AHA M:L survey reveals problems

News release

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

The American Heart Association’s Mission: Lifeline (AHA ML) conducted a survey of the nation’s EMS systems.

Significant findings include:

  • Only half of EMS systems have 12 lead ECG monitors 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 results to the hospital. Currently, paramedics use one or more of the following methods: 1.) verbally reporting the computerized interpretation, 2.) verbally reporting their own interpretation of the ECG reading, or 3.) using an advanced technology like Bluetooth or mobile phone to transmit the ECG for physician interpretation.
  • EMS field personnel remotely activate hospital catheterization labs only 40 percent of the time. 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 primary PCI 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 primary PCI 24 hours a day, seven days a week.

Robert E. O’Connor MD, chair of the AHA ML ECC task force said:

“We were encouraged that more EMS systems than anticipated had vehicles equipped with 12 lead ECGs, devices that diagnose STEMI and other heart attacks. 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.”

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.

One gripe that I’m hearing already is that the AHA ML survey did not take into account tiered systems like King County Medic One. Apparently a minority of ambulances in that system are ALS (with 12 lead monitors) and yet it’s one of the best EMS systems in the country.

That’s a fair point! It doesn’t matter whether or not every ambulance in the system has a 12 lead monitor. What matters is that ACS patients get an ambulance with a 12 lead monitor.

5 Comments

  • Bob Jester says:

    Here in the peoples republic of new jersey 12 lead monitors have been on the required list for ALS providers for at least 3 years. I’m not sure what the other ALS providers are doing with theirs, but Atlanticare (my department) and the University of Medicine and Dentistry of New Jersey EMS are the only programs in the state with a standardized system for pre- arrival activation of the CCL. My Medical Director and his opposite number up at the “U” are working with NJOEMS on field triage guidelines for STEMI that are similar to the trauma triage guidelines. I don’t know when they will be coming out, but I’m sure if you look to the northern horizon you’ll be able to detect the faint glow of the s**tstorm that erupts from the non PCI hospitals ;). As part of our QA/QI process any patient that arrives at the ED via EMS and winds up in the cath lab is automatically referred to the EMS peer review team. So far we haven’t found any that should have been called due to prehospital 12 lead irregularities.

  • Tom B says:

    That’s awesome, Bob! I’m looking forward to seeing something published on it! Tom

  • Bob Jester says:

    I understand that the going is slow and the folks involved are trying to coalition build as they go along. I asked about publishing our experiences and first year numbers for our STEMI alert program and he was receptive, but he’s got a lot on his plate.

  • Great points…unfortunately until programs are truly standardizated and in part funded by an organization, vendor or government, there will be variability depending where you are geographically. I agree with you – take me to the center that has PCI capabilities if I am having an STEMI. There is no reason, in my humble opinion that it’s optional for EMS and hospital organizations to participate in initiatives such as ML and deliver evidence-based STEMI and/or Stroke care. Any barriers that an organization has should be addressed and remedied in a partnership with their local hospital or regional system.

  • Bob Jester says:

    Barefoot Nurse wrote in part: There is no reason, in my humble opinion that it’s optional for EMS and hospital organizations to participate in initiatives such as ML and deliver evidence-based STEMI and/or Stroke care. Any barriers that an organization has should be addressed and remedied in a partnership with their local hospital or regional system.And I reply:We have a special set of circumstances here in the peoples republic of new jersey. We run a dual tiered system using local transporting BLS agencies and regional hospital based intercept paramedics, there is no regional dispatch agency, each municipality is it’s own PSAP and makes phone requests for paramedic response to our dispatch center so there’s a built in delay in getting us out the door. Second is the brand loyalty of most of our patient population, patients of “hospital x” don’t want to go anywhere else. We are having a good bit of success in combating this by doing some bedside education about how STEMI is treated and the benefits of going direct to the PCI capable hospital. Thirdly is the loyalty the squads have to the local hospitals and the fact that we are at the whim of the person behind the wheel, we are slowly making headway in teaching the closest appropriate hospital as opposed to the closest hospital. The biggest obstacle is the non PCI hospitals and the loss of revenue on patients they see and transfer to a PCI hospital they have an affiliation with.As always, my view is from the street and is limited to my own little corner of the pond. YMMV!

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