Transcript GWTG HFSA Poster 2006

Implementation of a Pre-Hospital 12-Lead ECG Program for the Treatment of STEMI
Patients in the City of Chicago: Lessons Learned from the Stroke System of Care
Atman P. Shah1, Eric Beck1, Joe Weber2, Leslee Stein-Spencer3, Stephen Archer4, Shyam Prabhakaran5, Ken Pearlman5, Richard Feldman6,
Kathleen O’Neill7, Art Miller7, Alex Meixner7, Eddie Markul6, Yanina Purim-Shem-Tov8, Adhir Shroff9, Gary L. Schaer8
1
University of Chicago Medicine, 2 John H. Stroger Jr Cook County Hospital, 3 Chicago Fire Department, 4Queens University School of Medicine, 5 Northwestern Memorial Hospital, 6 Advocate Illinois Masonic Hospital, 7 American Heart Association, Midwest Affiliate, 8 Rush
University Medical Center, Medical Center, 9 University of Illinois-Chicago Medical Center
Background
Methods
•Approximately 400,000 Americans suffer an acute ST
segment elevation myocardial infarction (STEMI)
each year.
•Early revascularization of the infarct related artery
reduces mortality and onset of heart failure.
•The AHA/ACC STEMI guidelines have highlighted
the importance of pre-hospital STEMI activation and
transportation to PCI capable hospitals.
•The 2013 ACC/AHA STEMI Guidelines1 state that:
• All Communities should create and maintain a
regional system of STEMI care (Ib).
• Performance of a 12-lead ECG by EMS is
recommended at first medical contact (Ib).
•Creation of a pre-hospital program of care
necessitates cooperation between stakeholders.
•The City of Chicago Fire Department (CFD) adopted
a pre-hospital stroke system of care (stroke SOC) in
March 2011.
•In May 2012, CFD launched a pre-hospital 12-lead
electrocardiogram (ECG) program designed to
transport patients (STEMI) to hospitals capable of
performing primary percutaneous coronary
intervention (pPCI).
•This project sought to identify lessons learned from
the initiation of the stroke SOC that proved
instrumental in developing the pre-hospital 12-lead
ECG program.
•The American Heart Association, the Chicago EMS
Medical Directors, and CFD leadership were involved in
the development of the stroke SOC.
•Their experiences with the stroke SOC were
instrumental and they were polled for the lessons they
felt were most instructive in establishing a pre-hospital
12-lead ECG program and a comprehensive STEMIsystem of care.
Results
Avoidance of SOC by Statute
Diversion Policy (T minus 5)
•IL law permits EMS diversion of stroke patients at
certain hospital-specific thresholds. A key stroke SOC
policy deters stroke patients from being diverted from
a dedicated stroke center. If the nearest stroke center
was on bypass, the patient could be taken to another
stroke center only if the 2nd center was < 5 minutes
away. This policy was instrumental in avoiding the
diversion of STEMI patients to a farther STEMI center
if the nearest one is on bypass.
•The STEMI SOC was initiated based on Illinois EMS
legislation that established a stroke SOC drafted by a
regional stroke advisory committee. Concurrent
attempts to establish a pre-hospital STEMI triage to
PCI capable hospitals was challenged by lack of
funding to outfit EMS with 12-lead ECG capability and
controversy regarding delegation of STEMI receiving
hospitals. Consensus was to avoid legislative creation
of a STEMI SOC.
EMS Empowerment
Cooperation & Collaboration
•Close cooperation between hospitals, EMS system
leadership and providers, municipal fire departments,
physicians, and regulators was crucial for planning,
implementation, and data collection.
P<0.0001
1: Illinois Masonic; 2: Advocate Trinity; 3: John H. Stroger Jr. Hospital; 4: Louis A. Weiss Hospital; 5: Mercy Hospital; 6: Mt. Sinai Hospital; 7: Northwestern Memorial Hospital; 8: Norwegian Hospital; 9: Our Lady of Resurrection Hospital;
10: Resurrection Medical Center; 11: Rush University Medical Center; 12: St. Joseph Hospital; 13: St. Mary Medical Center; 14: Swedish Covenant Hospital; 15: The University of Chicago Medicine; 16: University of Illinois; 17: Advocate
Christ Hospital; 18: Advocate Lutheran General Hospital; 19: Little Company of Mary Hospital; 20: Loyola University Medical Center; 21: MacNeal Hospital; 22: MetroSouth Medical Center; 23: St. Francis Medical Center; 24: West
Suburban Medical Center; 25: Franciscan St. Margaret Health; 26: Holy Cross Hospital; 27: Jackson Park Hospital; 28: Loretto Hospital; 29: Provident Hospital; 30: Roseland Community Hospital; 31: St. Anthony Hospital; 32: South Shore
Hospital; 33: St. Bernard Hospital; 34: Thorek Hospital
•Chicago EMS was able to identify a time critical
patient population in the pre-hospital setting through
education and triage protocols. Stroke SOC
protocols translated well for STEMI patients.
Continued education and ability to gather and track
data also allowed EMS to better serve the
community.
Disclosures
Conclusions
•The authors have no relevant financial disclosures.
•Lessons learned from the implementation of a pre-hospital stroke system of care facilitated implementation of a pre-hospital 12 lead ECG system of care for the City
of Chicago
1 O’Gara
PT, Kushner FG, Ascheim DD, Case DE, Chung MK, deLemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland
JE, Tommaso JE, Tracy CM, Woo J, Zhao DX. 2013 ACCF/AHA Guideline for the Management of STEMI. Circulation 2013:529-555.