Performance trends

Why is this measure important?

A "STEMI" (ST-segment elevation myocardial infarction) occurs when a coronary artery is totally occluded by a blood clot. Interventions in this type of heart attack by interventional cardiologists in catheterization ("Cath") labs have been proven to extend hundreds of thousands of lives nationally. MCFRS is able to acquire an electrocardiogram (ECG) quickly and alert the hospital of a patient with a possible STEMI, so that the hospital can activate the Cath Lab prior to the patient's arrival; thus, decreasing the amount of time the patient will continue to suffer. This also reduces the amount of heart tissue that will be damaged as a result of the heart attack.

Factors contributing to current performance

  • Emergency Medical Dispatch (EMD) protocols required by the Maryland Institute for Emergency Medical Services Systems.
  • Rapid ALS care and transport by skilled ALS providers.
  • Use of 12-lead ECG monitors.
  • Use of Lifenet system to transmit first diagnostic electrocardiogram (ECG) directly to the hospital to activate STEMI response team.
  • Four catheterization labs in Montgomery County.
  • Use of Electronic Patient Care Report (ePCR).
  • On 4/15/18, MCFRS increased its daily complement of ALS resources by upgrading Engine 702 and E720 to Paramedic Engines and adding ALS725 (paramedic chase unit) at Station 25.

Factors restricting performance improvement

  • Behavior of individuals experiencing STEMI: Ignoring the signs of a cardiac event, hesitating to call 911.
  • Demographic factors: Age, race/ethnicity, gender.
  • Patient stability: Signs/symptoms presented by the STEMI patient upon arrival in the hospital emergency room can delay transfer to the catheterization lab.
  • Traffic congestion, resulting in delayed response time and transport time.

Performance improvement plan

  • Educating the public on recognition of a cardiac event occurring, and partnering with the Montgomery County Department of Health & Human Services to encourage cardiac-healthy lifestyles of residents.
  • Training of new ALS providers in basic 12-lead ECG recognition.
  • Continued education for existing ALS providers in advanced 12-lead ECG recognition.
  • Tracking EMS-to-balloon (E2B) time vs. door-to-balloon (D2B) time to better capture the EMS component of the joint EMS/hospital STEMI response system. [E2B tracking is made possible through use of Lifenet.]
  • Implementation of the plan to better distribute paramedics and utilize them more efficiently through deployment of additional paramedic chase units.

SUPPORTING MEASURES

Percentage of STEMI patients receiving complete ''bundle of care''

Percentage of STEMI events with scene time by ALS providers of 15 minutes or less