The care of ACS patients at deployed locations is limited by the fact that cardiac care is provided in austere locations without rapid access to higher levels of care. While medical therapies can stabilize patients for short periods of time, any complications that arise do not have the benefit of being treated urgent/emergently in a cardiac catheterization laboratory. A plan for urgent MEDEVAC/aeromedical evacuation to a PCI capable center should be initiated as soon as they are diagnosed with ACS and initiated medical therapy.
Telemedicine/Cardiology Consultant
The first cardiology consultant within the evacuation chain should be consulted immediately for patients diagnosed with a STEMI or UA/NSTEMI at deployed locations. Diagnosis and treatment of ACS should be guided by expert consultation, to include electronic transmission of ECGs (by whatever means available).
MEDEVAC
When possible, all patients diagnosed with or with high suspicion of ACS at Role 1 or 2 facilities should be moved to a Role 3 facility (preferably a facility with a cardiologist) as soon as possible.
Host Nation
At times host nations (HNs) have facilities that meet U.S. standards for medical care. If relationships with these facilities have been established and have been utilized for emergent care of U.S. personnel, then their use should be considered for emergent PCI in the following situations:
Aeromedical Evacuation
Aeromedical evacuation of all ACS patients should adhere to the following principles when possible due to the evolving nature of the disease and limited ability to fully handle the complications that come with this disease process.
In-Flight Considerations
a.Hypotension/shock primarily due to suspected cardiovascular causes.
b.Recurrent ventricular arrhythmias that are unable to be controlled with ACLS medications (e.g., beta blockers, amiodarone).