The North Carolina EMS Stroke Toolkit:Improving Patient Outcomes and EMS Systems

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The North Carolina EMS Stroke ToolkitImproving
Patient Outcomes and EMS Systems
HDSP State Program Training Tuesday Sept 18, 2007
Ishmael Williams MA CDC Division for Heart
Disease and Stroke Prevention
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North Carolina EMS Stroke Toolkit

• Collaborators and partners
• Michael Matters, DHDSP HSRRT
• Margaret O. Casey, NACDD
• Marcus Plescia, NC Chronic Disease Director
• Anita Holmes, NC CVH Program
• Greg Mears, UNC NC EMS Medical Director
• Cindy Raisor, EMSPIC
• Drexdal Pratt, NCOEMS
• Staff of DHDSP

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NEMSIS National EMS Information System

• Developed by NASEMSO federal partners
• Implements a national standard for recording
  pre-hospital medical emergency care.
• Establishes a central database for national
  reporting.

• www.NEMSIS.org

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NEMSIS National EMS Information System
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NEMSIS National EMS Information System
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Building on NEMSIS with Toolkits
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NEMSIS EMS Toolkits

• North Carolina EMS toolkits
• Local EMS System Delivery
• SMARTT
• Trauma
• Cardiac Arrest
• Pediatric Care
• Airway Management
• Acute Coronary Syndrome
• Stroke (CDC DHDSP Sponsored)

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North Carolina EMS Stroke Toolkit

• One year project with NCOEMS UNC-Chapel Hill
  Dept. of Emergency Medicine.
• Develop report tool for emergency care of stroke
  using NCs EMS database.
• Utilizes PreMIS (Prehospital Emergency Medical
  Information System) used by all 100 NC counties.
• Designed by panel of EMS and Stroke care experts.

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North Carolina EMS Stroke Toolkit

• Objectives
• Implement emergency pre-hospital stroke care best
  practices,
• Facilitate incremental improvement of emergency
  stroke care,
• Support NEMSIS compliant EMS databases,
• Develop stroke care database with potential for
  collaborative partnership with Coverdell Stroke
  Register,
• Strategic partnership in a model state for stroke
  treatment.

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Stroke EMS Toolkit North Carolina State Stroke
Protocol
http//www.nccep.org/content/ems/standards/protoco
ls.htm
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North Carolina EMS Stroke Toolkit

• Public Education
• Community Awareness
• Community Education
• Stroke Recognition
• Access 911
• E911 Implementation

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North Carolina EMS Stroke Toolkit

• EMS Dispatch
• - Emergency Medical Dispatch (EMD) implementation
• Stroke Recognition
• Quality Management
• Call Location
• Dispatch Time Benchmarks (90 Seconds)

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North Carolina EMS Stroke Toolkit

• EMS Response
• - Stroke Care requires less EMS intervention or
  care than other acute EMS events
• Key interventions
• Quick Response
• First Responders
• Appropriate Timely Transport

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North Carolina EMS Stroke Toolkit

• EMS Dispatch Center Time
• EMS Chute Time or Wheels Rolling Time
• EMS Response Time
• EMS Total Response Time
• EMS Scene Time
• EMS Transport Time
• Total EMS Patient Contact Time
• EMS Response Delays
• EMS Scene Delays
• EMS Transport Delays

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North Carolina EMS Stroke Toolkit

• EMS Skills
• - Documentation
• Time of Onset
• Contact Information
• Stroke Scale
• Glucose
• Vital Signs
• Rhythm is capable
• Thrombolytic Screen

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North Carolina EMS Stroke Toolkit

• Patient Care
• Scene Time limited to 10 minutes
• Low probability of Airway compromise
• IV if gt 15 minutes transport time
• Stroke Screen
• Oxygen if lt97
• Assessment
• Neurologic Exam
• Mental Status Exam
• NPO

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North Carolina EMS Stroke Toolkit

• Transport and Destination
• - Stroke Plan/ Policy
• Thrombolytic drugs if 2 hours or less
• Invasive intervention in 6 hours or less
• Scene Times less than 10 minutes
• If Transport Times greater than 15 minutes
  consider
• Specialty Center
• Specialty Care Transport Services

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Concluding remarks

• NEMSIS establishes a common EMS data standard and
  national database.
• Toolkits track EMS performance, monitor patient
  outcomes, and facilitate improvement in both.
• Linkage of EMS and hospital registries will
  become an important next stage of development in
  tracking CVD from EMS to hospital release.
• Interlinked datasets like these will provide a
  vehicle for assessment of local health service
  delivery and identification of disparities in
  emergency health care.
• These tools will help EMS stakeholders recognize
  interventions that work and focus improvement
  efforts where most needed .

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Questions?