams in real-time, facilitating the selection of the nearest ready center.
• Practical Example:
A STEMI patient in a peripheral hospital: the physician accesses the dashboard, sees that Hospital X has an available bed, a ready catheterization lab, and Dr. Ahmad is on call, leading to immediate referral without repeated calls.
2. Direct Electronic Link Between Emergency Departments and On-Call Catheterization Physicians: 
• Objective: Accelerate decision-making by the receiving physician (PCI Center) without delays or reliance on unverified faxes or calls.
• Implementation:
• Within the same electronic system or through a dedicated application (e.g., “STEMI Link”):
• The emergency physician sends an immediate electronic alert to the on-call physician, including patient name, age, ECG, and any preliminary tests.
• The on-call physician receives the alert on their phone or computer and confirms receipt within minutes.
• The catheterization team prepares the lab based on this alert, even before the patient’s arrival.
• Practical Example:
An emergency physician in Zarqa sends an ECG via the system to a hospital in Amman; the catheterization team is activated before the patient’s arrival, saving 20–30 critical minutes.
3. Encrypted Emergency Communication System (Hotlines and Dedicated Applications):
• Objective: Provide a fast, secure, and reliable communication method, avoiding personal phones or paper-based systems.
• Implementation:
• Establish a dedicated hotline for the STEMI Unit in each catheterization center, directly connecting to the on-call physician or catheterization team.
• Utilize a secure, dedicated application (e.g., a Ministry of Health-licensed app) for exchanging:
• ECGs, patient data, ambulance location, and confirmation of receipt.
• Communications through the application are recorded and documented within the system for transparency and medical accountability.
• Practical Example:
An ambulance driver presses the “STEMI Case Arrival” button in the application; the hospital receives the alert with the ambulance’s location and estimated arrival time.
4. During the roundtable meeting, Dr. Abdulmajid Al-Zubaidi, a cardiologist from the UAE, discussed the “Bin Wraiqah” initiative launched by Dubai Police to facilitate the arrival of on-call physicians to hospitals during emergencies. This initiative allows physicians to exceed speed limits without incurring traffic violations when summoned, ensuring their rapid and safe arrival to provide urgent medical care.
The initiative operates through an electronic system that enables physicians to register their information and vehicles. Upon activation, relevant authorities are automatically notified to facilitate their passage through roads without delay. This system reflects the UAE’s commitment to enhancing medical service efficiency and ensuring a swift response to emergencies.
https://eurointervention.pcronline.com/article/how-to-set-up-regional-stemi-networks-providing-best-possible-stemi-care
https://pubmed.ncbi.nlm.nih.gov/34387547/
https://pmc.ncbi.nlm.nih.gov/articles/PMC9743232/
https://pubmed.ncbi.nlm.nih.gov/39105078/
https://www.researchgate.net/publication/385730879_Bypassing_Emergency_Service_Decoding_the_Drivers_of_Self-Referral_During_Acute_Myocardial_Infarction_on_Rural_Areas_in_Sachsen-Anhalt_Germany
https://en.wikipedia.org/wiki/Door-to-balloon
7. Instruct EMS teams, upon dispatch, to request the preparation of the patient’s medical documents, including previous reports, current medications, or past ECGs, to expedite diagnosis and decision-making.
8. Activate the communication and case follow-up unit within the national digital pathway to ensure data entry from the initial assessment, monitor the treatment plan post-catheterization, and close the treatment loop after hospital discharge.
9. Provide accredited and updated training for EMS and emergency teams on ECG interpretation and recognition of STEMI and its equivalents (e.g., Wellens and De Winter), enabling them to transmit ECGs electronically to hospitals before arrival.
10. Reactivate the “Life Network – Life Stent” project as a practical and national framework for delivering coordinated and rapid care for time-sensitive cardiac cases, linking field diagnosis with therapeutic intervention and post-discharge follow-up.
11. Urge the Private Hospitals Association to adopt a policy of utmost priority for life-saving cases such as STEMI, without administrative or financial delays, highlighting the legal and humanitarian implications of any unjustified postponement.
12. Recommend that health insurance companies issue immediate approvals for emergency cardiac cases, especially high-risk STEMI and NSTEMI, and adopt a “treat first – approve later” mechanism for these critical situations.
