Transcript Slide 1

Mission: Lifeline® EMS Recognition
4/25/2020
©2013, American Heart Association
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Agenda
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Evolution of Mission: Lifeline®
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Recognizing the critical role of EMS in STEMI systems of Care
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Certificates, press kits, etc.
Application Process and timeline
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Program and compliance requirements
Achievement and reporting measures
Recognized Agency Award Promotional Opportunities
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Formulated to match current hospital programs
Award Requirements and Measures
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Value of EMS recognition
Program Structure
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Introduction and program history
Current statistics and guidelines
Free online application tool
Sign off of Medical Director, EMS trainer, Quality Director
Staying Connected and Up-to-Date
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Mission: Lifeline is the American Heart Association’s
national initiative to advance systems of care for
patients suffering from Acute Myocardial Infarction
(AMI) and/or Cardiac Resuscitation. The overarching
goal of this initiative is to reduce existing barriers to
efficient treatment so that death and disability can be
reduced.
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Mission: Lifeline’s Guiding Principles
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Patient-centered care as the #1 priority
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High-quality care that is safe, effective and timely
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Stakeholder consensus
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Increased operational efficiencies
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Appropriate incentives for quality
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Measurable patient outcomes
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An evaluation mechanism
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A role for local community hospitals
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A reduction in disparities of
healthcare delivery
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The Reality of Today’s Patients
• 60% of STEMI patients call 911
• “Walk-in” patient potential delays
– Registration
– Quick triage to electrocardiograms (ECG)
for diagnosis
– ECG privacy
– Advanced warning to activate hospital
staff to prepare for reperfusion
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Barriers to Timely Reperfusion
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The Patient
– Failure to promptly recognize symptoms
– Hesitation to seek medical attention
– Not activating 9-1-1 (self transport)
Pre-Hospital (EMS)
– Inability to perform 12 lead ECG (lack of equipment)
– Variable clinical presentation
– Not providing alert to hospital for positive ECG results
– Lack of bypass protocols
– Long transport in rural areas (Adverse Weather)
Decision Process on Arrival
– Lack of Pre-determined Treatment Protocol Lytics vs. PCI
– Off Hours, Low Staffing, etc.
– Transfer to PCI facility
Time to implement treatment strategy
– Procedural Factors
– Team Assembly
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Ideal Systems of Care
Each community should develop a system of care following the standards developed
for Mission Lifeline (AHA) including:
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Ongoing multidisciplinary team meetings with EMS, non-PCI, and PCI centers
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A process for prehospital identification and activation
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Destination protocols
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Transfer protocols for referring centers for appropriate patients
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The Ideal System of Care
Referring Hospital
(non PCI-capable)
Patient
Ambulance / EMS
Public
Receiving Center
(PCI-Capable)
Payers
Health Agencies
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Policy Makers
©2013, American Heart Association
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History of Mission: Lifeline
MAY 2007
Eleven manuscripts are
published in Circulation
Mission: Lifeline was
formally launched
2010 - 2011
2010 - Mission: Lifeline
releases hospital reports
and hospital
recognition program
2011 - AHA collaborates
with SCPC and hospital
accreditation program
released
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APRIL 2012
Mission: Lifeline
announces the addition of
Cardiac Resuscitation
systems of care to the
program
2013 - PRESENT
312 hospitals meet
recognition criteria
EMS recognition program
is developed and initial
launch communications
begin
EMS recognition
applications can be
submitted starting Jan 1
2014 for data collected in
the 2013 calendar year.
©2013, American Heart Association
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Odds Ratio For Death
National Registry of Myocardial Infarctions (NRMI):
Primary PCI “Door-to-Balloon Time vs. Mortality”
P=0.0007
P=0.01
n = 2,30
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P=0.0003
5,734
6,616
4,461
2,627
5,412
Door-to-Balloon Time (minutes)
©2013, American Heart Association
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JAMA 2000; 283:284 1-47
EMS Survey Results
Survey conducted April 2008 through January 2010 with 381 unique systems involving 899 PCI
hospitals from 47 states, describes the organizational characteristics of collaborative efforts by
hospitals and EMS to provide timely reperfusion in the United States.
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Respondents identified the following interventions likely to improve treatment times:
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direct activation of the catheterization laboratory by EMS
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destination protocols,
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inter-hospital transfer protocols,
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data collection using national data
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timely feedback to healthcare providers
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Jollis “Systems of Care” Circulation 2012
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50% reported the availability of 12-lead ECGs in their vehicles
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35% having the ability to transmit the ECGs
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15% enabled EMS to directly activate the CCL for positive ECG results
“decisions on treating STEMI occur well before they reach the hospital We rely on paramedics
and nurses to diagnose patients with STEMI and activate the healthcare team.”
Jollis J, Granger CB, Henry TD, Antman EM, Berger PB, Moyer PH, Pratt FD, Rokos IC, Acuna AR, Roetig ML, Jacobs AK.
Systems of care for ST-elevation myocardial infarction: a report from the AHA Mission: Lifeline program. Circ
Cardiovasc Qual Outcomes published online May 22, 2012;DOI: 10.1161/CIRCOUTCOMES.111.964668
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60% of STEMI patients call EMS for
transport
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Use of EMS transportation is
associated with substantial
reductions in ischemic time and
treatment delays
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Community education efforts are
needed to improve the use of
emergency transport as part of
system-wide strategies to improve
STEMI reperfusion care.
Use of Emergency Medical Service Transport Among Patients With ST-Segment–Elevation Myocardial Infarction Findings From the National
Cardiovascular Data Registry Acute Coronary Treatment Intervention Outcomes Network Registry–Get With the Guidelines
Robin Mathews, MD; Eric D. Peterson, MD, MPH; Shuang Li, MS; Matthew T. Roe, MD, MHS; (Circulation. 2011;124:154-163.)
Regional Systems of STEMI Care, Reperfusion Therapy, and Time-toTreatment Goals
I IIa IIb III
I IIa IIb III
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All communities should create and maintain a regional system of
STEMI care that includes assessment and continuous quality
improvement of EMS and hospital-based activities. Performance
can be facilitated by participating in programs such as Mission:
Lifeline and the D2B Alliance.
Performance of a 12-lead ECG by EMS personnel at the site of
FMC is recommended in patients with symptoms consistent with
STEMI.
©2013, American Heart Association
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Regional Systems of STEMI Care, Reperfusion Therapy, and Time-toTreatment Goals
I IIa IIb III
Reperfusion therapy should be administered to all eligible patients
with STEMI with symptom onset within the prior 12 hours.
I IIa IIb III
Primary PCI is the recommended method of reperfusion when it
can be performed in a timely fashion by experienced operators.
I IIa IIb III
EMS transport directly to a PCI-capable hospital for primary PCI is
the recommended triage strategy for patients with STEMI with an
ideal FMC-to-device time system goal of 90 minutes or less.*
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Regional Systems of STEMI Care, Reperfusion Therapy, and Time-toTreatment Goals
I IIa IIb III
I IIa IIb III
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Immediate transfer to a PCI-capable hospital for primary PCI is the
recommended triage strategy for patients with STEMI who initially
arrive at or are transported to a non–PCI-capable hospital, with an
FMC-to-device time system goal of 120 minutes or less.*
In the absence of contraindications, fibrinolytic therapy should be
administered to patients with STEMI at non–PCI-capable hospitals
when the anticipated FMC-to-device time at a PCI-capable hospital
exceeds 120 minutes because of unavoidable delays.
©2013, American Heart Association
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Imagine Taking a Step Back In History
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Regional door-to-balloon: Total time <120 minutes
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15
60
Regional ECG to activation
Door-to-ECG 15 minutes
5 minutes
Regional
ED arrival
pt with
chest
pain
ECG
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Activation to Door 2
60 minutes
Door 2 to balloon
30 minutes
XX X X X XX X
Regional
ED
staff MD
evaluation
Call
SMH ED
Regional
ED
arrange
transport
Patient
Transfer
to
SMH ED
SMH ED
MD
evaluation
CCU
Fellow
evaluation
CCU
staff MD
evaluation
Cath lab
activation
PCI
First Medical Contact to Device ≤ 90 Minutes
Patient with
chest pain
dials 9-1-1
PH ECG
+ for
ST-elevation
Does
Hospital
Administer
Lytics?
Alert Hospital
YES
Consider
Hospital
Bypass
Eligible for
Lytics?
(Reperfusion
Checklist)
Receiving
Hospital
Arrival
CATH TEAM
IS READY
YES
ED Arrival
PCI
Lytic
administration
DOOR TO NEEDLE TIME ≤ 30 Minutes
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Value of EMS Recognition
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Integration with Hospitals
– Optimization vs. Fragmentation
– EMS Feedback Processes
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Quality improvement
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Expansion of Scope of Practice
– Destination Protocols
– EMT ECG Acquisition Transmission
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Recognition Program Structure
ANNUAL RECOGNITION
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Awards based on data submitted for the previous calendar year (January – December)
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Ex: 2014 Awards are based on data from January 2013 – December 2013
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Recognition awarded once a year
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Awards are valid for one year
TIERED AWARD LEVELS BASED ON DURATION OF CRITERIA COMPLIANCE
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Like the current hospital recognition program, awards are tiered as Bronze, Silver, or Gold.
MUST HAVE 12-LEAD ECG CAPABILITIES TO PARTICIPATE
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Required for achievement measures
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Volume and Compliance Timeframes
BRONZE
SILVER
GOLD
90 calendar days (1 calendar
quarter) of Mission: Lifeline
compliance criteria.
One calendar year achieving
overall composite scores of
Mission: Lifeline compliance
criteria.
Two consecutive calendar
years achieving overall
composite scores of Mission:
Lifeline compliance criteria.
CRITERIA COMPLIANCE
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Must meet 85% or greater composite score with no single measure below 75% for
specified periods of time
VOLUME REQUIREMENTS
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4 or more STEMI patients for the year
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Minimum of 2 STEMI patient in the reporting quarter
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Achievement Measures
• Percentage of patients with non-traumatic chest pain, ≥ 35 years, treated and
transported by EMS who get a pre-hospital 12-lead electrocardiogram
• Percentage of STEMI patients transported directly to a STEMI receiving center,
with first (pre-hospital) medical contact to device time  90 minutes
• Percentage of lytic eligible STEMI patients treated and transported to a referring
hospital for fibrinolytic therapy with a door to needle time  30 minutes
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Required Measures
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All agencies must fulfill Achievement Measure #1 (Percentage of patients with nontraumatic chest pain, ≥ 35 years, treated and transported by EMS who get a pre-hospital 12lead electrocardiogram) and Measure #2 AND/OR Measure #3 depending on current
transfer protocols.
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Agencies which transport to both PCI capable and Non-PCI capable hospitals will report
measures #1, 2, and 3.
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Agencies which only transport to PCI capable hospitals will report measures #1 and #2.
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Agencies which only transport to non-PCI capable hospitals will report measures #1 and #3.
*Only 2 measures meeting compliance will be required for recognition
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Other Measures
REPORTING MEASURES
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Time from symptom onset to EMS dispatch
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Time from EMS dispatch to vehicle arrival at hospital door
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Percentage of STEMI patients treated and transported to a referring hospital for fibrinolytics
therapy who have the Fibrinolytic Checklist completed
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Percentage of patients with STEMI treated and transported by EMS who get a pre-hospital
12-leadelectrocardiogram
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Percentage of patients with field diagnosis of STEMI and field activation of the cardiac
catheterization laboratory or STEMI receiving center for intended primary PCI
**Reporting measures will not be collected or considered for EMS recognition.
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Recognition Awards
RECOGNITION BENEFITS
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Certificate
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Press Kit
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Media press release templates
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Icons for websites or other use
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Pre-made advertisement template
Additional materials will be made available for purchase:
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Examples: Pins, Patches, Decals for Ambulances and
Trucks (Gold only)
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2014 Data Submission Timeline
DATA SUBMISSION
DATA REVIEW
RECOGNITION AWARDS
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January 1, 2014 –
February 28, 2014
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March 1, 2014 through
May, 2014
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Award notification sent
Mid April through May
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Submit summary of
quarterly data covering
Q1-Q4 of 2013
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Data summary
submissions will be
reviewed by National
Center Mission: Lifeline
Personnel
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Recognized agencies
will receive notification
of status, certificate and
press / promo packages
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Data Collection and Submission
DATA SUBMISSION PROCESS AND TIMELINES
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One time annual application via free online EMS Recognition Application tool
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Continuous data collection occurs independently of the Mission: Lifeline application tool
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Worksheets for inclusion / exclusion criteria will be available
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Online EMS recognition application tool available January 1 – February 28th for quarterly
summary data submission.
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Award notifications will be distributed beginning in Mid-April through May, 2014
January 1, 2013 –
December 31, 2013
Data reporting period
4/25/2020
January 1, 2014 –
February, 28 2014
March 1, 2014 – Mid
April, 2014
Mid April, 2014 –
May 2014
Data submission
available for award
application
Mission: Lifeline
Review of award
applications
Award notification to
Recognized EMS
agencies
©2013, American Heart Association
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Stay Connected
FACEBOOK
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www.facebook.com/AHAMissionlifeline
MISSION: LIFELINE NETWORK – EMS CENTRAL
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http://MLnetwork.heart.org/EMS
MISSION: LIFELINE HOMEPAGE AND RECOGNITION SITE
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http://www.heart.org/Missionlifeline
VISIT US AT:
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Contact us: [email protected]
©2013, American Heart Association
http://www.heart.org/missionlifeline
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