Mission: Lifeline North Texas STEMI Workshop The Model

Mission: Lifeline North Texas STEMI Workshop The Model Patient and Model EMS Chris Weinzapfel FF/NREMT-P(T) Mission: Lifeline North Texas Faculty Disclosure Information Chris Weinzapfel FF/NREMT-P(T) EMS Director Rowlett Fire Rescue The Model Patient and Model EMS FINANCIAL DISCLOSURE: NONE UNLABELED/UNAPPROVED USES DISCLOSURE: NONE 01/15/2020 2011, American Heart Association 2 Mission: Lifeline North Texas The Ideal System of Care 3

2011, American Heart Association Mission: Lifeline North Texas The Ideal Community Hands Only CPR with a goal of achieving >50% bystander CPR Early activation of 911 Apply AED before EMS arrival Designated Community Champion Multidisciplinary group to monitor, provide feedback and

improve processes and outcomes Implements and maintains public access defibrillation program Mission: Lifeline North Texas The Ideal Patient Recognizes the symptoms of STEMI Realizes the importance of: Activating emergency medical services (EMS) via 9-1-1 promptly Getting treatment quickly

Is familiar with the local hospitals role in STEMI care Understands the implications of inter-hospital transfer for PCI Is supported by the ideal system, which: Promotes culturally competent education efforts Includes patient representatives on community planning coalitions Provides coordinated and patient-centered care 2011, American Heart Association

5 Mission: Lifeline North Texas The Ideal EMS Emergency medical dispatchers provide bystanders CPR instruction Ambulances are equipped with 12-lead ECG machines and Manual defibrillators EMS providers are trained to: Use and transmit 12-lead ECGs Care for STEMI patients Provide feedback on performance and compliance with guidelines Standardized point-of-entry (POE) protocols define patient transport rules When there is STEMI, the Cath Lab is activated promptly Implements and maintains destinations protocols for triage of patients to hospitals able to care for Cardiac Resuscitation patients 2011, American Heart Association

6 Mission: Lifeline North Texas Mission: Lifeline Criteria to Support Timely Reperfusion Strong Multidisciplinary Teams Relationship Building between EMS and ED EMS Point of Entry/ Transport Destination Protocols based on data Data Collection and Sharing between Receiving Center and EMS Communication and Understanding of ACC/AHA Guidelines Early 12 Lead ECG Acquisition Early STEMI Receiving Center notification of 12 Lead ECG findings Early Activation of Cath Lab Team Consider lytic administration at Referral Centers 2011, American Heart Association 7 Mission: Lifeline North Texas We Know: Where Delays Occur THE PATIENT

Unfamiliar with signs and symptoms of a heart attack REFERRAL CENTER Denial Identification of STEMI patient Triage Protocols Access to 12 Lead Slow to activate 911 EMS System Arrives by POV (Personal Owned Vehicle)

ECG Machines Diagnostic Dilemma Transport Notification Transfer Acceptance Patient Condition Arrest/Shock TRANSPORT RECEIVING CENTER

Unavailability Acceptance Delay Weather STEMI Alert call Delay Delay in arrival to Referral Center

Cath Lab Team Delay Pumps and Drips Patient Condition Patient Records from Referral Center Arrest/Shock Transport Distance 2012, American Heart Association

8 Mission: Lifeline North Texas We Know: Why Delays Occur NON-MODIFIABLE Distance to STEMI Receiving Center MODIFIABLE WITH DIFFICULTY MODIFIABLE Patient/Public Awareness Lack of Triage Protocols

Corporate Loyalty No Pre-Planned Reperfusion Strategy Market Share Lack of Printed Transfer Plan Preferred Provider Transport Agreements Lack of Back Up Transfer Plan

Fear of Lytic Administration NTG and Heparin drips are started Needed Education (EMS and Hospital) All employees are not aware of STEMI protocols Lack of Data Collection Communication/Relationships

Geography PCI Cardiology On-Call Scheduling Non-Invasive Cardiologists on call Low Clinical Staffing Structure Budgetary Issues (Access to Equipment) 2012, American Heart Association 9 Mission: Lifeline North Texas

Relationship + Communication = Coordinated Care Feedback Right Here/ Right Now 24-48 Hours Retrospective Education EMS to Hospital Hospital to EMS Joint event Recognition Job Well Done Little Things Mean A LOT !! 2011, American Heart Association 10 Mission: Lifeline North Texas EMS ED Relationships DESTINATION TRANSPORT DECISIONS TIMELY APPROPRIATE TREATMENT

IMPROVED PATIENT OUTCOMES Mission: Lifeline North Texas FMC to Reper fusion THE BEST and PrePoint of Entry IT HospitalCAN Activation Protocol BE Adherence to ACC/AHA STEMI Guidelines Strong Multidisciplinary Multiagency Team EMS ED Relationship Mission: Lifeline North Texas MISSION: LIFELINE EMS RECOGNITION

Mission: Lifeline North Texas Mission: Lifeline EMS Recognition Measures 01/15/2020 2011, American Heart Association 14 Mission: Lifeline North Texas EMS Data Collection Workbook Template for follow up data collection on patients treated and transported to a STEMI receiving Center or a STEMI Referring Center 01/15/2020 2013, American Heart Association

15 Mission: Lifeline North Texas Mission: Lifeline EMS Recognition Volume Requirements BRONZE: A minimum of 75% compliance for each required measure. o Volume: at least 2 STEMI patients per reporting quarter with at least 4 STEMI patients in the 2014 calendar year. SILVER: Aggregated annual score achieving a minimum of 75% compliance for each required measure. o Volume: at least 8 STEMI patients in the 2014 calendar year. GOLD: 2 calendar years achieving an annual Aggregate minimum of 75% for each required measure. o Volume: at least 8 STEMI patients in the 2014 calendar year. Must have achieved a SILVER Award in 2014 16 Mission: Lifeline North Texas 2015 Mission: Lifeline EMS Recognition Timeline

2013, American Heart Association 17 Mission: Lifeline North Texas 2014 AHA Mission Lifeline EMS Recognition Awards Bronze Level Recognition Awards DFW Airport Department of Public Safety Keller Fire Rescue Southlake Fire Department U T A Silver Level Recognition Awards R Garland Fire Department G Grand Prairie Fire Department N O Plano Fire Rescue C

Rowlett Fire Department 2011, American Heart Association O I T A L ! S N 18 Mission: Lifeline North Texas 2014 AHA Mission Lifeline EMS Recognition North Texas Awardees! 2013, American Heart Association 19 Mission: Lifeline North Texas

Please see the Mission Lifeline EMS Recognition Resource Center! Available Resources: 1. EMS Recognition Overview Fact Sheet 2. EMS Recognition Data Worksheets 3. 2014 Texas AHA Mission Lifeline Hospital Recognition Award Poster 2013, American Heart Association 4. 2014 Texas AHA Mission Lifeline EMS Recognition Awards Poster 20 Mission: Lifeline North Texas THANK YOU !

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