Rural Nebraska 1 ©2013, American Heart Association Julie Smith, RN BSN MHA Director Mission: Lifeline Nebraska

2014 NeRHA Conference Mission: Lifeline Nebraska STEMI INITIATIVE WELCOME 10/2/2015 ©2013, American Heart Association 2

1. Mission: Lifeline 2. STEMI System of care in Nebraska 3.Grant funding opportunities for local EMS and Critical Access Hospitals. 4.Education OBJECTIVES 10/2/2015 3

Julie Smith, RN BSN MHA Director Mission: Lifeline Nebraska American Heart Association, Midwest Affiliate Mobile: (308) Gary W. Myers, MS Director Mission: Lifeline South Dakota EMS Consultant for Midwest Affiliate American Heart Association, Midwest Affiliate Mobile: (605) Kay Brown CSSBB Director of Quality & Systems Improvement KC, Kansas and Nebraska American Heart Association, Midwest Affiliate Mobile: (913) AHA NE MISSION: LIFELINE Support 10/2/2015 ©2013, American Heart Association 4

Brian Krannawitter Government Relations Director American Heart Association, Midwest Affiliate Office: (952) Kristin Waters Communications Director American Heart Association, Midwest Affiliate Office: (402) Ngia Mua Project Specialist American Heart Association, Midwest Affiliate Office: AHA NE MISSION: LIFELINE Support 10/2/2015 ©2013, American Heart Association 5

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) and Out of Hospital Cardiac Arrest. The overarching goal of the initiative is to reduce mortality and morbidity for STEMI and OOHCA patients to and improve their overall quality of care What is Mission: Lifeline? 10/2/2015 ©2013, American Heart Association 6

Improving the System of Care for STEMI Patients Mission: Lifeline will: –Promote ideal STEMI systems of care –Help STEMI patients get the life-saving care they need in time –Bring together healthcare resources into an efficient, synergistic system –Improve overall quality of care The initiative is unique in that it: –Addresses the continuum of care for STEMI patients –Preserves a role for the local STEMI-referring hospital –Understands the issues specific to rural communities –Promotes different solutions/protocols for rural vs. urban/suburban areas –Recognizes there is no “one-size-fits-all” solution –Knows the issues of implementing national recommendations on a community level 7 What is Mission: Lifeline?

How is STEMI Defined? ST elevation at the J point in at least 2 contiguous leads of ≥ 2 mm (0.2 mV) in men or ≥ 1.5 mm (0.15 mV) in women in leads V2–V3, and/or of ≥ 1 mm (0.1 mV) in other contiguous chest leads or the limb leads. New or presumably new LBBB at presentation occurs infrequently, may interfere with ST-elevation analysis, and should not be considered diagnostic of acute myocardial infarction (MI) in isolation. If doubt persists, immediate referral for invasive angiography may be necessary. ECG demonstrates evidence of ST depression suspect of a Posterior MI 8

9 What is a Mission: Lifeline STEMI System? At Least One EMS Agency At Least One referring Center At Least one Receiving Center …working together to decrease time to reperfusion and to reduce death and disability by improving patient outcomes.

Improving the System of Care for STEMI Patients Mission: Lifeline – A System of Care 10

Improving the System of Care for STEMI Patients The Patient and Family: Recognizing the signs and symptoms of a cardiac emergency Participate in community based cardiac education Need to use 911 and EMS PSA Announcements Community EMS: Timely response, assessment, care and deployment of 12-lead ECG technology during a cardiac emergency Initiate pre-hospital care and prepare for transport to a receiving facility Acquisition and transmit of 12 lead ECG STEMI Referring Hospital: Receive 12 lead ECG Provider notification and interpretation Local STEMI Treatment Team activation Implement early STEMI treatment Forwarding prehospital 12-lead ECG Timely arrangements for transfer to interventional care Feedback STEMI Receiving Hospital (PCI) Support referring facilities Receive 12 lead ECG from referring facility or EMS Provide consultation Interventional care Capturing STEMI data and reporting Feedback A System of Care – The Roles 11

10/2/2015©2013, American Heart Association 12

Mission: Lifeline Nebraska The Grant GRANT 10/2/2015 ©2013, American Heart Association 13

Mission: Lifeline Nebraska Grant million dollar initiative to enhance systems of care, save lives, and improve outcomes for heart attack patients in rural Nebraska, called Mission: Lifeline. The lead funder for this investment in Nebraska is The Leona M. and Harry B. Helmsley Charitable Trust, one of the nation’s largest foundations, providing a grant of $4.1 million to the American Heart Association for the initiative. Other current funders include the Fund for Omaha through the Omaha Community Foundation, the Ron and Carol Cope Charitable Fund, Aaron and Rachel Wagner, Mid – Nebraska Community Foundation, Valmont Foundation, Pinnacle Bank – Madison Branch and Hamilton County Foundation.

Mission: Lifeline NE Project Roll-out Three year grant: February 2014 – February Statewide Mission: Lifeline Task Force a. Leadership b. Advisory Committees c. Interventional Cardiology Steering Committee 3. Equipment allocation 4. Protocol Development – Guidelines 5. Provider Education 6. Public Education Campaign 7. Data Collection 8. State STEMI Conference

Mission: Lifeline Nebraska - Timeline 16 MAY 2014 – JULY 2014AUG 2014 – DEC 2014 Mission: Lifeline Director Hired – JULIE SMITH Contact with all PCI capable facilities - COMPLETED Met with DHHS / EMS Program director and specialists - COMPLETED Task Force Group CREATED Task Force leadership selected - COMPLETED Kick Off – Task Force Meeting – HELD Applications for EMS Services to be finalized and sent to services - COMPLETED EMS Advisory Committee Meeting and will review and determine eligibility – IN PROGRESS Award of first round funding for equipment MOU and contract work for PCI capable hospitals begins. Funding to start fall of 2014 Advisory Committees will begin meeting.- IN PROGRESS Interventional Cardiology Steering Committee –IN PROGRESS I Reporting 1 st quarter data for Action Registry participating hospitals. Second round funding for EMS equipment will begin Development of Guidelines – NE approved System of Care - IN PROGRESS Advisory Committees will continue to meet as needed to review data Mission: Lifeline Statewide Conference JAN MAY AND BEYOND Data collection continues Continued EMS equipment funding Hospital and EMS recognition Quality Improvement efforts statewide based on registry data 2 nd Annual Mission: Lifeline Statewide Conference 10/2/2015 ©2013, American Heart Association

PCI – 24/7 1. Faith Regional Health Services – Norfolk 2. Saint Francis Medical Center - Grand Island 3.Good Samaritan Hospital – Kearney 4.Kearney Regional Medical Center – Kearney 5. Great Plains Regional Medical Center – North Platte 6. Mary Lanning Healthcare – Hastings PCI – Non 24/7 1. Fremont Area Medical Center – Fremont 2. Regional West Medical Center - Scottsbluff Rural NE PCI Capable Hospitals 10/2/2015 ©2013, American Heart Association 17

Nebraska PCI Hospitals 10/2/2015 ©2013, American Heart Association 18

NE CAHS 10/2/2015 ©2013, American Heart Association 19

Improving the System of Care for STEMI Patients PCI Referring Hospitals NE Referring Hospitals 65 CAH hospitals  12-L receiving equipment funding available starting 2015  Referring Hospital Education Plan Development will begin Fall of 2014 with delivery to begin in Spring of /2/

Mission: Lifeline Nebraska Frequently Asked Questions for Hospitals Who is eligible to participate in the NE Mission: Lifeline statewide Taskforce? 2. Will all Hospitals be eligible to receive grant funding? 3. Are all hospitals required to participate in pre-hospital 12-lead transmission and receiving systems? 4. Will hospitals be required to purchase a particular brand of 12-lead ECG receiving equipment? 5. Will hospitals be eligible for reimbursement for equipment or software already purchased? 6. Will there be education for referring hospitals? 7. Will hospitals be required to participate in any data collection tool? 8. What is the timeline for the grant process? Ineligible Counties Cass CountyDouglas County Sarpy County Saunders County Lancaster CountySeward County Washington County

Mission: Lifeline Nebraska Frequently Asked Questions for EMS Agencies Will all EMS agencies be eligible to receive grant funding? 2. Will EMS agencies be required to purchase a particular brand of equipment? 3. Will EMS agencies be eligible for reimbursement for equipment already purchased? 4. Will EMS agencies only be able to apply for 12-lead monitors? 5. How much funding (amount) can EMS agencies apply for? 6. What is the timeline for the grant process? Ineligible Counties Cass CountyDouglas County Sarpy County Saunders County Lancaster CountySeward County Washington County

Mission: Lifeline Nebraska Task Force Taskforce & Committees 10/2/2015 ©2013, American Heart Association 23

Improving the System of Care for STEMI Patients M:L NE Meetings and Conferences Biannual NE M:L Taskforce in person meetings Monthly Teleconferences Subcommittee meetings Annual NE STEMI Summit Conference: Highlight NE successes and Lessons learned Hear from clinical experts about new science Network with peers to advance collaboration STEMI Survivor Celebration Recognize System excellence and award achievements 24

Nebraska Mission: Lifeline Taskforce Composition: All interested volunteers: Nurses/Nursing leaders, EMS Providers, Leadership & Medical Directors, Rural and Urban health care providers from Emergency medicine and Cardiology. State Health Department partners. Other medical professionals and leadership interested in improving emergency cardiovascular care in Nebraska. Nebraska Mission: Lifeline Chairs Composition: ED physician, 2 Cardiologists, Maximum 3 members Interventional Cardiology Steering Committee Composition: Cardiologist representation from each PCI Hospital Nebraska Mission: Lifeline Quality Committee Composition: Quarterly teleconference with Hospital Participants involved in Cardiovascular Care Quality improvement and/or the ACTION-GWTG Registry tool members Mission: Lifeline Nebraska Committee Structure 25

Nebraska Mission: Lifeline STEMI Hospital Advisory Committee Composition: at least 1 nursing and 1 physician representative from each included PCI Hospital, at least 1 representative from each regional non-PCI Hospital, and at least 2 EMS representatives (40 member maximum) Nebraska Mission: Lifeline EMS Advisory Committee Composition: –DHHS EMS regional specialists –EMS agency representatives from throughout the state –EMS agency medical directors –Other EMS representatives (max 18 members) Nebraska Mission: Lifeline STEMI Conference Planning Committee Mission: Lifeline Nebraska Committee Structure 26

Leadership Mission: Lifeline Nebraska Task Force Leadership 10/2/

Improving the System of Care for STEMI Patients 28 Dr. Matt Johnson Matthew Johnson, MD, is an Alma, NE native. Dr. Johnson is an interventional cardiologist withe Bryan Heart Cardiology group at Bryan Health. He providers outreach clinical services to several communities across NE. We are fortunate to have Matt as one of the task force leads. His knowledge of rural Nebraska will be a great resource. Dr. Doug Kosmicki Douglas. Kosmicki M.D. is a St. Paul, NE native. Dr. Kosmicki is an interventional cardiologist form the CHI Nebraska Heart Hospital and provides service to both Grand Island and Hasting PCI cath labs. He also serves rural communities providing outreach clinics. Doug will help provide insight from the central / rural areas of the state. Dr. David Cornutt Is the Medical Director for Emergency Services at Regional West Medical Center in Scottsbluff Nebraska. He and his wife live on a ranch 80 miles from Scottsbluff. He worked in an urban Emergency department for over 25 years and has in-depth knowledge of STEMI systems of care and is currently the Medical Director for the majority of EMS Services in the Panhandle. David’s rural and ED expertise are an essential part of representation needed. Chairs

Interventional Cardiology Steering Committee - Dr. Steve Martin Steve Martin, MD is a Nebraska Native. Dr. Martin is an interventional Cardiologist and the medical director for the Cardiovascular Service line for CHI/NHH in Lincoln. He is able to represent the overall CHI system concerning Cardiology here in Nebraska. As the lead for the Interventional Cardiology Steering Committee he will work with statewide interventionists across the state on the statewide guidelines. LEAD – Cardiology 29

INTERVENTIONAL CARDIOLOGIST STEERING COMMITTEE Dr. Arshad Ali Interventional Cardiologist Great Plains Health Center – North Platte Dr. John Cimino Interventional Cardiologist Bellevue Medical Center – Bellevue Dr. Azariah Kirubakaran Interventional Cardiologist Faith Regional Health Services – Norfolk Dr. Rick Markiewicz Interventional Cardiologist Kearney Regional Medical Center - Kearney Dr. Dan McGowan Interventional Cardiologist Central Nebraska Cardiology - Kearney Dr. Charles Olson Interventional Cardiologist Methodist Hospital – Omaha Dr. Drew Purdy Interventional Cardiologist Rapid City Regional Hospital Rapid City South Dakota Dr. Steve Diamantis Interventional Cardiologist Fremont Area Medical Center - Fremont 30

Hospital Advisory Committee - Dr. Ed Mlinek Dr. Ed Mlinek, is the Medical Director for Bryan Medical Centers Emergency Services. In addition, through Bryan Health, he has participated in outreach efforts in rural areas and is familiar with the differing care models in these areas. He has also hosted EMTALA conferences for the Heartland Health Alliance and has been a CIMRO reviewer which has furthered is understanding of the care provided in the more rural facilities. The Hospital Advisory Committee has good representation of PCI Capable facilities and CAH across the state. LEAD – Hospital Advisory 31

Mission: Lifeline Nebraska Task Force Group Decision Making 10/2/2015 ©2013, American Heart Association 32

Improving the System of Care for STEMI Patients Consensus Based Decision Making 33 Consensus Decision-Making– Participants make decisions by agreement rather than by majority vote. Inclusiveness– To the extent possible, all necessary interests are represented or, at a minimum, approve of the decision. Accountability– Participants usually represent stakeholder groups or interests. They are accountable both to their constituents and to the process. Facilitation– An impartial facilitator accountable to all participants manages the process, ensures the ground rules are followed, and helps to maintain a productive climate for communication and problem solving.

Improving the System of Care for STEMI Patients Flexibility– Participants design a process and address the issues in a manner they determine most suitable to the situation. Shared Control/Ground Rules– Participants share with the facilitator responsibility for setting and maintaining the ground rules for a process and for creating outcomes. Commitment to Implementation – All stakeholders commit to carrying out their agreement. 34 Consensus Based Decision Making

Improving the System of Care for STEMI Patients Elements of a Consensus-Based Decision All parties agree with the proposed decision and are willing to carry it out No one will block or obstruct the decision or its implementation Everyone will support the decision and implement it. Levels of Consensus I can say an unqualified “yes!” I can accept the decision. I can live with the decision. I do not fully agree with the decision, however, I will not block it and will support it. 35 Consensus Based Decision Making

Improving the System of Care for STEMI Patients Mission: Lifeline South Dakota Statewide STEMI Guideline Introduction letter signed by members of Interventional Cardiology Steering Committee representing all 7 PCI centers in the state sends a very powerful message on the need for standardized statewide guidelines.

Improving the System of Care for STEMI Patients Data, Public Awareness & Guidelines Mission: Lifeline Nebraska Task Force 10/2/

Improving the System of Care for STEMI Patients Data How Does the Nebraska Mission: Lifeline Project Support Data Colletion? The PCI Capable Hospitals in the included rural areas will receive funding support to participate in ACTION Registry-GWTG for three years 24/7 PCI capable hospitals will also receive FTE support for data abstraction ***Hospitals must agree to enter patients into ACTION Registry to receive any of these dollars All Hospitals will also be eligible for funding support for 12-L receiving software Non-funded, Metro PCIs are strongly encouraged to participate in ACTION Registry to be part of the state system data.

10/2/ AHA Mission: Lifeline 39 M:L Reports AHAACCDCRI Quality Improvement Specialists Mission: Lifeline Implementation Provide M:L Reports using AR-G data Keeper of AR-G Data Operational Support for data upload Executes Data Release Consent Forms Analyze the AR-G data using logic specific to ACTION reports Posts AR-G and M:L Reports Analyze the AR-G data using logic specific to M:L Mission: Lifeline® and ACTION Registry ® - Get With The Guidelines™ Relationship

Mission: Lifeline Reports are generated through the NCDR Registry called ACTION Registry-GWTG. This registry collects the data for the entire STEMI system and is the method for reporting outcomes, successes and understanding gaps.

Improving the System of Care for STEMI Patients Quarterly, hospitals will receive a Mission: Lifeline report in the Action Registry Dashboard 10/2/

South Dakota Data Examples 10/2/2015 ©2013, American Heart Association 42 Median time FMC to Primary PCI Overall % within 90 min ML STEMI participating hospitals State Aggregate SD ML STEMI participating hospitals National Aggregate 2013 Q155.0%59.0% 2013 Q256.0%59.0% 2013 Q361.0%59.0% 2013 Q465.0%60.0%

South Dakota Data Examples 10/2/2015 ©2013, American Heart Association 43 REC CTR Mission Lifeline Composite Score ML STEMI participating hospitals State Aggregate SD ML STEMI participating hospitals National Aggregate 2013 Q196.9%95.1% 2013 Q297.9%95.3% 2013 Q398.3%96.1% 2013 Q498.5%96.3%

South Dakota Data Examples 10/2/2015 ©2013, American Heart Association 44 SYSTEM Direct Pres % of patients Treated for reperfusion SYSTEM Transfer In % of patients Treated for reperfusion ML STEMI participating hospitals State Aggregate SD ML STEMI participating hospitals National Aggregate ML STEMI participating hospitals State Aggregate SD ML STEMI participating hospitals National Aggregate 2013 Q195.0%90.0%92.0%91.0% 2013 Q298.0%90.0%92.0%91.0% 2013 Q396.0%90.0%94.0%91.0% 2013 Q496.0%90.0%94.0%91.0%

South Dakota Data Examples 10/2/2015 ©2013, American Heart Association 45 RC Median time FMC to Primary PCI (min) Overall ML STEMI participating hospitals State Aggregate SD ML STEMI participating hospitals National Aggregate 2013 Q186 min85 min 2013 Q285 min 2013 Q380.5 min85 min 2013 Q477 min84 min

STEMI referring Center Achievement Measures: 1. Percentage of STEMI patients with a door-to-first ECG time <10 minutes 2. Percentage of reperfusion – eligible patients receiving any reperfusion (PCI or fibrinolysis) therapy 3. Percentage of reperfusion – eligible patients with door-to-needle time within 30 minutes 4. Percentage of reperfusion – eligible patients transferred to PCI center with door-in- to door-out time within 45 minutes * Facility goal to make STEMI referring Center ED FMC – to device (balloon) within 120 minutes (including transport time) 5. Percentage of STEMI patients receiving aspirin within 24 hours Mission: Lifeline Reports will also capture referring hospital metrics for system improvement 10/2/2015 ©2010, American Heart Association 46

Hospital and System Improvement Strategies Know your numbers, data sources and benchmarks Understand the performance measures and understand who is key to success (FMC is a collaborative measure!) Develop plan for Q1 to achieve award Q2 – small tests of change Look at your “misses”, Evaluate process change based on trends Provide messaging to champions for hospital key partners and use your data! Communicate ©2010, American Heart Association 47

Mission: Lifeline Statewide STEMI Guideline All communities should create and maintain a regional system of STEMI care that includes assessment and continuous quality improvement of EMS and hospital-based activities. Performance can be facilitated by participating in programs such as Mission: Lifeline and the D2B Alliance. I IIaIIbIII Performance of a 12-lead ECG by EMS personnel at the site of FMC is recommended in patients with symptoms consistent with STEMI. I IIaIIbIII Guidelines Constructed following the 2013 ACC/AHA Guidelines

Mission: Lifeline Statewide STEMI Guideline Reperfusion therapy should be administered to all eligible patients with STEMI with symptom onset within the prior 12 hours. Primary PCI is the recommended method of reperfusion when it can be performed in a timely fashion by experienced operators. I IIaIIbIII EMS transport directly to a PCI-capable hospital for primary PCI is the recommended triage strategy for patients with STEMI with an ideal FMC-to-device time system goal of 90 minutes or less.* I IIaIIbIII I IIaIIbIII *The proposed time windows are system goals. For any individual patient, every effort should be made to provide reperfusion therapy as rapidly as possible. Guidelines Constructed following the 2013 ACC/AHA Guidelines

Mission: Lifeline Statewide STEMI Guideline Immediate transfer to a PCI-capable hospital for primary PCI is the recommended triage strategy for patients with STEMI who initially arrive at or are transported to a non–PCI-capable hospital, with an FMC-to-device time system goal of 120 minutes or less.* In the absence of contraindications, fibrinolytic therapy should be administered to patients with STEMI at non–PCI-capable hospitals when the anticipated FMC-to-device time at a PCI-capable hospital exceeds 120 minutes because of unavoidable delays. I IIaIIbIII *The proposed time windows are system goals. For any individual patient, every effort should be made to provide reperfusion therapy as rapidly as possible. I IIaIIbIII Guidelines Constructed following the 2013 ACC/AHA Guidelines

Mission: Lifeline Statewide STEMI Guideline When fibrinolytic therapy is indicated or chosen as the primary reperfusion strategy, it should be administered within 30 minutes of hospital arrival.* Reperfusion therapy is reasonable for patients with STEMI and symptom onset within the prior 12 to 24 hours who have clinical and/or ECG evidence of ongoing ischemia. Primary PCI is the preferred strategy in this population. *The proposed time windows are system goals. For any individual patient, every effort should be made to provide reperfusion therapy as rapidly as possible. I IIaIIbIII I IIaIIbIII Guidelines Constructed following the 2013 ACC/AHA Guidelines

Improving the System of Care for STEMI Patients Mission: Lifeline South Dakota Statewide STEMI Guideline Page 1 – Initial Treatment Guidelines Definition of STEMI Patient Blue section: Arrive by EMS Starts the flowchart process Follow the “yes” & “no” Proceed to Page 2 or Page 3 Key items and goal in RED South Dakota

Improving the System of Care for STEMI Patients Mission: Lifeline South Dakota Statewide STEMI Guideline Page 2 – Primary PCI Patients FMC – PCI less than 120 min. Key items and goal in RED South Dakota

Improving the System of Care for STEMI Patients Mission: Lifeline South Dakota Statewide STEMI Guideline Page 3 – Fibrinolysis Patients Greater than 120 min. to PCI Door to Needle less than 30 min. Contraindication to fibrinolysis Key items and goal in RED South Dakota

Improving the System of Care for STEMI Patients 55 Mission: Lifeline Nebraska STEMI EMS Transport Guideline Draft

Improving the System of Care for STEMI Patients 56 Mission: Lifeline Nebraska STEMI EMS Transport Guideline Draft

Improving the System of Care for STEMI Patients 57 Mission: Lifeline Nebraska STEMI EMS Transport Guideline Draft

Improving the System of Care for STEMI Patients 58 Mission: Lifeline Nebraska STEMI EMS Transport Guideline

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DIDO Goal 45 minutes or less! Observed in-hospital mortality was significantly higher among patients with DIDO times >30 minutes than among those with DIDO times <30 minutes

STEMI Statistics Acute Coronary Syndrome (ACS) will strike 935,000 people a year in the United States, an estimated 250,000 of those will be STEMIs In 2011, 3,267 Nebraska Residents died from heart disease, according to the Nebraska Department of Health and Human Services. Heart disease is the #2 leading cause of death in Nebraska. Heart Disease and Stroke Statistic 2011 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2011;123:e18-e

Opportunities for Improvement  Are patients not aware of S&S and calling 911, thus causing a delay in treatment/out of hospital death prior to treatment? This supports the need for enhanced public awareness/education.  Access to care? Do we currently have systems in place in which patients are not able to get to the appropriate facility in a timely fashion, thus supporting the need to improve systems of care so that patients are transported to a facility with a plan in place to treat based on guidelines. 10/2/

10/2/ Public Awareness South Dakota

10/2/ Public Awareness North Dakota

10/2/ Public Awareness Minnesota

Improving the System of Care for STEMI Patients PCI Referring Hospitals  What does pre-hospital STEMI activation look like at your facility? Do you routinely call for the next leg of transfer pre-arrival? What are the greatest barriers in obtaining a door in- door-out of 45 min or less? What are the greatest barriers to obtaining a door to lytic administration time of < 30 minutes What are the greatest barriers to obtaining a door to ECG time of < 10 minutes? How do we break down political barriers and develop a unified voice for NE? 66

Improving the System of Care for STEMI Patients PCI Receiving Hospitals What mechanism is your facility currently utilizing for STEMI Data Collection, Quality Improvement, Outreach and Feedback? What is the level of support for ACTION GWTG – ARG Participation at your facility? What are the greatest barriers within your network to achieving a: – 90 FMC to Primary PCI reperfusion in your area? (non-transfers) –120 FMC to Primary PCI reperfusion in your area? (transfers) 67

Improving the System of Care for STEMI Patients Going Forward  Bi-Annual Face to Face Taskforce Meeting  Annual NE STEMI Conference  Local, Regional, and State STEMI system of care development, optimizing the destination plans and protocols and feedback recommendation development.  Referring Hospital Education Curriculum Development and Delivery – Learn Rapid STEMI ID and STEMI Provider Manual Distribution  Public Awareness Campaign Assessment, Development, and Delivery 68

Improving the System of Care for STEMI Patients Going Forward  EMS Education Curriculum  Data Analysis and Quality Improvement  Model sharing  Public Media and Awareness campaign  Sustainability Plan Development 69

Questions? 10/2/ AHA Mission: Lifeline 70 Thank You!