Presenter
Chris Bjerke, BSN, MBA
National Director, Mission:
Lifeline for the American Heart
Association
Disclosures
• I have not financial disclosures or conflicts of interest.
4/13/2015
©2013, American Heart Association
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ST Elevation Myocardial Infarction (STEMI)
• Early diagnosis and rapid reperfusion therapy for STsegment myocardial infarction (STEMI) limits infarct size
and improves survival
• Current guidelines recommend reperfusion therapy
within 90 minutes of first medical contact and within 120
minutes for hospital transfers
• Door-to-balloon is <90 minutes in 95% of cases (nontransfer) in ACTION Registry®- Get With The
Guidelines™
• Door-to-balloon time for transfers occurs <90 minutes
33% of the time and <120 minutes 66% of the time in
ACTION Registry®- Get With The Guidelines™
• Delay in symptom onset to treatment increases mortality
2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction.
Circulation. 2013;127:
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Pre-hospital ECGs
•
•
Pre-hospital electrocardiograms (PH ECG) have been shown to decrease
door-to-balloon times (DTB) and first medical contact-to-device times.
Over 60% of STEMI patients receive a PH ECG, yet they fail to be
integrated into systems of care to decrease total ischemic time.
•
60% of STEMI patients call EMS for
transport.
•
Use of EMS transportation is
associated with substantial reductions
in ischemic time and treatment delays.
•
Community education efforts are
needed to improve the use of
emergency transport as part of systemwide strategies to improve STEMI
reperfusion care.
Use of Emergency Medical Service Transport Among Patients With ST-Segment–Elevation Myocardial Infarction Findings From the National
Cardiovascular Data Registry Acute Coronary Treatment Intervention Outcomes Network Registry–Get With the Guidelines
Robin Mathews, MD; Eric D. Peterson, MD, MPH; Shuang Li, MS; Matthew T. Roe, MD, MHS; (Circulation. 2011;124:154-163.)
Protocol for Paramedics to Recognize and
Activate STEMI in the Field
• PH ECG interpreted by EMS paramedics
• Activation of the catheterization
laboratory in the field
• Bypass ER and admitted directly to
catheterization laboratory for clear
STEMI & hemodynamically stable
Value of EMS Recognition
•
Quality improvement
–
–
–
–
•
Hospitals Integration
–
–
•
To Improve efficiencies for patient care
Early recognition of STEMI
Early hospital alert
Reduced total ischemic time (System onset to Device)
Streamline care
- Reduce handoffs
- Bypass hospitals without PCI capability when applicable
Improve feedback processes
Expansion of Scope of Practice
–
–
4/13/2015
Destination Protocols
EMT provisions for ECG Acquisition & Transmission currently against many state mandates
©2013, American Heart Association
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EMS Agenda for the Future
•
The EMS Agenda for the Future is a strategic plan and needs assessment to guide the
development of Emergency Medical Services (EMS) into the twenty-first century. The
Agenda examines what has been learned during the past three decades and creates a
vision for the future of EMS.
•
As EMS systems continue to look for ways of delivering emergency critical care in a more
cost effective and efficient manner, there are several initiatives that should be considered to
strengthen the EMS team. These include:
–
Expand the role of EMS in public health and prevention.
–
Involve EMS in community health monitoring.
–
Integrate EMS with other health care providers and provider networks.
–
Be cognizant of the special needs of the entire population.
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Challenges Specific to AHA EMS Recognition
•
Focus on Quality
– New Formal Process
– Previously seen as low priority
– QI processes are foreign concepts/practices to most agencies
– Culture change
•
Data Collection
– Self Reporting Expectation
•
System Fragmentation
– Competition of Services
– Continuum of Care
– Patient Documentation
– Protocol Diversity & Equipment Variability
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Why EMS Recognition?
To expedite care for STEMI patients where
“Time is Muscle”
Guideline based
4/13/2015
©2013, American Heart Association
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Achievement Measures
• Percentage of patients with non-traumatic chest pain, ≥ 35 years, treated and
transported by EMS who get a pre-hospital 12-lead electrocardiogram
• Percentage of STEMI patients transported directly to a STEMI receiving center,
with first (pre-hospital) medical contact to device time  90 minutes
• Percentage of lytic eligible STEMI patients treated and transported to a referring
hospital for fibrinolytic therapy with a door to needle time  30 minutes
4/13/2015
©2013, American Heart Association
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How Can EMS Affect Door to Needle Time?
• Early Activation for positive STEMI on 12 Lead ECG
• Reperfusion Checklist completion on patients who will be
transported to a Referring Hospital (Non PCI capable)
4/13/2015
©2013, American Heart Association
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4/13/2015
©2013, American Heart Association
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2014 Data Submission Timeline
DATA SUBMISSION
DATA REVIEW
RECOGNITION AWARDS
•
January 1, 2014 –
February 28, 2014
•
March 1, 2014 through
May, 2014
•
Award notification sent
Mid April through June
•
Submit summary of
quarterly data covering
Q1-Q4 of 2013
•
Data summary
submissions will be
reviewed by National
Center Mission: Lifeline
Personnel
•
Recognized agencies
will receive notification
of status, certificate and
press / promo packages
4/13/2015
©2013, American Heart Association
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Recognition Awards
RECOGNITION BENEFITS
•
Certificate
•
Press Kit
•
•
Media press release templates
•
Icons for websites or other use
•
Pre-made advertisement template
Additional materials will be made available for purchase:
•
Examples: Pins, Patches, Decals for Ambulances and
Trucks (Gold only)
4/13/2015
©2013, American Heart Association
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Data Collection and Submission
DATA SUBMISSION PROCESS AND TIMELINES
•
One time annual application via free online EMS Recognition Application tool
•
Continuous data collection occurs independently of the Mission: Lifeline application tool
•
Worksheets for inclusion / exclusion criteria will be available
•
Online EMS recognition application tool available January 1 – February 28th for quarterly
summary data submission.
•
Award notifications will be distributed beginning in Mid-April through June, 2014
January 1, 2013 –
December 31, 2013
Data reporting period
4/13/2015
January 1, 2014 –
February, 28 2014
March 1, 2014 – Mid
April, 2014
Mid April, 2014 –
June 2014
Data submission
available for award
application
Mission: Lifeline
Review of award
applications
Award notification
to Recognized EMS
agencies
©2013, American Heart Association
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Stay Connected
FACEBOOK
•
www.facebook.com/AHAMissionlifeline
MISSION: LIFELINE NETWORK – EMS CENTRAL
•
http://MLnetwork.heart.org/EMS
MISSION: LIFELINE HOMEPAGE AND RECOGNITION SITE
•
4/13/2015
http://www.heart.org/Missionlifeline
©2013, American Heart Association
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From the American Heart Association Mission: Lifeline® Team:
Thank you
Contact us: Missionlifeline@heart.org
©2013, American Heart Association
http://www.heart.org/missionlifeline
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