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

2. ©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

3. 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

4. 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

5. ©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 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

6. ©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

7. 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

8. 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 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

9. 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

10. 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

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

12. 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

13. Mission: Lifeline North Texas
MISSION: LIFELINE EMS RECOGNITION

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

15. 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

16. 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 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

17. 2015 Mission: Lifeline EMS Recognition Timeline
Mission: Lifeline North Texas
2015 Mission: Lifeline EMS Recognition Timeline
©2013, American Heart Association

18. 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

19. 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

20. 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

21. Mission: Lifeline North Texas
THANK YOU !