EMS Survey Finds Deficiencies in Response,
Treatment, Transfer of Patients With Most Deadly Heart Attacks
American Heart Associations Mission:Lifeline study
did find more than anticipated had 12 lead ECGs that diagnose heart
attacks
Feb.
18, 2009 Senior citizens, the most likely people to have a heart
attack requiring a ride in an Emergency Medical Services (EMS) vehicle,
can find hope in a new survey by the American Heart Associations
Mission:Lifeline study that found more than anticipated had 12 lead ECGs
that diagnose heart attacks. But, the association urges other
improvements.
Preliminary results of one of the nation's largest
national surveys of 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.
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.
"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.
Keep up with the latest news for senior citizens, baby
boomers
Feb.
18, 2009 Senior citizens, the most likely people to have a heart
attack requiring a ride in an Emergency Medical Services (EMS) vehicle,
can find hope in a new survey by the American Heart Associations
Mission:Lifeline study that found more than anticipated had 12 lead ECGs
that diagnose heart attacks. But, the association urges other
improvements.