Creation of a pre-hospital program of care necessitates cooperation between stakeholders.

1. Implementation of a Pre-Hospital 12-Lead ECG Program for the Treatment of STEMI Patients in the City of Chicago: Lessons Learned from the Stroke System of Care Atman P. Shah1, Eric Beck1, Joe Weber2, Leslee Stein-Spencer3, Stephen Archer4, Shyam Prabhakaran5, Ken Pearlman5, Richard Feldman6, Kathleen O’Neill7, Art Miller7, Alex Meixner7, Eddie Markul6, Yanina Purim-Shem-Tov8, Adhir Shroff9, Gary L. Schaer8 1 University of Chicago Medicine, 2 John H. Stroger Jr Cook County Hospital, 3 Chicago Fire Department, 4Queens University School of Medicine, 5 Northwestern Memorial Hospital, 6 Advocate Illinois Masonic Hospital, 7 American Heart Association, Midwest Affiliate, 8 Rush University Medical Center, Medical Center, 9 University of Illinois-Chicago Medical Center Methods Background Results • The American Heart Association, the Chicago EMS Medical Directors, and CFD leadership were involved in the development of the stroke SOC. • Their experiences with the stroke SOC were instrumental and they were polled for the lessons they felt were most instructive in establishing a pre-hospital 12-lead ECG program and a comprehensive STEMI-system of care. • Approximately 400,000 Americans suffer an acute ST segment elevation myocardial infarction (STEMI) each year. • Early revascularization of the infarct related artery reduces mortality and onset of heart failure. • The AHA/ACC STEMI guidelines have highlighted the importance of pre-hospital STEMI activation and transportation to PCI capable hospitals. • The 2013 ACC/AHA STEMI Guidelines1 state that: • All Communities should create and maintain a regional system of STEMI care (Ib). • Performance of a 12-lead ECG by EMS is recommended at first medical contact (Ib). Avoidance of SOC by Statute Diversion Policy (T minus 5) • IL law permits EMS diversion of stroke patients at certain hospital-specific thresholds. A key stroke SOC policy deters stroke patients from being diverted from a dedicated stroke center. If the nearest stroke center was on bypass, the patient could be taken to another stroke center only if the 2nd center was < 5 minutes away. This policy was instrumental in avoiding the diversion of STEMI patients to a farther STEMI center if the nearest one is on bypass. • The STEMI SOC was initiated based on Illinois EMS legislation that established a stroke SOC drafted by a regional stroke advisory committee. Concurrent attempts to establish a pre-hospital STEMI triage to PCI capable hospitals was challenged by lack of funding to outfit EMS with 12-lead ECG capability and controversy regarding delegation of STEMI receiving hospitals. Consensus was to avoid legislative creation of a STEMI SOC. • Creation of a pre-hospital program of care necessitates cooperation between stakeholders. • The City of Chicago Fire Department (CFD) adopted a pre-hospital stroke system of care (stroke SOC) in March 2011. • In May 2012, CFD launched a pre-hospital 12-lead electrocardiogram (ECG) program designed to transport patients (STEMI) to hospitals capable of performing primary percutaneous coronary intervention (pPCI). • This project sought to identify lessons learned from the initiation of the stroke SOC that proved instrumental in developing the pre-hospital 12-lead ECG program. EMS Empowerment Cooperation & Collaboration • Close cooperation between hospitals, EMS system leadership and providers, municipal fire departments, physicians, and regulators was crucial for planning, implementation, and data collection. • Chicago EMS was able to identify a time critical patient population in the pre-hospital setting through education and triage protocols. Stroke SOC protocols translated well for STEMI patients. Continued education and ability to gather and track data also allowed EMS to better serve the community. P<0.0001 1: Illinois Masonic; 2: Advocate Trinity; 3: John H. Stroger Jr. Hospital; 4: Louis A. Weiss Hospital; 5: Mercy Hospital; 6: Mt. Sinai Hospital; 7: Northwestern Memorial Hospital; 8: Norwegian Hospital; 9: Our Lady of Resurrection Hospital; 10: Resurrection Medical Center; 11: Rush University Medical Center; 12: St. Joseph Hospital; 13: St. Mary Medical Center; 14: Swedish Covenant Hospital; 15: The University of Chicago Medicine; 16: University of Illinois; 17: Advocate Christ Hospital; 18: Advocate Lutheran General Hospital; 19: Little Company of Mary Hospital; 20: Loyola University Medical Center; 21: MacNeal Hospital; 22: MetroSouth Medical Center; 23: St. Francis Medical Center; 24: West Suburban Medical Center; 25: Franciscan St. Margaret Health; 26: Holy Cross Hospital; 27: Jackson Park Hospital; 28: Loretto Hospital; 29: Provident Hospital; 30: Roseland Community Hospital; 31: St. Anthony Hospital; 32: South Shore Hospital; 33: St. Bernard Hospital; 34: Thorek Hospital Conclusions Disclosures • Lessons learned from the implementation of a pre-hospital stroke system of care facilitated implementation of a pre-hospital 12 lead ECG system of care for the City of Chicago • The authors have no relevant financial disclosures. 1 O’Gara PT, Kushner FG, Ascheim DD, Case DE, Chung MK, deLemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso JE, Tracy CM, Woo J, Zhao DX. 2013 ACCF/AHA Guideline for the Management of STEMI. Circulation 2013:529-555.