STEMI Systems of Care and Learn: Rapid STEMI ID
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Every year, almost 400,000 people experience ST-Elevation Myocardial Infarction (STEMI) -- the deadliest type of heart attack. Unfortunately, a significant number don't receive prompt reperfusion therapy, which is critical in restoring blood flow. Worse yet, 30 percent of STEMI victims don't receive reperfusion treatment at all. Mission: Lifeline™ seeks to save lives by closing the gaps that separate STEMI patients from timely access to appropriate treatments. Although Mission: Lifeline is focusing on improving the system of care for the nearly 400,000 patients who suffer from a STEMI each year, improving that system will ultimately improve care for all heart attack patients.
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STEMI Systems of Care and Learn: Rapid STEMI ID
- 1. The Mission: Lifeline Provider Recognition Program and Learn:™ Rapid STEMI ID Customer Webinar September 24, 2009 Moderator: Mayme Lou Roettig, RN, MSN Presenters: Joseph P. Ornato, MD, FACP, FACC FACEP Mike Willingham, CCEMT-P Lee Garvey, MD, FACEP
- 2. The Need for Pre-Hospital ECGs in Systems of Care for STEMI Patients and Learn:™ Rapid STEMI ID Objectives Joseph P. Ornato, MD, FACP, FACC FACEP Past Chair of AHA’s National Emergency Cardiovascular Care Committee
- 5. Ornato, J. P. Circulation 2007;116:6-9 The STEMI Chain of Survival
- 6. Current Versus Ideal Processes to Integrate Prehospital ECGs into Systems of Care
- 7. Ting, H. H. et al. Circulation 2008;118:1066-1079 Reperfusion Time Goals for Patients With STEMI
- 13. Learn:™ Rapid STEMI ID Product Information and The Mission: Lifeline Provider Recognition Program Mike Willingham, CCEMT-P Senior Director, Mission: Lifeline
- 18. User Experience
- 22. User Experience On the ‘my courses’ page the student can select desired courses that have been activated
- 23. User Experience Student then chooses the active link to access course.
- 24. User Experience Student must review course overview to proceed And also complete the evaluation to complete the course and collect a certificate, CE, and option of recognized provider program
- 25. User Experience Certificate of Completion, Application for Continuing Education Credit, and Recognized Provider Program Can all be accessed from the completed courses page
- 27. Mission: Lifeline Provider Recognition
- 29. Pre-Hospital Activation Issues Within a STEMI System Lee Garvey, MD, FACEP Mission: Lifeline ECC Task Force Vice-Chair
- 32. POE Protocol
- 38. Los Angeles County Franklin Pratt, MD, FACEP 25 STEMI Receiving Centers - SRCs
- 39. EMS Assessment for STEMI: results of the Mission Lifeline National Survey EMS Agency Respondents N=5410
- 40. 12 Lead Devices Availability at the Scene Does your organization have 12-lead ECG devices available at the scene for at least 80% of the patients with chest pain?
- 41. Destination Protocols Are there destination protocols (i.e. bypass non-PCI hospitals to go directly to PCI centers) for patients that have had a pre-hospital identification of a STEMI?
- 42. 12 Lead Activates the Cath Lab In your Agency/Organization, is the field provider’s 12-lead ECG information used to activate the cath lab prior to arrival at the receiving facility?
- 43. Pre-hospital Activation. EMS identifies STEMI and: (Select all that apply.)
- 50. Questions?
Editor's Notes
- All taken from
- Jacobs, A.K.
- Ting, H. H. et al. Circulation 2008;118:1066-1079
- Moyer, P. and Ornato, J.P. et al. Circulation 2007;116:e43-e48
- In response to the training needs, ECC developed the Learn Rapid STEMI ID Program and released the product in August 2009.
- Healthcare providers, specifically pre-hospital personnel responsible for acquiring12-lead ECGs and identifying potential STEMI—also for those individuals promoting education and training for Mission: Lifeline™ providers.
- This on-line training is part of a suite of tools already available for system providers.
- "interactive self-study cards to allow the learner to remember important facts in the course"… example
- Students who successfully pass the cognitive and ECG recognition post-course tests can receive a completion certificate and are eligible for CE credits, and may also enroll in a Mission: Lifeline™ Recognized Provider program.
- There are various levels of involvement with Mission: Lifeline. This slide shows the upward progression of involvement.
- 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.
- Patient point-of-entry (POE) protocols should be developed with the understanding that a patient may call 9-1-1 and be in an EMS zone that transports to a STEMI-referral or STEMI-receiving hospital. Also, patients may directly present to a non-PCI center and be in need of inter-hospital transfer or present to a primary PCI center. The ACC/AHA guidelines encourage EMS on scene be equipped with 12-Lead ECG technology. Advanced systems may consider pre-hospital fibrinolysis, but the majority in the U.S. EMS should have a destination protocol in place. [Note to Presenter: Following text from the 2004 Full Text STEMI ACC/AHA Guidelines caption (pg 19).] Patient transported by EMS after calling 9-1-1. 1: Reperfusion in patients with STEMI can be accomplished by the pharmacologic (fibrinolysis) or catheter-based (primary PCI) approaches. Implementation of these strategies varies based on the mode of transportation of the patient and capabilities at the receiving hospital. Transport time to the hospital is variable from case to case, but the goal is to keep total ischemic time within 120 minutes. There are three possibilities: a) If EMS has fibrinolytic capability and the patient qualifies for therapy, pre-hospital fibrinolysis should be started within 30 minutes of EMS arrival on scene; b) If EMS is not capable of administering pre-hospital fibrinolysis and the patient is transported to a non-PCI-capable hospital, the hospital door-to-needle time should be within 30 minutes for patients in whom fibrinolysis is indicated; c) If EMS is not capable of administering pre-hospital fibrinolysis and the patient is transported to a PCI-capable hospital, the hospital door-to-balloon time should be within 90 minutes. Inter-hospital transfer: It is also appropriate to consider emergency inter-hospital transfer of the patient to a PCI-capable hospital for mechanical revascularization if: 1: There is a contraindication to fibrinolysis; 2: PCI can be initiated promptly (within 90 minutes after the patient presented to the initial receiving hospital or within 60 minutes compared to when fibrinolysis with a fibrin-specific agent could be initiated at the initial receiving hospital); fibrinolysis is administered and is unsuccessful (i.e.,"rescue PCI"). Secondary non-emergency inter-hospital transfer can be considered for recurrent ischemia. Patient self transport: Patient self-transportation is discouraged. If the patient arrives at a non-PCI capable hospital, the door-to-needle time should within 30 minutes. If the patient arrives at a PCI-capable hospital, the door-to-balloon time should be within 90 minutes. The treatment options and time recommended after first hospital arrival are the same.
- Taken from Garvey, Lee. et al. Journal of the American College of Cardiology Volume 47, Issue 3 , 7 February 2006, Pages 485-491
- 25 srcs 10 million people
- Mission: Lifeline is the American Heart Association’s national community based multidisciplinary 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 to and improve their overall quality of care.
- Q17. Does your organization have 12-lead ECG devices available at the scene for at least 80% of the patients with chest pain? Yes No
- Q29. Are there destination protocols (i.e. bypass non-PCI hospitals to go directly to PCI centers) for patients that have had a pre-hospital identification of a STEMI? Yes No Don’t know/ not applicable
- Q16. In your Agency/Organization, is the field provider’s 12-lead ECG information used to activate the cath lab prior to arrival at the receiving facility? Yes, for all receiving facilities Yes, sometimes or for some receiving facilities No Don’t know
- Ting, H. H. et al. Circulation 2008;118:1066-1079