ILLINOIS EMS

1
ILLINOIS EMS

• Overview and History

2
How it All Began

• Mid 1960s
• Presidents commission on highway safety
• White Paper
• Early 1970s in Illinois
• Vietnam and trauma
• The Inverness woman
• Uphill struggle
• Various organizations and MDs
• Very conservative approaches

3
Early Restrictions

• Paramedics cant diagnose
• Can their assessment be accurate?
• Field 12-leads waste of time and delay transport
• Get the patient to the Hospital ASAP
• Few aggressive medical directors

4
First Steps

• MITI Studies out of Washington State
• Can paramedics diagnose an MI
• 1982-1983 study (Initial Impression)
• 1985 12-Lead experiment
• Success Failure
• Transmissions and treatment
• Thrombolitics standard of care.
• Eminase study in 1989-90

5
The Real Problem

• Time is muscle became a cliché
• Hospitals
• Little understanding of EMS
• Emergency physicians
• Lack of trust with EMS
• Cardiologists
• Need to see patient

6
The Cardiac Alert Team

• Started in 2003
• Team approach
• EMS
• ED Physicians staff
• Cardiologists
• Commitment of all resources

7
Current Trends

• EMS Systems today
• Aggressive and progressive medical directors
• Informal survey
• 12-lead capability
• Within the last 3-5 Years
• Many can transmit
• Most utilize some form of cardiac activation
• ED physicians and staff
• Improved trust in EMS providers

8
New Initiatives

• Pre-hospital industry
• Monitors all Include 12-Lead module
• Cardiac alert concept in 2003
• Closing the care continuum loop
• IHI 100K lives initiative
• National recognition
• Door to balloon measurements
• 90 minute goals
• 60 minutes a reality

9
Whats Next

• Must believe in EMS
• When you want something done
• Cardiologists must support ED
• Similar trust factor as with EMS
• Transmission options
• Yes and no

10
The Future

• EMS is a proven success
• Over 30 years of experience/resistance
• EMS is ready for anything
• Highly trained teams are ready and waiting
• Less than ideal conditions are the norm
• Welcome new challenges

11
Impact of EMS

• Eliminates the time needed for an ED ECG to start
  the decision tree
• Eliminates the waiting time to call the
  cardiologist
• Eliminates the wait for the cath Lab to be opened
• All these activations can occur while the patient
  is being transported to the hospital

12
Further Impact

• Even patients without acute ST elevation can
  benefit
• Other changes that may resolve through
  pre-hospital treatment can be identified
• A pre-hospital EKG has a pre-treatment
  streamlined diagnosis for comparison

13
Ongoing Problems

• Varying degrees of resources
• EMS providers
• Education
• Equipment
• Hospitals
• Lack of consistency or sharing of ideas between
  EMS regions
• Misuse of economies of scale
• Continuing turf battles

14
History Repeats Itself

• Remember the Eminase study started in 1990?
• A new study out of Texas is a cooperation of cath
  lab staff and in pre-hospital fibrinolysis
• Illinois is almost 18 years ahead of its time