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Mission: Lifeline North Texas STEMI Workshop

The Model STEMI Receiving Center (PCI capable)Karen Yates, RN, BS, CEN, LP

10/8/2014 ©2011, American Heart Association 2

Mission: Lifeline North Texas

Faculty Disclosure Information

Karen Yates, RN, BS, CEN, LPThe Model STEMI Receiving Center (PCI Capable)

FINANCIAL DISCLOSURE: None

UNLABELED/UNAPPROVED USES DISCLOSURE: None

©2011, American Heart Association

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•What Makes the Model STEMI Receiving Center?

• Feedback to Referral Hospitals and EMS Agencies

• Public Outreach and Education


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•How Do You Provide Feedback?

• Referral Hospitals-Follow Up Emails -Follow Up Data/Images

• There Is No Such Thing As Too Much Feedback!

Ennis Regional Medical CenterSTEMI Transfer via PHI 6/26/14

• Symptom Onset 18:24

• Registration Time 18:52

• Triage Time 18:54

• Call for Transfer 19:01

• PHI Request Time 19:13

• PHI Arrival Time 19:27

• PHI Patient Contact 19:29

• PHI Lift Off 19:38

• PHI Landing at MMM 19:53

• Arrival Time in ED 20:00

• Cardiologist at Bedside 20:05

• Left ED for Cath Lab 20:15

• Groin Stick 20:27

• Balloon Time 20:48

• Door to Balloon 48 minutes

• Ennis to Balloon 116 minutes

• 100% RCA w/2 stents, 100% LAD referred for CV surgery

Ennis Regional/PHIMethodist Mansfield Medical Center Emergency/Cath Lab

Ennis Regional Medical Center STEMI Transfer via PHI 7/02/14

Ennis ED/PHI/Mansfield ED• Chest Pain Onset 05:30

• PMH: CABG, HTM, DM

• Ennis ED Arrival 06:58

• Ennis 12 Lead EKG 07:01

• Call for Transfer 07:12

• PHI Arrival 07:43

• At MMMC Helipad 08:12

• In MMMC ED 08:16

MMMC Cardiac Cath Lab• Left MMMC ED for CL 08:17

• CL Arrival 08:20

• Groin Stick 08:31


• MMMC D2B 35 minutes

• Ennis Door to MMMC Balloon 116 minutes

• 2 stents to the Circumflex and 1 to the RCA. Discharged home the next day!


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•How Do You Provide Feedback?

• EMS Agencies-Follow Up Letters-Follow Up Data/Images-Images Posted in EMS Room

• Again, There Is No Such Thing As Too Much Feedback!• EMS Agencies Are Competitive, They All Want The Best D2B

Midlothian Fire Department STEMI 4/22/14 Sam Villa, Ted McPherson, & Matt Sapp

• Symptom Onset 16:30

• 911 Call Time 16:39

• Patient Contact16:47

• 12 Lead EKG 16:48

• First STEMI EKG 16:54

• STEMI Activation 17:04

• ED Arrival 17:20

• Arrival in Cath Lab 17:31

• Groin Stick Time 17:36

• Balloon/Export Time 17:43

• Door to Balloon 23 min

• EMS to Balloon 56 min

Midlothian Fire DepartmentSTEMI 11/12/13 Caleb Bondurant, Justin Lampman, & Robert Etheridge

EMS/Emergency Department• 911 Call Time 10:57

• Patient Contact Time 11:03

• EMS 12 Lead EKG 11:05

• STEMI Activation 11:11

• ED Arrival Time 11:28

• Leave ED for Cath Lab Time 11:35

• ED Staff: Dr. Nguyen, Kat, & Josh

Cardiac Cath Lab• Cath Lab Arrival Time 11:38

• Groin Stick Time 11:42


• Door to Balloon 22 min

• 911 Call to Balloon 57 min

• EMS to Balloon 47 min

• CL Staff: Dr. Taylor, Thai, Jimmy, Susan, Tina, Stacey, Stephanie, & Huong


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Get Innovative With Your EMS Partners-Provide educational opportunities

-Facilitate “straight to Cath Lab” via EMS process-Encourage EMS crews to stay and observe cardiac catheterization

-STEMI Packs, Field Blood Draws-EMS patient visits-Life Saving Awards

EMS STEMI Kits and Blood Draw Kits



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•How Do You Tackle Public Education?

•What Are They Big Issues?-Delay In Seeking Medical Care-Not Calling 911-How Do You Spread The Word?


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• Health Fairs• Fire Department/EMS Open Houses• Fall Festivals• 5k/10k Runs• Giveaway Items Promoting Use of 911• Partnering With Other Agencies Such as AHA and NCTTRAC

Mission: Lifeline North Texas STEMI Workshop

The Model STEMI Receiving Center (PCI capable)David D. Muggli MBA, BSN, RN, FACHE

10/8/2014 ©2011, American Heart Association 22


Faculty Disclosure Information

David D. MuggliThe Model STEMI Receiving Center (PCI capable)

FINANCIAL DISCLOSURE:NoneUNLABELED/UNAPPROVED USES DISCLOSURE:None

The Ideal Receiving Hospital• Pre-hospital ECG diagnosis of STEMI, ED notification and Cath lab activation occurs according to standard algorithms

• Algorithms facilitate:

– A short ED stay for the STEMI patient

– Transport directly from the field to the Cath lab

• Single-call systems from STEMI-referral hospitals immediately activate the Cath lab

• Primary PCI is provided as routine treatment for STEMI 24-7

• Has plan for and ability to treat re-arrest, including mechanical CPR AND/OR

pharmacological support

• Capable of assessment of need for ICD placement and providing appropriate

follow up

• Defers assessment of prognostication and withdrawal of care for at least 72 hours

after Cardiac Resuscitation.

10/8/2014 24©2011, American Heart Association


• Implements and maintains standard triage and treatment protocols for Cardiac Resuscitation consistent with AHA guidelines

• Initiates hypothermia as soon as possible when indicated

• Initiates cardiology consult as soon as possible for cardiac arrest

• Accepts all STEMI and cardiac resuscitation patients regardless of diversion status

• Meets regularly with A multidisciplinary team regularly to identify and solve problems

• Designs and institutes a continuing education program is designed and instituted

• Establishes a mechanism for monitoring performance, process measures and

patient outcomes

25©2011, American Heart Association


The Ideal Receiving Hospital (continued)


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• Case #1 • 64 y/o female arrives to the ED with atypical CP via private vehicle• 12 lead EKG• Oxygen, IV, and Nitro x 2• Pain eliminated• 12 lead EKG repeated• Cardiology consulted• Cath Lab activated• Stent x 2 LAD• D/C home after 2 days with EF>35%


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0511 Pt Arrived

at ED

9 Cardiology consulted

40 Cardiology

arrives

2 EKG

12 Cath team activated

46 Case Started

55 Perfusion restored

35 Cath team arrives


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• Success• Commitment

• Administration• Medical Staff• Cath Lab Team• ED Team• EMS Providers

• Practice• Mock STEMI• Orientation

• Review• STEMI Workgroup• CP/EMS Meeting


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AHA Mission Lifeline STEMI Receiving Centers Recognition Measures

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