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Louisiana Emergency Response Network (LERN) Statewide STEMI initiative. 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

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Objectives
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


What is the louisiana emergency response network
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).


Lern board
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.


Regional leadership
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


Lern partnerships
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



What is a stemi
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.


Goals of care
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


Stemi
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


Stemi1
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.



Stemi workgroup
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 .


Stemi workgroup1
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


Barriers in stemi care
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



Progress stemi
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








Areas for development stemi
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


Summary
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.


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


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