1/9/2017. Systems of Care in EMS: An Integrated System of Cardiac Care. Describe systems-based response to time-sensitive clinical conditions
|
|
- Annis Rich
- 6 years ago
- Views:
Transcription
1 Systems of Care in EMS: An Integrated System of Cardiac Care NAEMSP Medical Director s Course January 23, 2017 Jefferson Williams, MD, MPH, FACEP Deputy Medical Director Wake County EMS System Clinical Assistant Professor (Adjunct) UNC Department of Emergency Medicine Disclosures none Objectives Describe systems-based response to time-sensitive clinical conditions Discuss examples of systems of care and how they are measured Discuss the role of EMS participation and leadership in these systems 1
2 What are Systems of Care Proactive integration of EMS Evidence-based assessment and triage protocols (developed together) Coordination and oversight of specialty centers, including availability Quality-based monitoring of process and outcomes (monitoring BY EMS) Verification of specialty center compliance An example: The Chain of Survival 2
3 EMS Medical Directors know: Cardiac Arrest survival rate in your community? Your Utstein number? Bystander CPR rates? First Responder AED utilization? But do you know these? Your STEMI diagnosis over-triage rate? What does the cardiologist think is acceptable? Your median and 90th %tile scene times for STEMI patients? What do YOU think is acceptable? But do you know these? The number of Stroke patients in your community that may benefit from an interventional procedure Whether or not the new interventioncapable stroke center down the road is actually available 24/7 (or should you bypass that one and go to the academic medical center the next county over?) 3
4 The Plan What are Systems of Care and how should EMS participate and lead? RACE and RACECARS as examples STEMI and OHCA Stroke- the next focus? Systems of Care in NC EMS Triage and Destination Plans Peer Review Meetings RACE and RACECARS Broad implementation across regions of evidenced-based best practices Education for ALL team membersbystanders, EMS, ED, Cardiology Common measurement of processes and outcomes 4
5 RACE- Jollis, et al JAMA 2007 QI study that evaluated STEMI process measures in 5 regions in NC before and after implementation of statewide reperfusion system ( like trauma ) Median reperfusion times significantly improved: cath lab, lytics, and transfer 5
6 Regional Systems of Care Demonstration Project STEMI Accelerator IManualAcceleratorTemplate pdf RACECARS Applying the principles of RACE to out of hospital cardiac arrest Implement OHCA best practices on a state-wide basis Education Treatment Structure Measurement 6
7 NC CARES Participation 2010 Green Participating Orange Not Participating 3 Counties / 4 agencies participating 21.5% of NC population captured CARES Participation Green Participating Yellow Partial Participation Orange Not Participating 71 systems participating 88.5% of NC population captured 7
8 8
9 RACECARS Implement OHCA best practices on a state-wide basis Education Treatment Structure Measurement What were the Interventions? Telecommunications Training: Utilizing Arizona and partners on-line training Process to provide them data they collect on-line 2.5 hour training Incorporates HR introduction, Review of NC data, on-line training, call review practice Train the trainer Con Ed across the state 600 trained Approx. 27 counties APCO and NENA state meetings New Resources: Seattle Resus Academy on line 26 9
10 First Responder Adoption of SCA practices to improve outcomes First Responder Critical role in improving survival Active Team Member Perform HP CPR and Defibrillation Improved relationships with EMS Participation in Community Events 10
11 The Association of Rates of Bystander and First-responder Intervention with Survival after Out-of-Hospital Cardiac Arrest in North Carolina, Carolina Malta Hansen, MD, Ph.D. Candidate Duke Clinical Research Institute On Behalf of Kristian Kragholm, James G. Jollis, Matthew Dupre, Bryan McNally, Lisa Monk, Clark Tyson, David A. Pearson, Darrell Nelson, Brent Myers, Emil Fosbol, Benjamin Strauss, Monique Anderson, Christopher B. Granger JAMA July 21, 2015 Volume 314, Number 3 In 4 years ( ) Bystander CPR has increased by 26% (to 49.4%) First responder debrillation has increased by 27% (to 52.1%) Overall survival has increased by 25% (to 10.5%) Favorable neurologic outcome increased by 37% (to 9.7%) By 55% (to 14%) for bystander-initiated CPR Bystander-initiated CPR was associated with this increase! Bystander and first responder CPR and defibrillation were associated with improved survival compared to EMS-initiated CPR and defibrillation 32 Emergency Medical Services Adoption of SCA practices to improve outcomes 11
12 EMS Implemented state wide protocols for SCA Adoption of Pit Crew CPR Training with Fire QA programs to monitor SCA Survival rates CPR quality Plan and participate in community events North Carolina CARES Utstein Survival Rates October 10, % 35.0% 30.0% Percentage 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Agencies not using Pit Crew CPR 2012 Agencies using Pit Crew CPR 12
13 RACE and RACECARS Broad implementation of best practices for STEMI and cardiac arrest across North Carolina improved processes and outcomes for these patients What s next? Stroke EMS engagement of the medical community re: triage and destination plans Stroke Another condition ready and waiting for systems of care? Primary vs. Comprehensive Stroke Centers Where does intervention fit? Could a System of Care Improve Process? 13
14 Stroke- Background- To Review 1996 to ~ 2012: TPA for Stroke 2008 to 2012: TPA < 3 hrs, TPA hrs TPA is good but not great, can we do better? 2012 to 2014: three RCTs show that first gen intra-arterial (IA) devices/treatment do not have benefit over standard treatment (TPA) Stroke- Moving Forward Dec 2014 April 2015 FIVE trials demonstrate that newer, next generation IAT devices have benefit over standard treatment for patients with large artery occlusions. MR CLEAN ESCAPE EXTEND IA SWIFT PRIME REVASCAT 14
15 Stroke Trials Consistent difference across all 5 trials in terms of good outcome (MRS) favoring interventional vs. control group ~ 14-31% improvement NNT approx 4 for one additional good outcome 15
16 2015 Guidelines Update More recommendations Effectiveness of intervention after 6 hours is uncertain, more research is needed. Patients with TPA contraindications may still be candidates for intervention, more research is needed. CTA is indicated for patients who may be candidates for endovascular therapy Patients should be transported to the closest primary or comprehensive stroke center; Regional Systems of Care should be developed. 16
17 Stroke Stroke So, do we take patients to the closest place that will give TPA and then anticipate transfer? Do we bypass all but interventional stroke centers? Should we screen for LVO in the field? From Wake EMS CME: 17
18 Take-Home Points Time is Brain. The most important thing we do in EMS is RECOGNIZE a possible stroke (stroke screen) and have an accurate LAST KNOWN NORMAL time. Be vigilant- repeat exams. Get family phone # if you can. NEW Stroke TDP, effective June hours from LKW = Current destinations for Stroke/TIA: UNC, Duke, Duke Raleigh, Rex, WMRaleigh, WMCary 4-6 hours from LKW = Duke Raleigh, Duke, UNC Stroke, revisited So, do we take patients to the closest place that will give TPA and then anticipate transfer? Do we bypass all but interventional stroke centers? Should we screen for LVO in the field? YOU Decide, with YOUR System Systems of Care in NC RACE and RACECARS EMS Triage and Destination Plans Peer Review Committees for all EMS Systems 18
19 Systems of Care in NC Systems of Care in NC: Peer Review EMS, Hospitals, Community Process and Outcomes Reporting Transparency Forum for communications and addressing systems issues Systems of Care in Wake County STEMI, Stroke, Trauma/Burn, Peds, OHCA, and FED Triage and Destination Plans Evidence-Based Reporting of QA metrics with a standing Clinical Report at Quarterly Peer Review Meetings Bi-directional Data Exchange 19
20 Systems of Care in Wake County How do Protocols and CME relate to our peer review process and reporting? 20
21 Best Practice #1 : Recognition **WCEMS PEER REVIEW CONFIDENTIAL 911 and EMS Times (example case) 911 call at 1321 EMS en-route 1323 At patient 1332 EKG done 1335 En-route to hospital 1340 STEMI Alert- EKG transmitted via LifeNet 1342 At ED 1401 FMC to balloon ~60 mins Best Practice #2: Scene Time At patient: Time 0 EKG done: Time 3 min En-route to Hospital: Time 8 min Goal: min or less (or justified reason) 21
22 Best Practice #3: EMS Rx: The STEMI Bundle ASA (pt took his own) 12 lead performed and interpreted Goal scene time less than minutes Correct destination (STEMI receiving center) Early notification: STEMI alert via radio or phone EKG transmission if possible and this is what we QA and report to Peer Review Did the patient get aspirin? Did the patient have a 12 lead performed and interpreted correctly? Did the patient go to the proper destination? 22
23 EMS STEMI Evidence Based Medicine Measures Patients Transported by EMS with Suspected or Confirmed STEMI 90% 80% 70% Percentage Performed 60% 50% 40% 30% 20% 10% Mar 2016 n=21 Apr 2016 n=40 May 2016 n=30 June 2016 n=34 July 2016 n=25 Aug 2016 n=44 Sept 2016 n=31 97% 98% The Wake County Clinically Excellent Care 12 Lead EMS System Prompt, Compassionate, ASA Proper Destination Mean Time for Patients with Confirmed STEMI; Combined for All Hospitals Time in Minutes Mar 16 Apr 16 May 16 June 16 July 16 Aug 16 Sept 16 Hospital Arrival to Intervention Scene Departure to Hospital 16 Prompt, 18 Compassionate, Clinically 15 Excellent The Wake County EMS System Care Arrival 1st Patient Contact to Scene Departure Over Triage 3rd Quarter 2016 There were 13 of 100 STEMI calls documented by the hospital as STEMI cancelled, categorized as EMS over triage There were 6 sent for consult only. There were 1 additional calls where EMS did not activate code STEMI All were independently reviewed and determined that all but 2 of the EMS activations were appropriate There were 3 actual over triage 2% overtriage n=100 STEMI calls 23
24 STEMI Feedback Report (edited for privacy- JGW) Recommend ed Targets (mins) Actual Data EMS ECG Time 1030 (ECG with ST changes noted) EMS Transmit Time Transmission Received to Activation N/A ED notified EMS on Scene time ED Door to ECG ED ECG to Activation 10 5 immediate Already activated Total Time in ED Activation to Cath Team Ready Activation to MD Arrive In Lab Door to Balloon First Medical Contact to Balloon Thank you for partnering with XXXXX! STEMI Feedback Report Thank you for partnering with XXXXXX! Summary What are Systems of Care and how should EMS participate and lead? RACE and RACECARS as examples STEMI and OHCA Stroke- the next focus? Systems of Care in NC EMS Triage and Destination Plans Peer Review Meetings 24
25 Take Home Points Implementation of Systems of Care can improve processes and outcomes for YOUR patients EMS Physician Medical Directors should lead interdisciplinary teams to establish common systems of care in your communities 25
Duke Life Flight. Systems of Care for Time Dependent Emergencies. Disclosures. Disclosures 9/19/2017
Duke Life Flight Systems of Care for Time Dependent Emergencies Claire M Corbett, MMS, NRP Manager of Neurodiagnostics and Stroke Center New Hanover Regional Medical Center Wilmington, NC Disclosures Clinical
More information2018 Mission: Lifeline EMS Detailed Recognition Criteria, Achievement Measures and Reporting Measures
2018 Mission: Lifeline EMS Detailed Recognition Criteria, Achievement Measures and Reporting Measures Table of Contents Mission: Lifeline EMS Recognition Award Levels Page 2 Mission: Lifeline EMS Recognition
More informationSupplementary Online Content
Supplementary Online Content Hansen CM, Kragholm K, Pearson DA, et al. Association of bystander and first-responder intervention with survival after out-of-hospital cardiac arrest in North Carolina, 2010-2013.
More informationSan Joaquin County Emergency Medical Services Agency
San Joaquin County Emergency Medical Services Agency http://www.sjgov.org/ems DATE: Mailing Address PO Box 220 French Camp, CA 95231 TO: FROM: SUBJ.: All Prehospital Personnel and Providers Emergency Department
More informationNew Stroke Treatments and Inter-facility Transport
New Stroke Treatments and Inter-facility Transport David Y. Huang, MD, PhD, FAHA, FANA, FAAN Professor, Department of Neurology Director, UNC Health Care Comprehensive Stroke Center The University of North
More informationSTEMI SYSTEM RECEIVING CENTER STANDARDS AND DESIGNATION
POLICY NO: FAC - 9 DATE ISSUED: 11/2016 DATE TO BE REVIEWED: 11/2019 STEMI SYSTEM RECEIVING CENTER STANDARDS AND DESIGNATION Purpose: To define the criteria for designation as a STEMI Receiving Center
More informationRACE COORDINATOR MEETING. North Carolina Mission: Lifeline and RACE CARS. Moving STEMI and Cardiac Arrest Care into the Future
RACE COORDINATOR MEETING North Carolina Mission: Lifeline and RACE CARS Moving STEMI and Cardiac Arrest Care into the Future https://cee.dcri.duke.edu/ Mission Lifeline and RACE CARS Discuss the concept
More informationSTEMI ALERT! Craig M. Hudak, MD, FACC,FACP 24 January 2015
STEMI ALERT! Craig M. Hudak, MD, FACC,FACP 24 January 2015 STEMI Overview ST segment Elevated Myocardial Infarction Patient Outcome Goals: Save myocardium Reduce CHF Reduce arrhythmias Improve quality
More informationMultidisciplinary Process Improvement Building Relationships
Multidisciplinary Process Improvement Building Relationships Mission: Lifeline - Relationships Improved Outcomes Presented by: Lori Hollowell, BSN, RN National Quality Systems Improvement Consultant, Mission:
More informationImplementing & Improving Upon A STEMI System
2 Implementing & Improving Upon A STEMI System Dipti Itchhaporia, MD, FACC, FESC Trustee, American College of Cardiology Assistant Clinical Professor, University of California, Irvine Robert and Georgia
More informationWashington State Emergency Cardiac & Stroke System of Care. Sample proof of concept Report Cardiac Measures
Washington State Emergency Cardiac & Stroke System of Care Sample proof of concept Report Cardiac Measures COAP IN 2011 COAP IN 2011 Washington State Emergency Cardiac & Stroke CLICK TO EDIT MASTER TITLE
More informationThe STEMI ALERT Packet
The STEMI ALERT Packet (At a PCI-capable institution) Use of a STEMI ALERT Packet is a key step in optimizing treatment of the STEMI patient. Opening a STEMI ALERT Packet upon first recognition of STEMI
More informationSTEMI Receiving Center Designation Process
PURPOSE STEMI Receiving Center Designation Process Rev. 2-6-2013 To define requirements for designation of a hospital as a ST-elevation myocardial infarction (STEMI) receiving center for the Austin-Travis
More informationNational Assessment of Clinical Quality Programs. Introduction. National Assessment of Clinical Quality Programs. Demographics
National Assessment of Clinical Quality Programs Introduction With the support of the NAEMSP Quality Improvement Committee, this study group is interested in understanding the national picture of clinical
More informationNATIONAL AMBULANCE SERVICE ONE LIFE PROJECT
February 2015 NATIONAL AMBULANCE SERVICE ONE LIFE PROJECT Improving patient outcomes from Out Of Hospital Cardiac Arrest David Hennelly AP MSc Jan 2015 THE ONE LIFE PROJECT IS BEING LED BY THE NATIONAL
More informationSouthwest Texas Regional Advisory Council Regional Percutaneous Coronary Intervention Facility & EMS Heart Alert Agencies
Southwest Texas Regional Advisory Council Regional Percutaneous Coronary Intervention Facility & EMS Heart Alert Agencies LETTER OF ATTESTATION August, 2015 BACKGROUND The Southwest Regional Advisory Council
More informationMission: Lifeline and GWTG-CAD (Coronary Artery Disease)
Mission: Lifeline and GWTG-CAD (Coronary Artery Disease) Gary Myers Sr. Quality and Systems Improvement Director & EMS Consultant American Heart Association Sioux Falls, SD I have no actual or potential
More informationContra Costa County Emergency Medical Services. STEMI System Performance Report
Contra Costa County Emergency Medical Services STEMI System Performance Report Quarter III 2009 Contra Costa Emergency Medical Services STEMI System Performance Executive Report: Quarter III, 2009 Advisory
More informationImproving Quality in EMS
Improving Quality in EMS Measuring and Improving Your EMS System Robert Swor DO, FACEP Professor, Emergency Medicine Oakland University William Beaumont School of Medicine Objectives Can I Get a QA program?
More informationEMS Subspecialty Certification Review Course
EMS Subspecialty Certification Review Course Public Health 2.4.3 Version Date: 7/2017 Public Health aka 2.4.3.1 Specialty hospital designations and transport of patient 2.4.3.2 Field triage issues 2.4.3.3
More informationCaring for the STEMI Patient:
Caring for the STEMI Patient: Primary PCI and Other Considerations John M Gallagher, MD EMS System Medical Director Wichita/Sedgwick County Kansas Conflicts: None but looking Disclosures: Chairman of the
More informationEast Texas Gulf Coast Regional Trauma Advisory Council Regional Advisory Council - R (RAC-R)
East Texas Gulf Coast Regional Trauma Advisory Council Regional Advisory Council - R (RAC-R) RAC-R proudly supports and serves Jasper, Newton, Hardin, Orange, Liberty, Jefferson, Chambers, Galveston and
More informationHow to Establish a Multi Hospital STEMI Transfer System
How to Establish a Multi Hospital STEMI Transfer System Dr. Greg Mishkel for the Doctors of Prairie Cardiovascular and in collaboration with our Community & Springfield Hospitals MI: Evolution of care
More informationStroke System-of- Care Plan. Mississippi State Department of Health
Stroke System-of- Care Plan Mississippi State Department of Health Bureau of Acute Care Systems MSDH Board of Health Approved: October 14, 2015 Revised July 6, 2015 Stroke System-of-Care Plan Table of
More informationCardiac Arrest Registry to Enhance Survival
Cardiac Arrest Registry to Enhance Survival Bryan McNally, MD, MPH Executive Director CARES Associate Professor of Emergency Medicine Emory University School of Medicine Rollins School of Public Health
More informationThe Medicare Beneficiary Quality Improvement Project (MBQIP) Monthly Performance Improvement Call
The Medicare Beneficiary Quality Improvement Project (MBQIP) Monthly Performance Improvement Call April 16, 2015 Amber Theel, Executive Director Patient Safety Susan Rivera-Lee, WSHA Consultant MBQIP MBQIP
More informationPSC Certification: What really happens
PSC Certification: What really happens Authors: Wendy J. Smith, BS, MA, RES, RCEP, RN, SCRN Christy Franklin, MS, RN, CNRN Julie Fussner, BSN, RN, CPHQ, SCRN Disclosures Wendy J. Smith- I have no actual
More informationStrategies to Improve Local and National Cardiac Arrest Data Registries
Strategies to Improve Local and National Cardiac Arrest Data Registries Bryan McNally, MD, MPH Executive Director CARES Associate Professor of Emergency Medicine Emory University School of Medicine Rollins
More informationRegion III STEMI Plan
Region III STEMI Plan I. Plan Goals A. To develop a Region III STEMI System that when implemented, will result in decreased mortality and morbidity in the MIEMSS Region III. In order to accomplish this,
More informationNorth Carolina College of Emergency Physicians Standards for the Selection and Performance of EMS Performance Improvement
Performance Improvement North Carolina Performance Improvement Guidelines The purpose of this guideline is to provide direction to Agencies with respect to patient care based quality management performance
More informationDr. Darrell Nelson, FACEP, FAAEM Medical Director Stokes County EMS
Dr. Darrell Nelson, FACEP, FAAEM Medical Director Stokes County EMS Steven Roberson, EMT-P Fire Chief City of King Fire Department Brian Booe, EMT-P Training Officer Stokes County EMS AHA changes from
More informationSan Luis Obispo Emergency Medical Services Agency. Continuous Quality Improvement Plan
San Luis Obispo Emergency Medical Services Agency Continuous Quality Improvement Plan February 2016 1 Table of Contents 1. Introduction. 3 Vision Statement Philosophical Statement of Professional Ethics
More informationContra Costa County Emergency Medical Services. STEMI System Performance Report
Contra Costa County Emergency Medical Services STEMI System Performance Report Quarter 4, 2009 & Year to Date 2009 Contra Costa Emergency Medical Services STEMI System Performance Executive Report: Quarter
More informationArizona Department of Health Services Bureau of EMS and Trauma System EMS Agency Performance Improvement Plan Manual
Arizona Department of Health Services Bureau of EMS and Trauma System EMS Agency Performance Improvement Plan Manual Approved by TEPI: July 17, 2014 Pending Approval from STAB, MDC, EMS council in September
More informationDaily Summit Conferences* Cardiology Conference & EMS Recognition Luncheon
APRIL 24-28, 2017 HILTON GARDEN INN CRABTREE VALLEY 3912 ARROW DR RALEIGH, NC 27612 REGISTER NOW! Daily Summit Conferences* Heart Failure Conference Tuesday, April 25, 2017 4:30PM The maximum number of
More informationHyperacute and Acute Stroke Care: What s New? Martin James Consultant Stroke Physician Royal Devon & Exeter Hospital, Exeter
Hyperacute and Acute Stroke Care: What s New? Martin James Consultant Stroke Physician Royal Devon & Exeter Hospital, Exeter What s new in hyperacute and acute care Mechanical thrombectomy (MT) IV Thrombolysis
More informationBirmingham Regional EMS System STEMI System Plan
Attachment 4 Birmingham Regional EMS System STEMI System Plan \\bremssdc\stafffiles\frontdesk\stemi\plan\stemi Plan for MDAP 2.9.10.doc - 1 - TABLE OF CONTENTS Rationale....3 Goals...3 Overview...4 Components
More informationThe Paramedic Paradox: Is Less Really More? J. Brent Myers, MD MPH Medical Director Wake County EMS System Raleigh, NC
The Paramedic Paradox: Is Less Really More? J. Brent Myers, MD MPH Medical Director Wake County EMS System Raleigh, NC 1 Now Faith is the assurance Of things hoped for The belief in Things unseen. -- Hebrews
More informationPURPOSE: The purpose of this policy is to establish requirements for designation as a STEMI Receiving Center (SRC) in San Joaquin County.
PURPOSE: The purpose of this policy is to establish requirements for designation as a STEMI Receiving Center (SRC) in San Joaquin County. AUTHORITY: Health and Safety Code, Division 2.5, Sections 1797.67,
More information12/30/2011. Dan Spaite : PI NIH/NINDS 1R01NS A1. Ben Bobrow: PI NIH/NINDS 1R01NS A1
Daniel Spaite, MD, FACEP Professor of Emergency Medicine Ben Bobrow, MD, FACEP Associate Professor of Emergency Medicine Dan Spaite : PI NIH/NINDS 1R01NS071049-01A1 Ben Bobrow: PI NIH/NINDS 1R01NS071049-01A1
More informationNassau Regional Medical Advisory Committee
Nassau Regional Medical Advisory Committee Advisories Advisory# Subject Issued Effective 07-02.1 BLS Assisted Medications 2/7/07 2/7/07 07-06.1 BLS Use of Pulse Oximeters 6/6/07 6/6/07 08-12.1 Incident
More informationEmergency Medical Services
Emergency Medical Services Program Description Fund 10 Directorate 04 Division 63 Department 205 The Emergency Medical Services (EMS) program is responsible to ensure the highest quality medical care is
More informationNCDR 13 Annual Conference. ACTION Registry-GWTG Workshop #1. Disclosures Dr. Fonarow, MD, FACC, FAHA. Objectives 2/28/2013.
NCDR 13 Annual Conference ACTION Registry-GWTG Workshop #1 Disclosures Dr. Fonarow, MD, FACC, FAHA Boston Scientific, Takeda, Amgen, Johnson&Johnson, Medtronic, Gambro, NIH/NIAID, Novartis, NHLBI Kim Hustler
More informationTwo Hospitals-One Heart: World Class Heart Care through Multi-Disciplinary Collaboration
Two Hospitals-One Heart: World Class Heart Care through Multi-Disciplinary Collaboration American Nurses Association Susie Schnitker RN, BSN, CEN 7 th Annual Nursing Quality Conference Director of Critical
More informationSTEMI System of Care: Where do you fit in?
presents STEMI System of Care: Where do you fit in? Saturday, April 16, 2016 8 a.m. - 2 p.m. Fogelson Forum Auditorium 8200 Walnut Hill Lane Dallas, TX 75231 TexasHealth.org/CME CME Presented by Conference
More informationMEMORANDUM OF UNDERSTANDING
THIS MEMORANDUM OF UNDERSTANDING (this Agreement ) is made by and among the American Heart Association ( AHA ) and each of the Emergency Medical Service agencies ( EMS agencies ) and hospitals ( Hospital
More informationSTEMI RECEIVING CENTER
Monterey County EMS System Policy Policy Number: 5150 Effective Date: 5/1/2012 Review Date: 12/31/2016 STEMI RECEIVING CENTER I. PURPOSE To define requirements for designation as a Monterey County STEMI
More informationAmbulance Operations Procedure Appropriate Hospital Access for ST Elevation Myocardial Infarction Patients. National Ambulance Service (NAS)
Ambulance Operations Procedure Appropriate Hospital Access for ST Elevation Myocardial Infarction Patients National Ambulance Service (NAS) Document reference number Revision number Approval date NASCG017
More informationEP15: Describe and demonstrate interdisciplinary collaboration using continuous quality and process improvement.
1 EP15: Describe and demonstrate interdisciplinary collaboration using continuous quality and process improvement. Interdisciplinary collaboration is an essential component of Riverside Medical Center
More informationCardiac Arrest Registry to Enhance Survival (CARES) Report on the Public Health Burden of Out-of-Hospital Cardiac Arrest.
() Report on the Public Health Burden of Out-of-Hospital Cardiac Arrest Prepared for: Institute of Medicine Submitted by: Kimberly Vellano, MPH Allison Crouch, MPH, MBA Monica Rajdev, MPH Bryan McNally,
More informationAmbulance Response 90th Percentile Times
Time Perth County Paramedic Services Perth County EMS Provincial Response Time Reporting: Prior to the downloading of land ambulance services in 2000 to the upper tier municipalities (UTM) and Designated
More informationEMS System for Metropolitan Oklahoma City and Tulsa 2017 Medical Control Board Treatment Protocols
PROTOCOL 17A: Adult General Medical s Adult General Medical s Four (4) Levels of General Medical s Priority I and II Priority III No Will time and distance to the hospital of choice be detrimental to the
More informationCritical Topics Cardiac Arrest CARE in EMS. Alan Thompson, NREMT-P EMS Director, Cabarrus County
Critical Topics Cardiac Arrest CARE in EMS Alan Thompson, NREMT-P EMS Director, Cabarrus County Disclosure Statement I have no conflict of interest to report. I am not employed by an organization or company
More informationMission: Lifeline Hospital Accreditation Webinar. June 21, :00PM 3:00PM CST
Mission: Lifeline Hospital Accreditation Webinar June 21, 2012 2:00PM 3:00PM CST Speaker Introductions Deb Koeppen, RN Society of Chest Pain Centers Director of Business Development Larry Brown, RN, BSN
More informationObjective Measurement
STEMI Designation Contract HOSPITAL SERVICES A. Current license to provide Basic Emergency Services in Contra Costa County Copy of License B. Cardiac Catheterization Laboratory services Copy of License.
More informationTrauma Service Area - B (BRAC) Regional Stroke Plan
Trauma Service Area - B (BRAC) Regional Stroke Plan Trauma Service Area- B (BRAC) P.O. Box 53597 Lubbock, TX 79453 806.791.2582 (office) BRAC serves the counties of Bailey, Borden, Castro, Cochran, Cottle,
More informationJohn Brown, MD, FACEP Medical Director Emergency Medical Services Agency Department of Emergency Management. February 16, 2010
Status of Emergency Medical Services and Medical Oversight in San Francisco John Brown, MD, FACEP Medical Director Emergency Medical Services Agency Department of Emergency Management February 16, 2010
More informationWired to Save Lives: A Virtual Hospital Experience
Wired to Save Lives: A Virtual Hospital Experience Donald J. Kosiak, MD, MBA, FACEP, CPE Vice President for Medical Development Thursday, March 3 rd -- 11:30am Conflict of Interest Donald Kosiak, MD Has
More informationAnnual Report. DUFFERIN COUNTY PARAMEDIC SERVICE 325 Blind Line Orangeville, ON L9W 5J8
2014 Annual Report DUFFERIN COUNTY PARAMEDIC SERVICE 325 Blind Line Orangeville, ON L9W 5J8 Table of Contents Human Resources... 2 Vehicles... 2 Stations... 3 Responses... 4 Public Access Defibrillator
More informationSIMPLE SOLUTIONS. BIG IMPACT.
SIMPLE SOLUTIONS. BIG IMPACT. SIMPLE SOLUTIONS. BIG IMPACT. QUALITY IMPROVEMENT FOR INSTITUTIONS combines the American College of Cardiology s (ACC) proven quality improvement service solutions and its
More informationGET WITH THE GUIDELINES-STROKE UPDATE. Abby Fairbank, MPH Senior Director, Quality & Systems Improvement American Heart Association
GET WITH THE GUIDELINES-STROKE UPDATE Abby Fairbank, MPH Senior Director, Quality & Systems Improvement American Heart Association 1 OVERVIEW STROKE SYSTEM OF CARE PLAN HIGHLIGHT GWTG-STROKE MEASURES HIGHLIGHT
More informationSTEMI System of Care Policy
County of Kern Emergency Medical Services STEMI System of Care Policy Ross Elliott EMS Director Robert Barnes, M.D. Medical Director 1 TABLE OF CONTENTS PURPOSE... 2 AUTHORITY... 2 DEFINITIONS... 2 DESIGNATION...
More informationImproving Clinical Outcomes The Case for Electronic ED Door to EKG Time Monitoring
Improving Clinical Outcomes The Case for Electronic ED Door to EKG Time Monitoring 2014 Distinguished Achievement Award for Clinical Excellence TM Competition October 22, 2014 St. Dominic-Jackson Memorial
More informationGAMUT QI Collaborative Consensus Quality Metrics (v. 05/16/2016)
1) Ventilator use in patients 1 with advanced airways reported as Percent of patient transport contacts with an advanced airway 2 supported by a mechanical ventilator. 2) Scene and bedside times for STEMI
More informationKGH Endovascular Thrombectomy Acute Ischemic Stroke Pilot Study Evaluation Report 2017
KGH Endovascular Thrombectomy Acute Ischemic Stroke Pilot Study Evaluation Report 2017 WHY? - Context for EVT Most significant advance in stroke care in 20 years 5 Landmark Trials in 2015: strong evidence
More informationSARASOTA MEMORIAL HOSPITAL POLICY
smh0076850ps1070 SARASOTA MEMORIAL HOSPITAL POLICY TITLE EFFECTIVE DATE: REVIEWED/REVISED DATE: POLICY TYPE: Job Title of Responsible Owner: Director, Patient Care 12/09/13 08/19/16 Clinical Non-Clinical
More informationKentucky Sepsis Summit. August 2016
1 Kentucky Sepsis Summit August 2016 St. Elizabeth Healthcare About Us: - 7 facilities & over 1200 licensed beds - Serving the NKY/Cincinnati Region in: - Orthopedic Care - Heart and Vascular Institute
More informationTHE EVIDENCED BASED 2015 CPR GUIDELINES
SAUDI HEART ASSOCIATION NATIONAL CPR COMMITTEE THE EVIDENCED BASED 2015 CPR GUIDELINES Page 1 Chapter 9 EDUCATIONAL STRATEGY EDUCATION MODULE In educational research, which often include manikin studies,
More informationWESTCHESTER REGIONAL
WESTCHESTER REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL POLICY STATEMENT Supersedes/Updates: New Policy No. 11-02 Date: February 8, 2011 Re: EMS System Resource Utilization Pg(s): 5 INTRODUCTION The Westchester
More informationStatistical Note: Ambulance Quality Indicators (AQI)
Statistical Note: Ambulance Quality Indicators (AQI) The latest Systems Indicators for April 2018 for Ambulance Services in England showed that three of the six response standards in the Handbook 1 to
More informationVictoria FIRE DEPARTMENT VICTORIA T E X A S T H E C I T Y O F
Victoria FIRE DEPARTMENT 2016 Annual Report T H E C I T Y O F VICTORIA T E X A S Message From the Chief On behalf of all members of the Victoria Fire Department, I am pleased to present the 2016 Annual
More informationNorth Carolina College of Emergency Physicians Standards Policy Table of Contents
Policy North Carolina College of Emergency Physicians Standards Policy Table of Contents Disposition Policy Section 1. Criteria for Death or Withholding Resuscitation 2. Deceased Subjects 3. Discontinuation
More informationQuarterly Performance Report For the Period of July September 2014 Produced on November 27, Paramedic Services (PS) Performance Measurement 1
Quarterly Performance Report For the Period of July September 2014 Produced on November 27, 2014 Paramedic Services (PS) Performance Measurement 1 Table of Contents SUMMARY... 3 A. VOLUME AND SERVICE LEVEL
More informationHFAP Stroke Survey. Overview of the Survey Process 8/17/2011
HFAP Stroke Survey Surveyors Viewpoint Bernard C. McDonnell, D.O. Stroke Center Accreditation from the Surveyors Viewpoint 01.00.01 Primary stroke Center Facility Commitment. The leadership of the facility
More informationBUCKS COUNTY EMERGENCY HEALTH SERVICES ADVISORY COUNCIL NEWSLETTER WINTER 2008
BUCKS COUNTY EMERGENCY HEALTH SERVICES ADVISORY COUNCIL NEWSLETTER WINTER 2008. EXECUTIVE DIRECTOR REPORT Jeryl L. DeGideo Bucks County EHS Director During 2007 Bucks County EHS hosted 10 EMT classes,
More informationDNV GL - Healthcare Advisory Notice Notice No:
DNV GL - Healthcare Advisory Notice Notice No: 2015-06 DATE: September 3, 2015 SUBJECT: New Version Comprehensive Stroke Center Standards 2.0 DISTRIBUTION: All DNV GL - Healthcare Customers, Employees
More informationImplementation of Student Pharmacist-Led Anticoagulation Counseling
Implementation of Student Pharmacist-Led Anticoagulation Counseling Jamie Sebaaly, PharmD Candidate Class of 2013 UNC Eshelman School of Pharmacy Co-Investigator: Jenna M. Huggins, PharmD, BCPS Clinical
More informationDevelopment of a Database for Comparative Effectiveness Research (CER) on Prehospital and In-hospital Emergency Care
Development of a Database for Comparative Effectiveness Research (CER) on Prehospital and In-hospital Emergency Care Derek DeLia, Ph.D. Associate Research Professor Center for State Health Policy Academy
More informationAirStrip ONE Cardiology
AirStrip ONE Cardiology A Synchronized View of the Vital Patient Data Needed to Improve Care Heart disease is the leading cause of death in the U.S. The associated costs exceed $100 billion annually. AirStrip
More informationOHCAR National Out-of-Hospital Cardiac Arrest Register Project THIRD ANNUAL REPORT EXECUTIVE SUMMARY
OHCAR National Out-of-Hospital Cardiac Arrest Register Project THIRD ANNUAL REPORT EXECUTIVE SUMMARY FEBRUARY 2011 Overview of OHCAR The National Out-of-Hospital Cardiac Arrest Register Project (OHCAR)
More informationEMS Quality Improvement Program ( ) I. Authority II. Mission Statement III. Vision Statement... 2
Contents Emergency Medical Services Division Policies Procedures Protocols EMS Quality Improvement Program (1002.00) I. Authority... 2 II. Mission Statement... 2 III. Vision Statement... 2 IV. Kern County
More informationWhere do you fit in? STEMI System of Care. Saturday, May 16, a.m. to 12:15 p.m.
STEMI System of Care Where do you fit in? Fogelson Forum Auditorium 8200 Walnut Hill Lane Dallas, TX 75231 Saturday, May 16, 2015 8 a.m. to 12:15 p.m. CME presented by www.texashealth.org/cme Conference
More informationPre-Hospital. 8 Minutes stops the clock but doesn t burst the clot. Gerry Egan
Pre-Hospital 8 Minutes stops the clock but doesn t burst the clot Gerry Egan First contact ACC Medical Priority Dispatch System MPDS sets the questions SAS set the Call acuity SAS set the Response Cat
More informationObjectives. Emergency Medicine Risk Factors
The Uniqueness of Emergency Medicine Risk Management W. Peter Vellman, MD, FACEP Serio Physician Management, LLC Littleton, CO Objectives Recognize key areas impacting the provision of emergency medical
More informationAchieving the Triple Aim: Decreasing Use of Inappropriate Telemetry Monitoring
Achieving the Triple Aim: Decreasing Use of Inappropriate Telemetry Monitoring Marylynn Hippe, MSN, RN, ACNS-BC, CMSRN St. Luke s Health System Boise, Idaho Objectives Learners will understand the appropriate
More informationTIME CRITICAL DIAGNOSIS SYSTEM
TIME CRITICAL DIAGNOSIS SYSTEM Recommendations to Advance Emergency Medical Care for Stroke and STEMI in Missouri Time Critical Diagnosis System Task Force for Stroke and STEMI August 2008 online version
More informationCENTRAL CALIFORNIA EMERGENCY MEDICAL SERVICES
CENTRAL CALIFORNIA EMERGENCY MEDICAL SERVICES Manual Subject Emergency Medical Services Administrative Policies and Procedures First Responder Prehospital Care Report - BLS Policy Page 1 of 13 References
More informationMBQIP Measures Fact Sheets December 2017
December 2017 This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U1RRH29052, Rural Quality
More informationIMPORTANT INFORMATION. Subject: Santa Clara County EMS STEMI Care System - Effective August 4, 2008
Emergency Medical Services Agency 645 South Bascom Avenue San Jose, CA 95128 408.885.4250 408.885.3538 fax www.sccemsagency.org July 22, 2008 IMPORTANT INFORMATION To: From: Santa Clara County EMS System
More informationinterventional cardiac facility (see Appendix 2). Notify receiving hospital, as soon as possible of impending arrival of the patient and give ETA.
Page 1 of 9 Purpose: To define the decision-making process to be followed by EMS personnel in order to ensure patients are transported to a facility appropriate for their condition. I. Transportation Procedure
More informationResuscitation Centers of Excellence: Designation Process Rev January 2010
Resuscitation Centers of Excellence: Designation Process Rev January 2010 The Path to Improved Outcomes from Sudden Cardiac Arrest in the Austin/Travis County Area The concept of regionalized and specialized
More informationPATIENT CARE SERVICES REPORT Submitted to the Joint Conference Committee, November 2017
Report Contents: PATIENT CARE SERVICES REPORT Submitted to the Joint Conference Committee, November By: Terry Dentoni, MSN, RN, CNL - ZSFG Chief Nursing Officer 1. Professional Nursing.....1 2. Emergency
More informationChapter 190 Emergency Medical Service: Overview and Ground Transport
Chapter 190 Emergency Medical Service: Overview and Ground Transport Episode Overview There are multiple designs for EMS systems, including public and private services, those operating at basic and advanced
More informationClinical Resource Manual For The Protocol On Iabp
Clinical Resource Manual For The Protocol On Iabp perinatal or IABP transports) must follow the criteria listed below: 1. 01.10.03 Policies- A policy manual (electronic or hard copy) is available and Important
More informationStroke Coordinator Boot Camp
Stroke Coordinator Boot Camp Gena Kreiner RN BSN FHS Stroke Coordinator Karen C. Kiesz MN RN CNRN SCRN MHS Stroke Program Manager Lisa Shumaker, BSN, RN, CMSRN (Moderator) PRMC- Everett Stroke Program
More informationData 101. EMS Information Systems
EMS Information Systems Data 101 William Fales, MD, FACEP Western Michigan University Homer Stryker MD School of Medicine and Kalamazoo County Medical Control Authority William.fales@med.wmich.edu Disclosures
More information12/11/12 GUIDELINES FOR PEDIATRIC PREPAREDNESS. Na#onal Pediatric Readiness Project Institute of Medicine Report on EMS for Children
Na#onal Pediatric Readiness Project A Na%onal Assessment of Emergency Department Readiness for Children Katherine Remick, MD Visiting Assistant Professor in Medicine David Geffen School of Medicine at
More informationMONDAY, JULY 11, 2016
AGENDA A Workshop on the Institute of Medicine * Report, Strategies to Improve Cardiac Arrest Survival: A Time to Act July 11-12, 2016 National Academies of Sciences Building 2101 Constitution Ave., NW,
More informationCountywide Emergency Department Ambulance Patient Transfer of Care Report Performance Report
Countywide Emergency Department 9-1-1 Ambulance Patient Transfer of Care Report Performance Report Prepared by: Contra Costa Emergency Medical Services Visit us at www.cccems.org 2/28/2017 Patient Transfer
More informationDriving High-Value Care via Clinical Pathways. Andrew Buchert, MD Gabriella Butler, MSN, RN
Driving High-Value Care via Clinical Pathways Andrew Buchert, MD Gabriella Butler, MSN, RN 1 Andrew Buchert, MD Medical Director, Clinical Resource Management Children s Hospital of Pittsburgh of UPMC
More information