I. A Survey EMS and STEMI in Virginia II. A Discussion Presenter: - - PowerPoint PPT Presentation

EMS and STEMI in Virginia

• I. A Survey

EMS and STEMI in Virginia

• II. A Discussion

Presenter: David R. Burt, MD (on behalf of Frank and Mike)

VHAC/OEMS EMS Survey

In November of 2013, VHAC, in collaboration with Virginia OEMS, distributed a survey assessing the pre- hospital ECG capabilities of 429 transport agencies throughout the state.

We asked a bunch of questions…

a. Are you a response and transport unit? yes/no b. Does your agency have prehospital 12 leads?

1. If yes, did you receive assistance from OEMS or other source in obtaining funding for 12-lead machines 2. If yes, did you obtain 12-leads after the survey, and did the survey play any role in encouraging you to obtain 12-leads 3. If no, is there a reason you don’t have 12-leads?

i. Lack of funding ii. Feel training is insufficient to utilize iii. Operating with hospital systems that are not responsive to PHECG iv. Anything we haven’t thought of, etc.

4. If no, are you aware of assistance in obtaining funding that OEMS Rescue Squad Assistance Fund (RSAF) grant can provide? 5. Obtain a contact from the agency that does the grant writing 6. What are the coverage boundaries of your dept/agency 7. Do you have a dept/agency website

VHAC EMS Survey Results

Did not respond, 59 Unusable responses, 60 Had ECG capability, 294 No ECG capability, 16 Usable Responses, 310

429 Agencies contacted

About a 75% response rate: not bad

Mission #1

Analyze the big picture Initially reviewed at last year's state meeting Take home points—A refresher

Moving on—Mission #2

Interrogate outliers

(The role of Mike and Frank)

How we did it

• Identify agencies with “Unverified capacity”
• Track down members/leaders of these

agencies

• Ask them questions…
• Document answers!

NOT AS EASY AS IT SOUNDS….

RATE LIMITING STEP:

When did we quit?

After a Reasonable Effort

“Either we got the answers we were looking for,

• r we started to feel like stalkers!”

—Frank and Mike

What we found

35% 12% 29% 24%

Of 16 Agencies known not to have ECGs:

Did not respond First responders (no ECGs) Already have ECG In the process of getting ECG

16 294

Agencies that responded

No ECGs Had ECGs

Example results

VHAC – Northwestern

• 1. BRANDY STATION VOLUNTEER FIRE DEPARTMENT

shows no ambulances either)

• 1. CASTLETON COMMUNITY VOLUNTEER FIRE COMPANY
• 2. CHESTER GAP VOLUNTEER FIRE DEPARTMENT
• 3. DOOMS VOLUNTEER FIRE DEPARTMENT(shows no am

bulances either)

• 4. FLINT HILL VOLUNTEER FIRE COMPANY
• 5. RICHARDSVILLE VFD & RESCUE SQUAD
• 6. SALEM VOLUNTEER FIRE DEPARTMENT

Example results

1. Brandy Station: Erroneously listed as having transport

• capabilities. Actually a first-response only department

2. Castleton Volunteer Fire Dept. Agency is a response and transport unit, but does not have 12-lead ECG machines. They recently became certified to perform PH-ECG as

• dept. is a BLS unit run predominantly run by husband and

wife who are not working towards ALS capability. They would be supportive of any young members who wanted to (none currently). Ms. Komar was aware of the RSAF grant but is not currently pursuing as the Assistant Firefighter Grant pays 90:10 and they are pursuing this

• grant. Ms. Sharon Komar is the grant writer and her

contact information is skomar5225@gmail.com ; 540-937- 5225

Example results

• 3. Chester Gap VFD: A BLS only transport agency. They

do not currently have ECGs but Rappahannock County has put in for a grant to obtain ECGs. 4. Dooms VFD: Reported that dept. is a first response

• nly agency and was erroneously reported as having

transport capability

• 5. Flint Hill:

In the process of obtaining ECGs. Funding had been a barrier but Culpepper county obtained a grant to obtain machines.

• 6. Richardsville VFD & Rescue Squad: Unable to contact
• 7. Salem VFD:

Has 12 lead capabiliQes. Lack of ECG machine was erroneously reported.

2015 Conclusion I

Virtually ALL EMS agencies in Virginia who transport patients have access to 12 lead capability…

Aka We all have the machines!

2015 Conclusion II

Of those agencies that don’t have ECG machines, most are getting them or have a plan to get them

2015 Conclusion III

Those agencies that don’t have ECG machines and don’t have a plan to get them need our help So VHAC will work with all that don‘t have machines…

EMS and STEMI in Virginia

• II. A Discussion

Now what do we do?

Future Action(s)?

• Better Technology?
• Better Training?
• Better Protocols?
• Better Adherence?
• Better Assessment?

Better Technology

• Transmit or not?
• Fixed or floating?
• Proprietary or free?

Better Training

• Acquisition of ECG
• “Evaluation” of ECG

Better Protocols

• Improve systems for transmitting ECG
• Better EMS-ED connectivity to enhance “the

decision”

Adherence

• Better adherence to existing protocols for ECG

acquisition and decision-making

Better Assessment of EMS-centric process

• 1. Pt. to ECG (any site)

10 min

• 2. ECG to Decision (any site) 10 min

Result: Pt. to Decision 20 min

Next step

Another Survey?