American Heart Association EMS Survey Uncovers Deficiencies in Response, Treatment and Transfer of Patients with Most Deadly Heart Attacks

American Heart Association EMS Survey Uncovers Deficiencies in Response, Treatment and Transfer of Patients with Most Deadly Heart Attacks

Article May 31, 2009

DALLAS, Feb. 16 -- Preliminary results of one of the nation's largest national surveys of Emergency Medical Services (EMS) systems indicate the need for improvements in the way heart attack, specifically ST-elevation myocardial infarction (STEMI), is managed.

STEMI is the most serious and deadly type of heart attack, characterized by a complete blockage of a coronary artery. It requires rapid response and treatment to reopen the artery and restore blood flow to the heart muscle. The preferred treatment is primary percutaneous coronary intervention (PCI), which involves mechanically opening the artery using a small balloon to clear the blockage followed by the insertion of a stent, a type of scaffolding used to prop open the artery.

The American Heart Association conducted the survey as part of its Mission: Lifeline initiative to improve the response and treatment of STEMI patients and ultimately all heart attack patients. The association gave the survey October - December 2008 to more than 5,400 EMS system or agency directors and asked questions about staffing, funding, training, and existing processes for handling patients who have experienced a STEMI.

The most significant findings:

  • Only half of EMS systems have 12-lead electrocardiograms (ECGs), used to detect STEMI, on 75 percent or more of their vehicles.
  • Of EMS systems with 12-lead ECGs:
  • Most lacked a standard method for EMS to communicate the 12-Lead ECG results to the hospital. Currently, paramedics use one or more of the following methods: verbally reporting the ECG algorithm (an automatic, software-generated analysis of the ECG reading); verbally reporting their own interpretation of the ECG reading; or using an advanced technology like Blue Tooth or mobile phone to transmit the ECG algorithm or reading.
  • EMS field personnel remotely activate hospital catheterization ("cath") labs only 40 percent of the time. (Cath labs perform procedures like angioplasty and stenting). This can significantly delay evaluation and treatment.
  • Destination protocols are only used a third of the time to enable EMS to take STEMI patients directly to a hospital capable of providing angioplasty/stenting 24 hours a day, seven days a week. Instead, many EMS departments take patients to the closest hospital, which can cause significant delays to appropriate care.
  • Only about 20 percent of hospitals are able to perform procedures like angioplasty and stenting for STEMI patients 24 hours a day, seven days a week.

"We were encouraged that more EMS systems than anticipated had vehicles equipped with 12 lead ECGs, devices that diagnose STEMI and other heart attacks," said Robert E. O'Connor, M.D., chair of the American Heart Association's Mission: Lifeline Emergency Cardiovascular Care task force. "However, we found the need for better systems to allow EMS to transmit data from ECGs and activate the cath lab on the way to the hospital and for policies allowing them to take patients to the facility able to provide appropriate care, whether it's the closest facility or not."

According to the American College of Cardiology/American Heart Association guidelines, primary PCI, typically balloon angioplasty with stenting, is the preferred treatment over clot busting drugs if it can be achieved within 90 minutes. EMS is a critical part of the system of care to decrease time to treatment for STEMI patients.

In coming months, the association's staff will receive survey data for their state or region and share it with coalitions composed of EMS and hospital personnel, physicians and nurses and health policy makers. The coalitions will use the information to create appropriate plans to improve the care of STEMI patients.

"EMS systems are the point of entry for all heart attack patients and are extremely important to reducing delays to STEMI care," said Alice K. Jacobs, M.D., former president of the American Heart Association and chair of the Mission: Lifeline advisory working group. "Our survey provides the American Heart Association and its coalition partners a great snapshot of their local EMS and where we need to make progress. It confirms the need for better coordination between EMS, emergency departments and hospitals in order to do what's best for the patient."

Other findings include:

  • More paramedics should receive training on interpreting 12 lead ECGs.
  • Funding is needed for additional 12 lead ECG devices and training.
  • Information sharing between EMS and hospitals is poor, so it's difficult to track the quality of care a patient receives as they move from EMS to hospital-based care. Confidentiality requirements are hindering the process.
Continue Reading

The need for Mission: Lifeline

Each year, about 400,000 people in the U.S. have a type of heart attack known as STEMI, in which blood flow is completely blocked to a portion of the heart. Unless the blockage is eliminated quickly, the patient's health and life are at serious risk. The American Heart Association recommends that STEMI patients receive PCI procedures like angioplasty to restore blood flow to the heart muscle within 90 minutes. The association created Mission: Lifeline to close the gaps that separate STEMI patients from timely access to appropriate treatment. For more information about Mission: Lifeline, visit www.americanheart.org/missionlifeline.

State troopers rendered aid before turning them over to responding EMS units and New Castle County Paramedics.
Three people were fatally shot and at least 21 others were wounded in separate attacks from Saturday morning to early Sunday.
Crestline Coach attended the Eighth Annual Saskatchewan Health & Safety Leadership conference on June 8 to publicly sign the “Mission: Zero” charter on behalf of the organization, its employees and their families.
ImageTrend, Inc. announced the winners of the 2017 Hooley Awards, which recognize those who are serving in a new or innovative way to meet the needs of their organization, including developing programs or solutions to benefit providers, administrators, or the community.
Firefighters trained with the local hospital in a drill involving a chemical spill, practicing a decontamination process and setting up a mass casualty tent for patient treatment.
Many oppose officials nationwide who propose limiting Narcan treatment on patients who overdose multiple times to save city dollars, saying it's their job to save lives, not to play God.
While it's unclear what exact substance they were exposed to while treating a patient for cardiac arrest, two paramedics, an EMT and a fire chief were observed at a hospital after experiencing high blood pressure, rapid heartbeat, and mood changes.
After a forest fire broke out, students, residents and nursing home residents were evacuated and treated for light smoke inhalation before police started allowing people to return to their buildings.
AAA’s Stars of Life program celebrates the contributions of ambulance professionals who have gone above and beyond the call of duty in service to their communities or the EMS profession.
Forthcoming events across the country will provide a forum for questions and ideas
The Harris County Office of Homeland Security & Emergency Management (HCOHSEM) has released its 2016 Annual Report summarizing HCOHSEM’s challenges, operations and key accomplishments during the past year.
Patients living in rural areas can wait up to 30 minutes on average for EMS to arrive, whereas suburban or urban residents will wait up to an average of seven minutes.
Tony Spadaro immediately started performing CPR on his wife, Donna, when she went into cardiac arrest, contributing to her survival coupled with the quick response of the local EMS team, who administered an AED shock to restore her heartbeat.
Sunstar Paramedics’ clinical services department and employee Stephen Glatstein received statewide awards.