Implementing M:L
in
South Dakota
Darrin Smith, Senior Director of Advocacy
and State Health Alliances
What is Mission: Lifeline?
Mission: Lifeline is the American Heart Association's
national initiative to advance the systems of care for
patients with ST-segment elevation myocardial
infarction (STEMI). The overarching goal of the
initiative is to reduce mortality and morbidity for
STEMI patients and to improve their overall quality of
care.
The Need
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1.4 million people will suffer a heart attack
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Approximately 400,000 of those will experience STEMI
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30% of STEMI patients do not receive any form of treatment to restore
blood flow, whether through clot-busting drugs or percutaneous
coronary intervention (PCI), the latter being the preferred therapy which
uses mechanical means such as stents, balloon angioplasty or surgery.
Time is muscle. The outcome of STEMI events depends greatly on the
care patients receive and the timeframe in which they receive it.
Through Mission: Lifeline, the American Heart Association wants to
ensure that healthcare systems are able to deliver prompt and
appropriate care to STEMI patients during the critical "golden hour"
following their heart attack.
The Need, cont…
According to the Centers for Disease Control, South Dakota is in the Class
5 category for STEMI death rates, making it one of the states with the
highest STEMI death rates in the nation. To make timely and
appropriate care for STEMI patients the standard across this country,
Mission: Lifeline has identified a number of complex challenges that
must be overcome:
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Public/Patient Education
Enhancing Emergency Medical Services
Enhancing Hospital Services
Quality Data Tracking
Protocols
The Goal
To meet the overarching goal, Mission: Lifeline will bring together the
necessary partnerships between:
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Patients and care givers
EMS
Physicians, nurses and other providers
PCI-Referring hospitals (Non-PCI capable)
PCI-Receiving hospitals (PCI capable)
Department of Health
Office of EMS
Office of Rural Health
Quality Improvement Organizations
State and local policymakers
Third-party payers
Health Systems
South Dakota Today
• Hospital/EMS Map
• M:L Hospital Survey results
• ML EMS Survey results (next slide)
SD M:L EMS Survey
• ALS complete = 8 (6%)
• ALS complete w/o transmsn = 19 (14.3%)
• ALS not complete = 22 (16.5%)
• BLS w/12-Lead = 3 (2.3%)
• BLS w/o 12-Lead = 81 (60.9%)
SD M:L Project
• $9M+ three year project funded by an $8.4M grant from
the Helmsley Charitable Trust
• This is the 2nd largest grant the American Heart
Association has ever received on any level – national,
regional, or local
• This project will impact literally every licensed
ambulance service and licensed hospital in the state of
South Dakota
SD M:L Project, cont…..
• This will revolutionize heart attack patient care in SD –
we currently have one of the highest 10 STEMI death
rates according to the CDC
• This project is designed to produce a “model system”
that can then be implemented across the Midwest and
nation, making SD a leader in heart attack systems of
care
What it means to SD?
Successful implementation of Mission: Lifeline will mean that South
Dakota will have:
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One of the most advanced, if not the most advanced, coordinated heart
attack systems of care in the United States
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The highest percentage of ambulance services in the nation equipped
with 12-lead ECGs
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The highest percentage of 12-lead ECG-trained emergency medical
technicians in the nation
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The highest percentage of ambulance services transmitting 12- lead
ECG results in the nation
What it means to SD, cont….
• The highest percentage of hospitals with 12-lead ECGreceiving station software in the nation
• The highest percentage of hospitals in the nation
utilizing the ACTION Registry-Get WithThe Guidelines
(GWTG) data collection tool
• One of the states with the highest percentage of
hospitals in the nation with written STEMI patient
treatment and transport protocols.
Implementation Strategies
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Aggressive public education and awareness campaigns will be
executed to raise awareness and knowledge levels with respect to
signs and symptoms of heart attack and the need to activate the 9-1-1
system immediately
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Aggressive medical provider education and awareness efforts will be
executed to recruit medical professionals as partners in educating their
patients about heart attack warning signs and symptoms, and the need
to call 9-1-1 immediately
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Assistance to every ambulance service in South Dakota in acquiring
the most up-to-date 12-lead ECG equipment
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Implementation of a robust, comprehensive 12-lead ECG training
program and ensuring that every ambulance service in South Dakota
has access to quality 12-lead ECG training;
Implementation Strategies….
• Assurance that 12-lead ECGs in South Dakota
ambulance services are transmitting results to medical
facilities that are equipped to receive those
transmissions
• Through work with our stakeholders, assurance that
emergency department staff in every South Dakota
hospital are trained to properly administer fibrinolytic
therapy
Implementation Strategies….
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Assurance that appropriate protocols are in place for EMS and
hospital personnel to provide for the most appropriate care for
each STEMI patient
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Establishment of the first of its kind “real time” evaluation tool
with the American Heart Association/American College of
Cardiology jointly developed quality improvement program,
Action Registry-Get With The Guidelines, which will track
patient data and information throughout the entire continuum
of STEMI system care and allow us to evaluate and monitor on
a regular basis the improvements being made and the need for
improvement in other areas of each system
Project Budget Highlights
• EMS: $4M
– $3.5M for 12-Leads
– $225K for transmission
– $300K for training & materials
Project Budget Highlights….
• Hospitals: $3M
– $775K for 12-Lead receiving station software
– $2M for ACTION Registry GWTG
– $75K for Lytics Training
Project Budget Highlights….
• Other highlights:
– Full Time SD M:L Director
– Annual Conferences in SF & RC
– Public/Provider Education
– Evaluation
– Positioning SD as a leader
Miscellaneous
• Register your system
• www.americanheart.org/missionlife
linesd
LUNCH
The Plan & The Budget
• $9M+ over 3 years
“Human Resources”
• ML Director
• Travel Budget
• Lobbyist/Regulatory Consultant
EMS
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12-Lead ECG’s
12-Lead Modem’s
12-Lead subscription
12-Lead Transmission
Hands On Training
Training Materials
12-Lead ECG’s
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181 12-Lead ECG’s placed
All 127 licensed ground services
135 placed @ 100%
46 placed @ 75% (16 services)
• Grant-like application process
12-Lead ECG’s
• Modems placed in all 12-Lead’s
(where applicable)
• 3 year subscription provided (when
necessary)
12-Lead ECG’s
• All units will transmit
• Transmission data plan provided
EMS Training & Materials
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Hands on Training
Learn: Rapid STEMI ID online tool
STEMI Provider Manual
Every SD Ambulance Service
Every EMT
Hospitals
• 12-Lead ECG Receiving capability
• Action Registry – Get with the
Guidelines (ARG)
• Fibrinolytic Therapy Training
12-Lead Receiving Capability
• 50 Hospitals
• Receiving capabilities/formats
ACTION – Registry GWTG
• Data Collection Tool developed by
AHA/ACC
• Focused on entire continuum of
care
• QI Staff & Webinars
• 50 Hospitals – 3 Funding Tiers
ACTION – Registry GWTG
• PCI Receiving Centers:
– Year 1: 6 receiving centers, 90% of $75,000
FTE
– Year 2: 6 receiving centers, 70% of $75,000
FTE, 1 new center at 90% of $75,000 FTE
– Year 3: 6 receiving centers at 50% of
$75,000, 1 center at 70%, 2 new centers at
90% of $75,000 FTE
ACTION – Registry GWTG
• Referring FTE Reimbursement TIER 1:
– Year 1: 5 largest PCI-referring facilities - 70%
of $50,000 FTE
– Year 2: 4 PCI-referring facilities - 50% of
$50,000 FTE
– Year 3: 2 PCI-referring facilities - 30% of
$50,000 FTE
ACTION – Registry GWTG
• Referring FTE Reimbursement TIER 2:
• Remaining PCI-referring facilities – to be
divided accordingly, total FTE reimbursement
incentive of $195,000
Fibrinolytic Therapy Training
• 50 Hospitals
• $75K budgeted over 3 years
• Hands-On or Online/CD based?
Public Awareness/Education
• $85K annually for 3 years
• Campaign TBD
Evaluation
• Public Awareness – Years 1 & 3
• Project Evaluation – 1 manuscript
in Year 1; 2 manuscripts in Years 2
&3
M:L Model Sharing
Sharing the SD system model:
• 4 Trips in Year 2
• 8 Trips in Year 3
QUESTIONS???
Annual Conferences
• 2 Annually
• 1 East River – Sioux Falls
• 1 West River – Rapid City
Annual Conferences
• 150 Attendees East River
• 100 Attendees West River
• 1 Paid Speaker per event
Annual Conferences
• Similar Topics/Schedules
• Dates (November 3rd or 4th)
• Format/Topics???
Policy Issues
• EMS Protocols
• Hospital Designation
Other Items/Open Discussion
Next Task Force Meeting
ADJOURN!!!