The Model Patient and Model EMS Mission: Lifeline North Texas STEMI Workshop The Model Patient and Model EMS Chris Weinzapfel FF/NREMT-P(T)

©2011, American Heart Association 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 9/17/2018 ©2011, American Heart Association

The Ideal System of Care Mission: Lifeline North Texas The Ideal System of Care Just a graphic to note the “Ideal System” ©2011, American Heart Association

The Ideal Community Mission: Lifeline North Texas 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

©2011, American Heart Association 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 hospital’s 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 In the ideal system, patients and the public would recognize the symptoms of STEMI and the importance of time to treatment, activate EMS promptly, be familiar with their community hospital’s role in the delivery of STEMI care, and understand the implications involved in inter-hospital (rapid) transfer for PCI. The ideal system promotes culturally competent education efforts, includes patient representatives on community planning coalitions, and provides coordinated and patient-centered care. ©2011, American Heart Association

©2011, American Heart Association 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 In the ideal system for EMS, standardized point-of-entry (POE) protocols (created by regional or state-based coalitions of EMS personnel, emergency physicians and nurses, and cardiologists and supported by payers and administrators) would advocate which patients are transported to the nearest hospital and which patients are transported to the nearest primary PCI/STEMI-receiving hospital based in part on the acquisition, interpretation, and transmission of a pre-hospital 12-lead ECG. EMS plays a role in activating the primary PCI staff when proper equipment, training in 12-leads ECG interpretation and relaying the 12-lead information with adequate medical control is in place to STEMI-receiving hospital. If EMS takes patient to a non-PCI or STEMI-referral hospital, a strategy of leaving the patient on the EMS stretcher with EMS present for potential STEMI transfer to STEMI-receiving hospital would be time saving. In addition, when walk-in patients present to STEMI-referral hospital in need of primary PCI, activation of EMS, as in a call to 9-1-1, to transport should occur. ©2011, American Heart Association

Mission: Lifeline® Criteria to Support Timely Reperfusion 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

We Know: Where Delays Occur Mission: Lifeline North Texas We Know: Where Delays Occur The patient Referral center transport Receiving center Unfamiliar with signs and symptoms of a heart attack Denial Slow to activate 911 EMS System Arrives by POV (Personal Owned Vehicle) Identification of STEMI patient Triage Protocols Access to 12 Lead ECG Machines Diagnostic Dilemma Transport Notification Transfer Acceptance Patient Condition Arrest/Shock Unavailability Weather Delay in arrival to Referral Center Pumps and Drips Patient Records from Referral Center Transport Distance Acceptance Delay STEMI Alert call Delay Cath Lab Team Delay Patient Condition Arrest/Shock ©2012, American Heart Association

We Know: Why Delays Occur Mission: Lifeline North Texas We Know: Why Delays Occur Non-Modifiable Modifiable with difficulty modifiable Distance to STEMI Receiving Center Geography Patient/Public Awareness Corporate Loyalty Market Share Preferred Provider Transport Agreements PCI Cardiology On-Call Scheduling Non-Invasive Cardiologists on call Low Clinical Staffing Structure Budgetary Issues (Access to Equipment) Lack of Triage Protocols No Pre-Planned Reperfusion Strategy Lack of Printed Transfer Plan 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 ©2012, American Heart Association

Relationship + Communication = Coordinated Care 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

EMS – ED Relationships Mission: Lifeline North Texas DESTINATION TRANSPORT DECISIONS TIMELY APPROPRIATE TREATMENT IMPROVED PATIENT OUTCOMES

Mission: Lifeline North Texas FMC to Reperfusion THE BEST IT CAN BE Point of Entry and Pre-Hospital Activation Protocol Adherence to ACC/AHA STEMI Guidelines Strong Multidisciplinary – Multiagency Team EMS – ED Relationship

Mission: Lifeline North Texas MISSION: LIFELINE EMS RECOGNITION

Mission: Lifeline EMS Recognition Measures 9/17/2018 ©2011, American Heart Association

EMS Data Collection Workbook 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 9/17/2018 ©2013, American Heart Association

Mission: Lifeline EMS Recognition Volume Requirements Mission: Lifeline North Texas Mission: Lifeline EMS Recognition Volume Requirements For Bronze, there are no changes regarding volume. For Silver, the biggest change is taking away the quarterly requirement. Previously, Silver was awarded if each of the reporting quarters were above 75%. With the new change, the combined (or aggregate) score for the entire year will be counted. Ex: 1 STEMI in Q1, 4 STEMIs in Q2, 3 STEMIs in Q3 and 7 STEMI in Q4. Total for the year is 15. If the 1 STEMI in Q1 had a FMC to Balloon time of 92 min, the service would fall from Silver eligibility. For an Aggregate Silver score, 12 of the 15 patients, would have to have FMC to Balloon time of 90 min or less. ( 75% would be 11.25 patients.) Silver award winners from the previous year can receive a Bronze this year if volumes are low in 2014. BRONZE: A minimum of 75% compliance for each required measure. 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. 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. Volume: at least 8 STEMI patients in the 2014 calendar year. Must have achieved a SILVER Award in 2014

2015 Mission: Lifeline EMS Recognition Timeline Mission: Lifeline North Texas 2015 Mission: Lifeline EMS Recognition Timeline ©2013, American Heart Association

2014 AHA Mission Lifeline EMS Recognition Awards 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 Silver Level Recognition Awards Garland Fire Department Grand Prairie Fire Department Plano Fire Rescue Rowlett Fire Department CONGRATULATIONS! ©2011, American Heart Association

2014 AHA Mission Lifeline EMS Recognition North Texas Awardees! Mission: Lifeline North Texas 2014 AHA Mission Lifeline EMS Recognition North Texas Awardees! ©2013, American Heart Association

Please see the Mission Lifeline EMS Recognition Resource Center! Mission: Lifeline North Texas Please see the Mission Lifeline EMS Recognition Resource Center! Available Resources: EMS Recognition Overview Fact Sheet EMS Recognition Data Worksheets 2014 Texas AHA Mission Lifeline Hospital Recognition Award Poster 2014 Texas AHA Mission Lifeline EMS Recognition Awards Poster ©2013, American Heart Association

Mission: Lifeline North Texas THANK YOU !