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 429 Agencies contacted Had ECG Unusable capability, 294 Usable responses, 60 Responses, Did not 310 No ECG respond, 59 capability, 16 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, or we started to feel like stalkers!” —Frank and Mike
Agencies that responded What we found No ECGs Had ECGs 294 Of 16 Agencies known not to have ECGs: 16 Did not respond 24% First responders (no 35% ECGs) Already have ECG 29% In the process of 12% getting ECG
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 only 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?
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