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Louisiana Emergency Response Network (LERN) Statewide STEMI initiative

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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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Presentation Transcript
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.

slide26
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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