EMS Chest Pain/ACS/STEMI Activation Note

Patient name/MRN: [Full name and MRN / Unknown adult male/female with temporary identifier]

DOB/age: [Date of birth / Age] (Document exact DOB if available; otherwise document age and how determined.)

Sex: [male / female / unknown]

Weight: [Actual weight (kg) / Estimated weight (kg)] (Specify method if estimated.)

Allergies: [Allergies listed / NKDA] (Highlight aspirin/NSAIDs, nitrates, opioids. If unknown, state "Unknown" with source.)

Incident/Call #: [Incident or call number]

Unit ID: [Unit identifier]

Crew roles/agency: [Crew names and roles; agency name]

Scene location type: [Private residence / Public place / Workplace / Healthcare facility / Roadway / Other]

Chief clinical label: [Suspected ACS / STEMI Activation (field) / STEMI Activation initiated then cancelled]

Activation Summary

[One-line case summary synthesizing demographics, symptom duration/character, key ECG finding, treatments given or withheld with brief rationale, and activation status.]

Symptom onset time: [Date/time] (If intermittent, capture time of last persistent onset. If unknown, state "Unknown" with source/reason.)

First medical contact (FMC): [Date/time]

First 12-lead ECG obtained: [Date/time]

ECG interpretation completed: [Date/time] — Interpreter: [paramedic / computer algorithm / physician]

STEMI alert/cath lab activation: [Date/time / Not activated] (Include who initiated and criteria used.)

Receiving facility notified: [Facility name] at [Date/time] (Include role contacted and confirmation time.)

Scene departure: [Date/time]

Arrival at destination: [Date/time]

Patient handoff time: [Date/time] — Recipient: [Role and location]

First aspirin time: [Date/time / Not given]

First nitroglycerin time: [Date/time / Not given]

IV access time: [Date/time / No IV]

Initial clinical status: Pain [0–10]; Vitals: SBP/DBP [value/value] mmHg, HR [value] bpm, RR [value]/min, SpO2 [value]% [room air / O2 device and flow]; Rhythm: [rhythm]; Hemodynamic instability: [present / absent] (If present, briefly note hypotension, shock signs, or arrhythmia.)

Chief Complaint & History of Present Illness

Chief complaint: "[Patient's own words]" (If from other source, identify who reported.)

Information source & reliability: [patient / family / bystander / facility staff] — [reliable / limited by altered mental status / language barrier / severe distress]

HPI narrative: [Onset time and circumstances; course (sudden vs gradual, intermittent vs continuous); duration; quality; location; radiation; severity with initial pain score; associated symptoms (dyspnea, diaphoresis, nausea/vomiting, syncope/presyncope, palpitations); provoking/relieving factors; similar prior episodes; known CAD history.]

Red-flag screening: [Screen for aortic dissection (tearing pain, pulse/neurologic deficits), pulmonary embolism (pleuritic pain, hemoptysis, leg swelling), tension pneumothorax (sudden pleuritic pain with unilateral breath sounds)] (For straightforward cases, "Screen negative" is acceptable. If not assessed, state "Not assessed.")

Cardiovascular Risk & Relevant History

• Known cardiovascular disease: [Prior MI / PCI with stents / CABG / Heart failure / Arrhythmias / Stroke or TIA / PAD / None known] (Include dates if known.)
• Risk factors: [Hypertension / Hyperlipidemia / Diabetes / Smoking / CKD / Family history of premature CAD / None known]
• Home medications relevant to ACS: [Antiplatelets / Anticoagulants / Beta blockers / Nitrates / PDE5 inhibitors (specify agent and last use time) / None / Unknown] (For PDE5 inhibitors, document who reported and reliability.)
• Bleeding risk: [Recent bleeding / Anticoagulation / Known coagulopathy / Recent surgery / None identified] (Note if this influenced treatment decisions.)

Physical Examination

• General: [Level of distress; diaphoresis; pallor; ability to speak in full sentences]
• Airway/Breathing: [Airway patency; work of breathing; lung sounds (rales / wheezes / clear); accessory muscle use]
• Circulation: [Skin perfusion; peripheral pulses; capillary refill; JVD; peripheral edema]
• Cardiac: [Rate and rhythm on monitor; murmurs if appreciated]
• Neurologic: [Mental status (AVPU or GCS); focal deficits]

Serial Vitals & Pain Scores

(Document baseline before therapy, reassess after each intervention and at protocol-driven intervals.)

• [Time]: BP [value/value], HR [value], RR [value], SpO2 [value]% [room air / O2 device and flow], Rhythm [rhythm], Pain [0–10], Mental status [AVPU or GCS]
• [Time]: BP [value/value], HR [value], RR [value], SpO2 [value]% [room air / O2 device and flow], Rhythm [rhythm], Pain [0–10], Mental status [AVPU or GCS]
• (Add additional entries as needed. If unable to obtain any value, state reason.)

ECG Findings

(Create a separate entry for each ECG obtained. Do not create placeholders for ECGs not performed.)

• Time obtained: [Date/time]; ECG type: [Standard 12-lead / Right-sided leads V3R-V4R / Posterior leads V7–V9]; Interpretation method: [Computer algorithm / Paramedic interpretation / Physician overread via transmission]

  Key findings: [ST elevation by lead groups with magnitude; reciprocal changes; rhythm; conduction abnormalities]

  Meets field STEMI criteria: [Yes / No / Uncertain] (If Yes, list specific criteria met. If activated despite not meeting standard criteria, document rationale.)

  Activation status: [Activated / Not activated / Cancelled] (If cancelled, include time, decision-maker, and reason.)

• (Repeat for additional ECGs.)

Treatments & Contraindication Documentation

• Oxygen: [Administered / Not indicated] — If given: indication [hypoxemia / respiratory distress / shock], device and flow, SpO2 before/after. If not given: "Not indicated — SpO2 [value]% on room air."

• Aspirin: [Given / Withheld] — Time [date/time]; Dose [mg]; Route [chewed / swallowed]; Prior self-administered ASA [Yes with dose and time / No]. If withheld, document contraindication [true allergy or anaphylaxis / active major bleeding / inability to safely administer] with source and rationale.

• Nitroglycerin: [Given / Withheld] — Pre-dose BP [value] and HR [value]; Dose and route [sublingual tablet or spray]; Number of doses and intervals; Pain and hemodynamic response after each dose. If withheld, specify contraindication(s) with supporting data: [hypotension or borderline BP (value) / recent PDE5 inhibitor (agent and timing) / suspected RV infarct (clinical and ECG features) / severe bradycardia or tachycardia / PDE5 status uncertain]. Document any mitigation such as medical control consultation.

• Analgesia/Antiemetics: [Agent], [dose], [route], [time] — Effect on pain score and hemodynamics; adverse effects. If withheld due to hypotension or altered mental status, document reason.

• IV access and fluids: IV site [location], gauge [size], time [date/time]. Fluids: [type], [volume], [rate]; Indication [hypotension / RV infarct concern / other]; Response [vitals and symptoms].

• Resuscitation interventions: [Defibrillation / Cardioversion / Pacing] — Time(s), energy or settings, rhythm before and after, response. (Omit section if no resuscitation required.)

STEMI System Communications

(Document in chronological order with exact times.)

• [Time]: ECG transmission to [recipient role/facility] via [method]; [successful / failed]; confirmation [time / pending]
• [Time]: STEMI alert initiated by [role]; Criteria: [specify]
• [Time]: Receiving facility notified: [facility name], [contact role]; Confirmation received [time / pending]
• [Time]: Destination decision: [Direct to PCI center / Nearest facility]; Rationale: [distance / weather / patient stability / other]
• [Time]: Activation [maintained / cancelled]; Decision-maker: [role]; Reason: [clinical improvement / non-diagnostic ECG / alternative diagnosis / other]

Transport Course & Clinical Impression

[Brief narrative: stability vs deterioration, recurrent symptoms, ECG evolution, hemodynamic events, interventions en route and patient response.]

Working clinical impression: [Suspected ACS / Field STEMI – inferior / anterior / lateral / posterior / RV involvement / STEMI equivalent] (For atypical or borderline cases, briefly note reasoning and differential considerations that influenced management.)

Handoff Summary

• Patient ID: [Name or temporary ID, age, sex]
• Chief complaint & onset: [Symptom description] — Onset [time]
• Key risk factors: [Most relevant factors]
• ECG summary: [Most diagnostic ECG time and type; territory and findings; field STEMI criteria status]
• Treatments: [ASA given or withheld with rationale; Nitro doses or withheld with rationale; O2; IV and fluids; analgesia; resuscitation]
• Most recent status: Vitals: BP [value/value], HR [value], RR [value], SpO2 [value]% [room air / O2 device and flow]; Rhythm [rhythm]; Pain [0–10]
• Active concerns: [Borderline BP / recurrent arrhythmia / RV involvement concern / ongoing symptoms / other / None]
• Transfer of care: [Recipient role and name] at [location] — Handoff time [date/time]

(Missing information handling: Use "Unknown" with source/reason, "Not assessed," "Unable to obtain (reason)," or "Refused." Do not leave critical fields blank or infer values not explicitly obtained.)