Status of Washington State Emergency Cardiac and Stroke System

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Status of Washington State Emergency Cardiac and
Stroke System

• Kathleen Jobe, MD FACEP
• Chair, Emergency Cardiac and Stroke Technical
  Advisory Committee

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• Centers for Disease Control and Prevention
• NAEMSP
• Minneapolis Level One Heart Attack Program
• WA State Department of Health
• EMS and Trauma System
• Heart Disease and Stroke Prevention Program

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In Washington

• 1999-2001 EMS/T recognized MI and stroke as
  time-critical conditions similar to trauma.
  Conducted assessment of emergency cardiac and
  stroke care no funding to address findings
• 2005 DOH gets CDC funding for Heart Disease and
  Stroke Prevention Program. Top priority
• Improve emergency response for cardiac and stroke
  care
• HDSP and EMS/T resurrect project and convene
  Emergency Cardiac and Stroke Work Group
• 2007-8 Findings and recommendations reported,
  Emergency Cardiac and Stroke TAC formed to
  implement recommendations, objectives in EMS/T
  Strategic Plan

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Assessment of Emergency Cardiac and Stroke Care
- Findings

• Effective treatments are available-many
  appropriate patients are not treated
• Variation across the state in

• Level and timeliness of emergency response
• Protocols, patient care procedures, and resources
  to diagnose and treat
• Access to optimal treatment
• Patient outcomes

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Assessment of Emergency Cardiac and Stroke Care
in WA.

• PCI performed in only 39 of cases
• t-PA given in only 2.4 of ischemic strokes

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PCI Hospital 30 minute Drive Time
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Recommendations

• Establish statewide emergency cardiac and stroke
  system similar to trauma (right pt/right
  place/right time)
• Create Emergency Cardiac and Stroke Technical
  Advisory Committee to implement system

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Emergency Cardiac (Stroke) System
Community Education Outreach
Dispatch Protocols training
EMS Protocols Training
Triage destination plan PCPs COPs
Hospital Verification/ Categorization training

• pre arrival notification
• 15 minutes on-scene time

Patient Outcomes Feedback
Data, Evaluation, Quality Improvement Website
ECS TAC
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ECS TAC Membership

• Hospitals
• Dispatch and EMS
• Clinicians (ED MDs, Cardiologists, Neurologists,
  RNs, EMS Directors)
• DOH, AHA, WSHA, COAP, ACC(???)

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Recommendations continued

• Patient early recognition and call 911
• Standardized prehospital EMS protocols and triage
• Uniform training
• Hospital capability verification program
• Quality improvement based on standard data
  collection and reporting

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Where we are now

• Prehospital ACS and Stroke Protocol Guidelines
• ACS and Stroke Triage and Destination Plans
• Hospital Criteria
• Key data measures
• Public education strategies
• 4 Regional STEMI systems forums
• Assisting with regional STEMI systems development

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The goal in WA

• Total ischemic time of 120 minutes
• E2B 90 minutes or 30 minutes
• Hospital door to balloon 90 minutes

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Whats next

• Final comments coming in
• Present to EMS/T November 18
• Train EMS and categorize hospitals in 2010
• Collect data (ACTION/GWTG, COAP)
• Public education
• Full implementation by 2011
• Evaluate and revise as indicated by the data

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Regulatory and Legislative Options for a
Statewide system

• Designation
• The highest level of state regulation and
  oversight
• Verification
• State oversight to assure compliance with
  verification requirements
• Categorization
• Hospitals voluntarily comply with system
  requirement
• No regulatory or oversight authority

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Legislative possibilities

• A hospital verification program is unlikely due
  to the state deficit but we can do prehospital
  triage to participating hospitals
• AHA legislation to support development of the ECS
  System.
• Sponsor for bill.
• Awaiting legislative session to drop bill

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Future goals

• Would ACC join as major partner to push for a
  statewide system of STEMI care ??

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Thank you Kathleen Jobe, MD, FACEP 206-508-4220 k
aj_at_u.washington.edu