State Cardiac Reperfusion Strategy

State cardiac reperfusion strategy

The state cardiac reperfusion strategy (SCRS) includes four models of care for patients with suspected acute coronary syndrome. This is a group of conditions caused by reduced blood flow to the heart and includes angina, ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction.

STEMI is a type of heart attack which is a time-critical, life-threatening, medical emergency. It is essential to rapidly diagnose STEMI and restore blood flow to the heart to reduce the risk of heart failure or death. This process is known as reperfusion.

NSW Health clinicians are working in partnership to improve access to early medical advice and reperfusion therapy across NSW tailored to specific settings.


Pre-hospital assessment for primary angioplasty

The pre-hospital assessment for primary angioplasty (PAPA) model involves paramedic assessment of the patient and electrocardiogram (ECG) transmission to a cardiologist. If STEMI is confirmed, the patient is immediately transferred to the cardiac catheterisation laboratory to open the blocked artery, bypassing the emergency department and hospitals that do not have a catheterisation laboratory.

There are 11 hospitals across metropolitan Sydney, Wollongong and the Newcastle region that provide PAPA services 24 hours a day, seven days a week. Canberra Hospital also provides a PAPA service for some patients in Southern NSW.

Pre-hospital thrombolysis

Paramedics in NSW have been trained to record and transmit a 12 lead ECG and administer thrombolysis. These skills are required for the pre-hospital thrombolysis model.

In this model, paramedics working in rural and regional locations transmit an ECG to a cardiologist or emergency physician for rapid interpretation. The doctor calls the paramedics within ten minutes and, if a STEMI is confirmed and the patient meets specific criteria, the paramedics administer protocol directed medication to dissolve the blood clot and open the artery.

This treatment is provided at the scene (which may be the patient’s home or workplace) or while the patient is being transferred to hospital.

Nurse administered thrombolysis

The nurse administered thrombolysis model is an option for small hospitals that do not have 24 hour on-site medical cover where patients self-present. Clinicians transmit the ECG to a cardiologist or emergency physician for interpretation. If a STEMI is confirmed and the patient meets specific criteria, protocol directed thrombolysis is administered by nurses to dissolve the blood clot and open the artery. If the patient has another diagnosis, advice on patient management is provided.

Clinical support model

The clinical support model is a supportive framework to provide expert advice to staff working at small hospitals for patients who self-present. Staff transmit a 12 lead ECGs to a nominated reading service for expert interpretation. A doctor from the reading service provides rapid interpretation of the ECGs and clinical advice on ongoing management to local clinicians.


Clinician summaries

Use these summaries to support local implementation of the strategy.

NSW Ambulance protocols

The relevant NSW Ambulance protocols to support the SCRS are:

The protocols are available on the NSW Ambulance app.

Apple link:

Google play  link:

Consumer resources

A new service for people having a heart attack in NSW (PDF 110 KB)Promote the strategy in your area.
Published: October 2013. Next review: 2023.


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