Development of Systems of Care for ST-Elevation Myocardial Infarction Patients The Emergency Medical Services and Emergency Department Perspective Peter Moyer, MD, Co-Chair; Joseph P. Ornato, MD, FAHA, Co-Chair; William J. Brady, Jr, MD; Leslie L. Davis, MSN, RN, ANP-C; Chris A. Ghaemmaghami, MD; W. Brian Gibler, MD; Greg Mears, MD; Vincent N. Mosesso, Jr, MD; Richard D. Zane, MD Central to the development of systems and centers of care for ST-elevation myocardial infarction (STEMI) patients will be the key role played by emergency medical services (EMS) at entry into the system and within the system when emergency interhospital transport is required. Current System of Care Emergency Medical Services System Design Prehospital EMS systems have 3 major components: emergency medical dispatch, public safety (fire and law enforcement) first response, and EMS ambulance response. Each of these operates within a broader emergency care system, which includes acute care facilities and regionalized healthcare services. In most states, an EMS regulatory entity within the state government oversees the emergency care system. Many states have regional EMS councils and advisory boards that function with varying levels of authority. Emergency Medical Dispatch Early access to EMS is promoted by a 9-1-1 system currently available to 95% of the US population. Enhanced 9-1-1 systems provide the caller’s location and number to the dispatcher, which permits rapid dispatch of prehospital per- sonnel to locations even if the caller is not capable of verbalizing or the dispatcher cannot understand the location and telephone number of the emergency. Although cellular phones have been problematic because they do not stay in a fixed location, new technology exists that allows triangula- tion of a cellular phone caller’s location. This technology is being phased in throughout the country at a rapid pace. In most communities, law enforcement or public safety officials are responsible for operating 9-1-1 centers, because in most locations, 85% of calls are for police assistance, 10% are for EMS, and 5% are for fire-related emergencies. Dispatchers who staff 9-1-1 centers may have minimal medical training, be emergency medical technicians, or on occasion be paramedics trained and certified as emergency medical dispatchers. In any case, dispatchers operate under standardized, written (often computerized) protocols. Such protocols are developed nationally and then modified locally or nationally. The ideal system has intense quality improve- ment programs to ensure that dispatchers follow protocols and procedures correctly and consistently. This is particularly true for the prearrival instructions that are given to cardiac arrest bystanders to instruct them on how to perform cardio- pulmonary resuscitation (CPR) while awaiting arrival of emergency personnel (telephone CPR). Emergency medical dispatchers can also prompt patients with symptoms sugges- tive of an acute STEMI to take aspirin while awaiting the arrival of EMS personnel. Public Safety First Responders To minimize time to lifesaving treatment, most communities have volunteer and/or paid firefighters and/or law enforce- The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. The opinions expressed in this manuscript are those of the authors and should not be construed as necessarily representing an official position of the US Department of Health and Human Services, the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, or the US government. These opinions are not necessarily those of the editor or the American Heart Association. The Executive Summary for these proceedings is available in the July 10, 2007, issue of Circulation (Circulation. 2007;116:217–230). Writing group reports are available online at http://circ.ahajournals.org (Circulation. 2007;116:e29 – e32, e33– e38, e39 – e42, e43– e48, e49 – e54, e55– e59, e60 – e63, e64 – e67, e68 – e72, and e73– e76). The publication of these proceedings was approved by the American Heart Association Science Advisory and Coordinating Committee on April 18, 2007. A single reprint of the entire conference proceedings is available by calling 800-242-8721 (US only) or writing the American Heart Association, Public Information, 7272 Greenville Ave, Dallas, TX 75231-4596. Ask for reprint No. 71-0413. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com. Expert peer review of AHA Scientific Statements is conducted at the AHA National Center. For more on AHA statements and guidelines development, visit http://www.americanheart.org/presenter.jhtml?identifier=3023366. Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.americanheart.org/presenter.jhtml?iden- tifier=4431. A link to the “Permission Request Form” appears on the right side of the page. (Circulation. 2007;116:e43-e48.) © 2007 American Heart Association, Inc. Circulation is available at http://www.circulationaha.org DOI: 10.1161/CIRCULATIONAHA.107.184047 e43 AHA Conference Proceedings by guest on February 22, 2016 http://circ.ahajournals.org/ Downloaded from