Meeting Notes

The Virginia Heart Attack Coalition-Mission: Lifeline Continues to Gain Momentum (March 2010)

The Virginia Heart Attack Coalition-Mission: Lifeline (VHAC-ML) concluded another successful Task Force Meeting, as evident by the presence and active involvement of over 40 attendees at our gathering in Richmond on March 25, 2010. During this busy and productive event, members and guests heard presentations from each Project Team, Regional Leads, the Virginia Office of Emergency Medical Services (OEMS), and representatives from the American College of Cardiology (ACC) and the American Heart Association's (AHA) ACTION-GWTG ("Get With the Guidelines") Registry. The organizational and political challenges of streamlining STEMI care were openly discussed as Virginia moves forward to meet the Mission: Lifeline’s goals.

Paul Sharpe RN, NREMT-P from the OEMS, reported on adoption of an EMS & STEMI white paper by the Medical Direction Committee, and gave an update on implementation of the National Emergency Medical Services Information System (NEMSIS), the data collection tool that will be used by all EMS agencies, to allow standardized data collection across the state, including data related to STEMI patients. There was also discussion about an EMS Inventory of 12-lead ECG equipment and training currently underway by OEMS, to help assess support needed in the field. The Office hopes to use the results to help establish a special grant cycle that focuses on increasing the number of agencies providing optimal STEMI care.

Recognition of Mission: Lifeline STEMI Centers was presented by Eric Walker of AHA and Kim Hustler of the ACC. Dr. Chris Granger from Duke University gave a presentation on the RACE program in North Carolina and talked about how they dealt with a variety of challenges and barriers. A discussion entitled “ACTION-Revelations From the Trenches” was conducted by a panel of users to assist those in transitioning to this registry.

The Regional Leads of all six VHAC regions discussed activities in their areas, key individuals and organizations on their teams, and progress in setting up ideal STEMI systems. In addition, the Regional Organization and Development team discussed ways to enlist the involvement of key stakeholders across the state in an effort to drive effective change. Going forward, the Regional Leads are charged with completing a STEMI System Progress Tool, as recommended by the AHA’s Mission: Lifeline. This important document serves as a “checklist” of the ideal components of a STEMI System -- everything from ECG education for EMS providers to single call activation of the Cardiac Cath lab.

The Data and Evaluation Project team forwarded a proposal as to how data about reperfusion times would be collected and presented. The Website and Tool Shed team discussed the VHAC website and plans for developing an online repository of protocols and other tools to assist members in improving STEMI care. Plans for a D2B Webinar are also underway.

The next VHAC-ML task force meeting will be held in Richmond in September. All those interested in improving STEMI care in the Commonwealth are encouraged to attend.

The Virginia Heart Attack Coalition-Mission Lifeline (VHAC-ML) Closely Focused on Education and Protocol Guidance(December 2009)

• An EMS position paper on STEMI systems prepared by members of the VHAC-ML Task Force, including representation from EMS field providers, was presented and approved by the Virginia Office of EMS (OEMS) Medical Direction Committee. The document, which is carefully constructed to address concerns on a state and local level, uses ML Criteria to outline recommended strategies and tactics, and provide guidance for EMS agencies and providers in fine-tuning STEMI protocols.
• Mission Lifeline’s STEMI Provider Course was taught at the annual EMS Symposium in November by Drs Pete O’Brien and David Burt. Over 100 EMS personnel participated in this intensive class that included real life case scenarios. AHA STEMI Provider Manuals were given to all participants for further study and review. A vendor display booth at the Symposium further promoted Mission Lifeline and the importance of building STEMI systems of care, to the 3500+ attendees.
• Virginia OEMS provides monthly satellite training for EMS providers across the state, and worked with AHA and ML-VHAC to produce a segment for November outlining pre-hospital response to STEMI in the field. Dr Mike Kontos served as the Course Instructor, assuring the training adhered closely to ML Criteria. The course will remain accessible via web for the next year.

Virginia Heart Attack Coalition/Mission Lifeline Making Great Strides to Improve MI Care in the Commonwealth (September 2009)

The VHAC/ML Task Force held its fourth meeting in Richmond on September 22, 2009. This was the first statewide meeting after a highly successful May Summit to gather all Coalition members and stakeholders. Progress continues as this important initiative continues to gather momentum.

Over 25 participants, from across Virginia and the STEMI Stakeholder spectrum, attended this Richmond event. Participants discussed a STEMI position paper to be presented to the State EMS, and heard updates on data from the Virginia Department of Health, the status of AHA funding, and reports from Project Teams and Regional Leaders.

The work of VHAC/ML is currently being carried out by three Project Teams. These subcommittees outlined their progress to date. The Regional Organization and Development Team has identified six separate Regions and established Regional leadership structures. Each Regional Lead discussed their current status, including challenges and opportunities.

The Data and Evaluation Team presented data demonstrating reductions in door to balloon time when 1995/96 was compared to 1998, an effect that was seen in each of the 6 regions. Summary data of over 1100 patients included demonstrated 85% of Virginia STEMI patients treated in < 90 minutes. Data from a survey of Virginia PCI and non-PCI hospitals was presented. Subsequently, this information will be helpful to better target educational and equipment needs for EMS to improve pre hospital recognition.

Finally, the Field Adaptations-Toolshed/Web team presented the website, www.virginiaheartattackcoalition.org, and discussed improvements and updates to follow. Work begins on a Toolkit which will provide participants with important resources for education and process improvement. This will include order sets and pathways to assist individualizing STEMI care for each hospital. In addition, the goal is to separate out educational material based on provider (e.g., EMS, ED, cardiologist, nurse, etc), for ease of use.

The “Virginia Heart Attack Coalition” (VHAC) is a volunteer collaborative that is helping to initiate the AHA’s Mission: Lifeline guidelines in Virginia and fostering cooperation and coordination of STEMI care providers.