1. 9/18/2018
©2011, American Heart Association

2. MISSION: LIFELINE EMS RECOGNITION

3. Mission: Lifeline EMS Recognition Updates
Part 1 of 2

4. Objectives for Today Review the EMS Recognition Measures
Discuss data collection strategies
Provide a brief update of the 2014 changes
Question & Answers
9/18/2018
©2010, American Heart Association

5. Ben Leonard Mic Gunderson
Presenter/Panelist
Ben Leonard
Mission: Lifeline Director
Casper, WY
Mic Gunderson
Director of Clinical Systems Lakeland, Florida
9/18/2018
©2010, American Heart Association

6. EMS Recognition FAQ Brief note on Mission: Lifeline Recognition
Mission: Lifeline is a program that is focused on the “system” of care.
Main goal is minimizing time from incident (disruption of cardiovascular blood flow) to reperfusion (either PCI or Thrombolysis)
The program is backed by current published guidelines and recommendations.
Component of the program is to recognize stakeholders that perform in accordance with the guidelines > Hence Mission: Lifeline Recognition Awards for Hospitals (Receiving and Referring) and EMS Agencies.
9/18/2018
©2013, American Heart Association

7. Mission: Lifeline EMS Recognition Measures
Open this section for people to share their ideas on data collection.
Collect the number of patients that are 35 years or older, that complain of non traumatic chest pain (consistent with ACS- Mic, can we add this statement?)- (Denominator)
Of those, how many received a 12 lead ECG? (Numerator)
Track the STEMIs that were recognized by EMS crews
The modifiable tool is available on the website
You also want to be tracking the Fire, BLS, Flight crews that are responding on the STEMIs. (Mic, can we talk about the tiered award?)
What vendors are some services using- How are they running reports?
Did any of the tools that were provided from the EMS Recog website useful?
9/18/2018
©2011, American Heart Association

8. MEASURE 1 – Collecting the data
% 12 Lead ECG Acquired
MEASURE 1 – Collecting the data
INCLUSION CRITERIA:
Denominator
Number of Patients with c/c Non-Traumatic Chest Pain
Number of Patients that are 35 years of age or over
Numerator
Number of the patients included in the denominator that had a Pre-Hospital 12 Lead ECG acquired
9/18/2018
©2011, American Heart Association

9. % FMC to Device Activation/Primary PCI < 90 Minutes
Measure 2 – collecting the data
INCLUSION CRITERIA
Denominator
Number of Patients (18 years of age or over) with a STEMI noted on Pre-Hospital ECG
AND Were transported to a STEMI Receiving Center
AND Had Primary PCI Performed
Numerator
Number of patients in the denominator where the total time from Pre-hospital FMC to Device activation/Primary PCI was achieved in 90 minutes or less
9/18/2018
©2011, American Heart Association

10. % FMC to Device Activation/Primary PCI < 90 Minutes
Measure 2 – collecting the data
REPORTING OUTLIERS/APPLYING EXCLUSIONS
Report the number of patients, included in the denominator volumes, where the total time from pre-hospital FMC to device activation/Primary PCI was more than 90 minutes.
Using the outlier volume, identify the number of patients that experienced one or more of the allowable exclusions:
Delay caused by patient or family providing consent for treatment/transport
Delay caused by patient experiencing cardiac arrest and/or the need for intubation
Delay caused by difficulty in accessing femoral or radial artery (cath lab)
Delay caused by difficulty in crossing coronary lesion (cath lab)
9/18/2018
©2011, American Heart Association

11. % Arrival to Fibrinolytic Administration < 30 Minutes
Measure 3 – collecting the data
INCLUSION CRITERIA
Denominator
Number of Patients (18 years of age or over) with a STEMI noted on Pre-Hospital ECG
AND Were transported to a STEMI Referring Center
AND Had Fibrinolytic Therapy Administered
Numerator
Number of patients in the denominator where the total time from Arrival at the Referring Center to Fibrinolytic Administration was achieved in 30 minutes or less
9/18/2018
©2011, American Heart Association

12. % Arrival to Fibrinolytic Administration < 30 Minutes
Measure 3 – collecting the data
REPORTING OUTLIERS/APPLYING EXCLUSIONS
Report the number of patients, included in the denominator volumes, where the total time from Arrival at the Referring Center to Fibrinolytic Administration was greater than 30 minutes.
Using the outlier volume, identify the number of patients that experienced one or more of the allowable exclusions:
Delay caused by patient or family providing consent for treatment/transport
Delay caused by patient experiencing cardiac arrest and/or the need for intubation
9/18/2018
©2014, American Heart Association

13. Pre-hospital Impact on Fibrinolytic Administration
December 2013 ACTION Registry-GWTG Data shows
Only 44% of the patients that receive Fibrinolytic Therapy do so in 30 minutes or less
When patients are transported from the field to a STEMI Referring Center, the events that occur in the pre-hospital environment affect the timeliness of care in the ED
Early identification of the STEMI via 12 Lead ECG
Completion of the Pre-Hospital Lytic Checklist
IF patient is identified as Lytic Ineligible – consider by-pass of the referring center and transport directly to the STEMI Receiving Center (PCI Hospital)
Early notification of the STEMI patient to the Referring Center
Early ED preparation for STEMI patient’s arrival
Early administration of Fibrinolytics (Lytics)
9/18/2018
©2011, American Heart Association

14. Exclusions TRACKING EXCLUSIONS TIPS
A patient may only be applied once in the exclusions – even if the patient meets more than 1 of the criteria
The exclusions regarding delays in consent and the need for CPR and/or intubation can be used when these delays occur with EMS or when they occur after arrival to the destination center
In the application, the achievement will be calculated with the excluded patients applied to the original denominator
9/18/2018
©2011, American Heart Association

15. EMS Data Collection Workbook
Template for follow up data collection on patients treated and transported to a STEMI receiving Center or a STEMI Referring Center
9/18/2018
©2013, American Heart Association

16. 2015 EMS Recognition Updates
9/18/2018
©2011, American Heart Association

17. Mission: Lifeline EMS Recognition Volume Requirements
BRONZE: A minimum of 75% compliance for each required measure.
o Volume: at least 2 STEMI patients per reporting quarter with at least 4 STEMI patients in the 2014 calendar year.
For Bronze, there are no changes regarding volume.
9/18/2018
©2011, American Heart Association

18. Mission: Lifeline EMS Recognition Volume Requirements
SILVER: Aggregated annual score achieving a minimum of 75% compliance for each required measure.
o Volume: at least 8 STEMI patients in the 2014 calendar year.
For Silver, the biggest change is taking away the quarterly requirement. Previously, Silver was awarded if each of the reporting quarters were above 75%. With the new change, the combined (or aggregate) score for the entire year will be counted.
Ex: 1 STEMI in Q1, 4 STEMIs in Q2, 3 STEMIs in Q3 and 7 STEMI in Q4. Total for the year is 15. If the 1 STEMI in Q1 had a FMC to Balloon time of 92 min, the service would fall from Silver eligibility.
For an Aggregate Silver score, 12 of the 15 patients, would have to have FMC to Balloon time of 90 min or less. ( 75% would be patients.)
9/18/2018
©2011, American Heart Association

19. Mission: Lifeline EMS Recognition Volume Requirements
GOLD: 2 calendar years achieving an annual Aggregate minimum of 75% for each required measure.
o Volume at least 8 STEMI patients in the 2014 calendar year.
Must have achieved a SILVER Award in 2014
For Silver, the biggest change is taking away the quarterly requirement. Previously, Silver was awarded if each of the reporting quarters were above 75%. With the new change, the combined (or aggregate) score for the entire year will be counted.
Ex: 1 STEMI in Q1, 4 STEMIs in Q2, 3 STEMIs in Q3 and 7 STEMI in Q4. Total for the year is 15. If the 1 STEMI in Q1 had a FMC to Balloon time of 92 min, the service would fall from Silver eligibility.
For an Aggregate Silver score, 12 of the 15 patients, would have to have FMC to Balloon time of 90 min or less. ( 75% would be patients.)
Silver award winners from the previous year can receive a Bronze this year if volumes are low in 2014.
9/18/2018
©2011, American Heart Association

20. 2015 EMS Recognition Application (almost final – subject to change)
INDIVIDUAL APPLICATION
TEAM APPLICATION
JOINT APPLICATION
No change from 2014
EMS agency/department acquires the 12 lead ECG AND Transports the patient to the destination hospital
Applying agency name will be on the Award Certificate
Applying agency must meet the volume criteria
Primary EMS Agency must complete the application
Primary EMS Agency has the option to name any/all Medical First Responding agencies/departments that provide a coordinated response to the possible STEMI patients
Applying agency name will be on the Award Certificate
All Medical First Responder agencies/departments will also be included on the Award Certificate
Applying agency must meet the volume criteria
Designed for agencies/departments where one agency acquires the 12 Lead ECG and a second agency either provides the transport to the destination hospital or provides the Paramedic to treat the patient
The 2 agencies/departments must apply together in one application
The volume criteria must be met with patients where the 2 applying agencies/departments treat the same patients
9/18/2018
©2014, American Heart Association

21. 2015 Mission: Lifeline EMS Recognition Timeline
9/18/2018
©2014, American Heart Association

22. Lessons Learned (Per 2014 Post-Recognition Survey) Sent to all agencies that achieved a level of EMS Recognition
Why are we (EMS) held accountable for the PCI time? We (EMS) have no control over patient care once the patient is at the hospital.
Mission: Lifeline – Looks at STEMI care from a SYSTEM perspective
Dispatch
Medical First Responders
EMS (Air/911 and Interfacility)
STEMI Recieving Centers
STEMI Referring Centers
9/18/2018
2012 AHA Mission: Lifeline

23. EMS can AFFECT Care Attend the STEMI Multidisciplinary Team Meetings
Monthly or Quarterly
Non-Punitive
Collaborative and Supportive
Provide Feedback to each other
Collaborate with the hospital to look at process improvement opportunities
Participate in Mock STEMI Drills
Together with the STEMI Receiving Center – Develop a Pre-Hospital Activation Process
Review Internal Data and present to the multidisciplinary team
Time of Call – Time of Arrival (Avg)
Time of Arrival – Time of ECG
Time of STEMI Identification – Notification at destination hospital
9/18/2018
2014 AHA Mission: Lifeline

24. Lessons Learned (Per 2014 Post-Recognition Survey) Sent to all agencies that achieved a level of EMS Recognition
We (EMS) had trouble getting the needed data from the hospitals
Relationships take time
Work to build the relationship between the STEMI Outreach Coordinator and your agency
Request hour feedback on EVERY STEMI patient
Request to attend the Multidisciplinary Meetings
Request to be notified of any STEMI’s missed in the field
Request to collaborate on STEMI Identification Education for pre-hospital and ED personnel
9/18/2018
2014 AHA Mission: Lifeline

25. Questions/Comments?
We will be having an additional webinar to go through the application process a little later this winter, once we are closer to the applications opening.
Strongly encouraging the collection of responses that had fire, flight or other BLS service assistance.
9/18/2018
©2010, American Heart Association

26. Contact Information
Wyoming, Oklahoma and Texas Panhandle Central Texas and Rio Grande Valley
Katie Butterfield Diana Barrett-
Colorado Houston and Greater Gulf Coast
Julie Blakie Kate Simpson-
New Mexico, El Paso and Lubbock Dallas/ Fort Worth Metro
Stephanie Chapman Shanthi Raj-
Arkansas Mid- Market/ Rural Texas
Cammie Marti Cherie Boxberger-
9/18/2018
©2011, American Heart Association

27. Slides, audio and resources will be posted on www. heart
Slides, audio and resources will be posted on within one week of webinar.
9/18/2018
©2011, American Heart Association