State Cardiac Reperfusion Strategy (SCRS)
The State Cardiac Reperfusion Strategy (SCRS) is a system of care for patients with a suspected Acute Coronary Syndrome (ACS), a group of conditions due to reduced blood flow to the heart.
When a heart attack happens, the heart muscle does not receive enough blood and oxygen and some of the heart muscle begins to die. In many cases, a blood clot is completely blocking an artery in the heart. If the artery can be opened quickly there will be less damage to the heart, which is why it is important to confirm this type of heart attack, known as ST elevation myocardial infarction or STEMI, as soon as possible. If you think you are having a heart attack ring Triple Zero (000).
NSW Health clinicians are working collaboratively to deliver increased access to medical advice and cardiac therapy across NSW tailored to specific settings.
Pre-hospital Assessment for Primary Angioplasty (PAPA)
The Pre-hospital Assessment for Primary Angioplasty (PAPA) model involves paramedic assessment of the patient and ECG transmission to a cardiologist. If STEMI is confirmed, the patient is immediately transported to the cardiac catheterisation laboratory (CCL) to open the blocked artery, bypassing the emergency department and hospitals that do not have a CCL. The process of restoring blood flow to the heart is known as reperfusion.
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.
The SCRS builds on the Early Triage of Acute Myocardial Infarction (ETAMI) program which aimed to provide pre-hospital triage of patients with chest pain to expedite reperfusion. ETAMI commenced at the Royal North Shore Hospital and Westmead Hospital in 2004.
Pre-Hospital Thrombolysis (PHT)
All 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 which is based on the successful ‘proof of concept’ in 2008 at the Hunter New England Area Health Service.
In the PHT model, paramedics working in more remote locations transmit the ECG to a cardiologist or emergency physician who interprets the ECG. The doctor calls the paramedics 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 work place) or whilst the patient is being transferred to hospital.
Nurse Administered Thrombolysis (NAT)
The Nurse Administered Thrombolysis (NAT) 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 (CSM)
The Clinical Support Model (CSM) is a supportive framework to provide expert advice to staff working at small hospitals on 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.
Evaluation of the State Cardiac Reperfusion Strategy
All elements of the strategy are being evaluated by the ACI against measures reflecting outcomes for patients, staff and health services so that better practices can be continuously identified, shared and promoted across NSW.
The SCRS relies upon close working partnerships and strong collaboration between the ACI, NSW Ambulance and Local Health District teams. These relationships have resulted in more timely access to care for patients with suspected ACS across NSW.
- State Cardiac Reperfusion Strategy – Clinician Information
- A New Service for People Having a Heart Attack in NSW: Consumer Information
- Authorisation to Supply Tenecteplase
- Tenecteplase Replacement In Public Hospitals for Ambulance Paramedics
- Pre-Thrombolysis Checklist
- Nurse Administered Thrombolysis: Clinician fact sheet
- Nurse Administered Thrombolysis: Patient fact sheet
NSW Ambulance Protocols
These protocols are only available to NSW Health staff.
- Tenecteplase - Pharmacology 231
- Enoxaparin Sodium - Pharmacology 232
- Clopidogrel - Pharmacology 236
- Acute Coronary Syndrome - Protocol C1
- Cardiac Reperfusion Prehospital Thrombolysis - Protocol C13
For further details see the SCRS page on the Excellence and Innovation in Healthcare site.
Network Manager, Cardiac
NSW Agency for Clinical Innovation
Phone: 02 9464 4620