The Myth of the Stable STEMI Transfer

Lull - “To cause (someone) to feel safe and relaxed instead of careful and relaxed.”
Heilman, J. Inferior STEMI. Wikipedia Commons. http://commons.wikimedia.org/wiki/File:IandRStemi.JPG.
Heilman, J. Inferior STEMI. Wikipedia Commons. http://commons.wikimedia.org/wiki/File:IandRStemi.JPG.

We fly/transfer many patients with STEMI on Air Care and Mobile Care.  And, fortunately, a majority of these patients end up doing very well.  You accept them at the referring facility, load them in the helicopter, and transfer them to the cath lab at the receiving facility without incident.  You certainly may make some adjustments in nitro drips, maybe give some metoprolol, certainly review their outside hospital records, but usually the biggest benefit you are offering them is rapidity of transport.  Transport 20 or 30 of these patients without incident and you might get lulled into thinking that these patients are so incredibly stable that nothing bad will happen during the course of the transport.  To do so would be folly.  There's a cognitive bias that describes this turn of thinking quite well. (2)

Gambler's Fallacy

  • Definition = estimating the pretest probability of a given diagnosis or condition based on preceding, independent events
  • Medical Example = "I transferred 20 anterior MIs and never once have I seen significant dysrhythmia."
  • Non-medical Example =  Ever play roulette? Ever bet black or red based on the last spin of the wheel? ("4 reds in a row, it must be about time for a black") Seriously.  Don't do that.  Not with roulette and not with your patients.

In the accompanying podcast to this blog post, Dr. Hinckley and Dr. Hill discuss the different complications you should mentally prepare for in caring for these patients.

References

  1. Merriam Webster Online Dictionary. http://www.merriam-webster.com/dictionary/lull. Accessed 5/26/14.
  2. Croskerry, P. (2002) Achieving Quality in Clinical Decision Making: Cognitive Strategies and Detection of Bias. Academic Emergency Medicine. 9 (11). 1184-1204
  3. Heilman, J. Inferior STEMI. Wikipedia Commons. http://commons.wikimedia.org/wiki/File:IandRStemi.JPG. Accessed 5/27/14.