Louisiana Emergency Response Network (LERN) Statewide STEMI initiative

1. Louisiana Emergency Response Network (LERN) Statewide STEMI initiative

2. Objectives • Establish a cohesive understanding of the Emergency Response Network and the role of each participating entity • Discuss the components of systems for Time Sensitive illness • Identify structures and partnerships currently in place, available resources, and anticipated needs • Outline various ways each component of the network can contribute to successful development of the systems

3. What is the Louisiana Emergency Response Network? • The Louisiana Emergency Response Network was created by legislation in 2004. • Responsible for developing and maintaining statewide systems coordination for patients with traumatic injury or time-sensitive illness (such as heart attack and stroke).

4. LERN Board • LERN Board is governor appointed - made up of 28 organizations that relate to all the components of systems of trauma and time sensitive systems. • It is a governing board that was created to plan, govern and direct the statewide system for trauma and time sensitive illness.

5. Regional Leadership • LERN is organized into 9 geographic regions • Guided by Regional Commissions • Commissions are an advisory body of key community, stakeholders • Each Commission has a minimum of 12 members

6. LERN Partnerships • Partners in the Network include: • 118 acute care hospitals with Emergency Departments • Including many that offer definitive care services for trauma, stroke, and heart attack • 54 ambulance companies, 4 air medical providers • Multiple other entities/stakeholders throughout the state • LERN Staff /Medical Directors/Tri-Regional Coordinators • LERN Communication Center • Louisiana Citizens

7. STEMI

8. What is a STEMI? • STEMI- means ST segment Elevation Myocardial infarction • This is the most severe of all heart attacks. • In a STEMI, the coronary artery is completely blocked off by the blood clot, and as a result virtually all the heart muscle being supplied by the affected artery starts to die • It is the most time critical of heart attacks to resolve.

9. Goals of care Goals of care: timely re-opening of artery • Clot-busting medications (easier, faster, less effective) within 30 minutes • Primary percutaneous coronary intervention (PCI) -more efficacious and safer but less available within 90 minutes

10. STEMI • Approximately 5% of all chest pain calls to EMS will be STEMI. • Up to 30 percent of patients in the U.S. suffering from STEMI never receive either clot buster or PCI* treatment, often times due to the lack of a comprehensive system of care

11. STEMI • Only 40 percent of patients receiving primary PCI treatment receive this therapy within the American Heart Association’s recommended 90-minute timeframe. • Lower PCI delay time resulted in a decreased long-term mortality rate among STEMI patients.

12. Goal of an organized system

13. STEMI Workgroup • LERN formed a work group comprised of subject matter experts and invested community leaders throughout the state to develop a system that could provide high level STEMI care to all Louisiana residents. • Workgroup met September 2011 to assess need for state-wide system and identify what we knew and what we did not .

14. STEMI Workgroup • Workgroup Findings: • Some Regions are further ahead in process of organizing; others lag. • No central data registry exists to assess efficacy of triage strategies or outcomes of transferred patients. • Survey disseminated October 2011-January 2012

15. Barriers in STEMI Care • PCI centers are clustered around metropolitan areas, creating uneven distribution of resources. • Some regions are further ahead in process of organizing; others lag. • No central data exist to evaluate effectiveness of triage or patient outcomes

16. MAP – Current Percutaneous Coronary Intervention Hospitals

17. Progress - STEMI • Created best practice guidelines for triage, thrombolysis guidelines, and transfer from non-PCI Centers • Created guidelines/requirements defining a PCI hospital • Added an American College of Cardiology-nominated cardiac chair to each regional LERN commission – to champion system in each region

18. Progress - STEMI

19. Progress - STEMI

20. Progress - STEMI

21. Progress - STEMI

22. Progress - STEMI

23. Progress - STEMI

24. Areas for Development- STEMI • Establishing Registry • Performance Improvement – involving EMS, receiving and referral centers • Determine how Receiving center/ Referral Centers are verified • Establish/Support no diversion transfer protocols between Receiving and Referral Centers • Establish/Support Emergent EMS Transfer agreements • Support increased EMS education on EKG interpretation/STEMI recognition • Development of relationships and trust between EMS and hospital-based providers • Public education on symptom recognition/911 usage

25. Summary Trauma and time-sensitive care is a team sport and to do it well we must work together. Louisiana Emergency Response Network is the foundation for success in decreasing mortality and morbidity from trauma and time-critical illness.

26. Q & A • Visit website at http://lern.la.gov/resources/stemi-stroke • 14141 Airline Highway • Building 1, Suite B • Baton Rouge, LA 70817 • 225-756-3440