Virginia Beach EMS: Improving Cardiac Care

Virginia Beach EMS: Improving Cardiac Care

Earlier in 2015, Virginia Beach EMS was recognized by the American Heart Association’s Mission: Lifeline EMS program.  The care our patients receive is our number one priority.  That’s why we’re proud to be among the agencies and hospitals recognized by the American Heart Association’s Mission: Lifeline program for our excellence in improving the quality of patient care.

2015 Bronze Mission Lifeline Award

Virginia Beach EMS continuously strives to improve the quality of care and Virginia Beach EMS is one of the agencies in the Tidewater region working closely with the American Heart Association to improve care delivered to patients experiencing an acute myocardial infarction, more commonly known as a “heart attack”.  The Regional Systems Accelerator: Regional STEMI Systems of Care Implementation of Mission: Lifeline focuses on improving response, treatment, and follow-up care for people who experience an ST-elevation myocardial infarction (STEMI).  The Mission: Lifeline STEMI System Accelerator provides an intense focus to develop and refine systems of care for the ST-elevation myocardial infarction patient by engaging multiple entities that provide emergency medical care and reperfusion therapy within the same geographical region.  This project is being carried out over the next two years in 14 areas of the country, and will build on the success of the original STEMI ACCELERATOR project, which demonstrated that collaboration between EMS and hospitals in treating heart attack patients resulted in shorter emergency department wait times that ultimately reduced death rates.  (Source)

The following information is directly from the American Heart Association Mission: Lifeline website (source) and includes defined strategies for EMS to achieve the ideal cardiac system of care:

Initial Contact

By an EMT Basic or Intermediate Provider

  • 911 operator trained to recognize potential acute cardiac symptoms and dispatch appropriate EMS resources to potential STEMI patient
  • ECG equipment and personnel dispatched to allow for 12 lead ECG within a total scene time of  less than or equal to 15 minutes
  • ECG acquisition to be extended to basic providers including EMT basic and first responders
  • ECG obtained on all patients with chest discomfort suspected to be of ischemic origin
  • In the field ECG (to be interpreted by receiving physician on arrival or by transmission)
  • Documentation of symptom onset
  • Scene time of less than 15 minutes
  • Patient stays on ambulance stretcher for STEMI evaluation for hospitals that routinely transfer all or some patients by same ambulance

By an EMT-Paramedic

In addition to above:

  • Training to diagnose STEMI by symptoms and ECG
  • In the field ECG with a goal scene time of 15 minutes
  • Administer reperfusion checklist (See tools)
  • If patient is fibrinolytic ineligible, EMS notifies and diverts to a STEMI-Receiving hospital, as long as transportation time < 90 minutes
  • Early notification of the receiving hospital on all STEMI patients prior to arrival that includes direct communication with the physician capable of activating a reperfusion plan regarding symptom onset, ECG findings, and reperfusion checklist in addition to:
    • Patient Age, gender, and DNR status
    • Time of onset of symptoms
    • Primary physician/cardiologist
    • Whether patient taking wafarin
    • Past hx of MI, PCI/stent/CABG, renal failure, contrast allergy
    • Specific to Virginia Beach EMS: transmission of 12 lead ECG within 5 minutes of acquisition
  • Administer aspirin (325 mg chewed) to chest pain patients suspected of having STEMI unless contraindicated or an adequate dose of immediate-release aspirin can be verified as taken
  • EMS data elements collected, made available to receiving hospitals via run event sheet, and reviewed on a regular basis regarding symptom onset, time of 1st medical contact, ECG performance and findings, and transportation complications including arrest and death
First Medical Contact (FMC) to Balloon

This Mission: Lifeline EMS recognition measure utilizes the time of pre-­hospital “First Medical Contact”.  First Medical Contact (FMC) is broadly defined as the time of eye to eye contact between STEMI patient and caregiver.  For the purposes of Mission: Lifeline EMS Recognition, First Medical Contact (FMC) is the time of eye-to-eye contact between STEMI patient and the first caregiver (Medical First Responder, Physician at a clinic, or EMS personnel).  When the Medical First Responder or physician at a clinic is the first caregiver at the patient’s side, and their time of initial contact with the patient is known, the eye-to-eye contact time between the patient and that first caregiver is preferred.  For the patient to be included in the Mission: Lifeline EMS Recognition program, there must have been a prehospital 12 lead, but not necessarily performed by the first caregiver.  (Source)

The ultimate goal for chest pain patients is to achieve an FMC to balloon (FMC2B) time of 90 minutes or less.  The “balloon” time is the time at which percutaneous coronary intervention (PCI) is performed, the occluded coronary artery is opened, and blood flow to the cardiac muscle is restored.

Tips for Decreasing FMC2B (Remember, Time is Muscle!):

  • For all chest pain patients, take the LifePak out of the ambulance with you and acquire the 12 lead ECG at the patient’s side; following acquisition, immediately transmit to the hospital.
  • Calling the hospital very early in the call means they are prepped and ready for us; eventually, we may be able to pass right through the ED to the cath. lab.
  • For known STEMIs, emergent (lights and siren) transport to the hospital is indicated.