According to the American Heart Association, out of the 931,000 heart attacks throughout the United States each year, about 250,000 of them are a more severe type of heart attack; an ST-elevated myocardial infarction (or STEMI). The heart is not receiving blood during a heart attack, which can be fatal if not addressed quickly. The sooner EMS can start administering life-saving treatment, the better the outcome. With the right tools, paramedics can notify the ED and the cardiac catheterization team; and they can prepare the lab, equipment, and personnel for the patient’s arrival so angioplasty and other critical treatment can begin as quickly as possible.
Through the use of a specialized digital mobile telemedicine app, EMS and STEMI teams are uniquely positioned to improve the saving of lives through timely intervention with engaging hospital and STEMI team staff via app features to initiate broader acute workflow improvements. Multi-faceted alerts including data collection and vitals shared real-time with ETA tracking to providers, speeds treatment and engagement to improve outcomes while adding short and long-term educational value. A vital part of STEMI cases is making sure treatment is handled in a timely manner. Having a configurable mobile telemedicine solution allows for ED and STEMI teams to effectively communicate in order to properly treat the patient.
SAMPLE TELESTROKE WORKFLOW
The STEMI case workflow process below utilizes GD’s e-Bridge Workflow Mobile Telemedicine app. The solution provides an easy to use, state or region-wide mechanism to alert notify and track all STEMI cases in real time from prehospital first medical contact through hospital emergency department, handoff to STEMI teams. This will help the STEMI team be better prepared for the inbound patient while lessening the handoff time and increasing data accuracy.
Note that all e-Bridge Workflow templates are highly configurable, allowing flexibility to operate protocols your way, ensuring maximum effectiveness and compliance to your teams and STEMI accreditations.
1. 911 communications center receives a call for a possible sepsis and dispatches EMS
2. EMS receives the CAD location information and responds
3. Dispatch and arrival times documented in CAD
4. Upon arrival, EMS’ patient assessment identifies a possible STEMI case
5. Once the patient is determined a STEMI case EMS selects the destination/ hospital
6. EMS clicks the “STEMI” button of the e-Bridge app on their mobile device and treats the patient
7. The location is tagged and the running clock begins*
8. The highly configurable workflow template prompts for initial patient demographic*, driver’s license, ID scan/picture, and medical incident and treatment information
9. Notifications for events are time stamped, logged and shared in real- time with preselected team members via e-Bridge (ED computer, mobile devices, etc.)
10. Existing or newly assigned specialists can be notified and added to the team- either preconfigured or at any point by ED after arrival
11. Live (synchronous) or asynchronous video consult with a physician, specialist, etc. is available. Secure multimedia such as pictures, video, audio, text, team chat and vital sign and ECG sharing is available
12. If transporting, live ETA is sent to receiving hospital and specialists once in route
13. If AMA refusal, video consult with physician or specialist may avert refusal, otherwise video documentation of refusal to mitigate risk
14. Hospital ED physician/nurse to notify and add hospital patient registration to the case, allowing them to pre-register the patient before arrival
15. ED member assigns bed and EMS is notified pre-arrival, via the app
16. Hospital ED can see tracking map with priority and live ETA. Once the ambulance is within “geofence” of the hospital an “arrival” alert is announced and displayed and team members are alerted on the e-Bridge app
17. ED team assesses the need for a lab scan
18. If needed, ED team members can activate the cath lab
19. EMS arrives and moves the patient to the pre-registered assigned bed and hands off the patient to the ED staff that is already prepared and ready with a pre-registered ID wristband.
20. ED staff take over patient care and the pre-hospital phase has ended
21. If the patient has to be transferred to a PCI center it can be initiated through the e-Bridge app
22. EMS clears us from the call and goes back in service but is available for questions, team chat, notifications an outcome results
23. Downstream outcome feedback/status is entered by hospital staff, EMS is notified via e-Bridge
STEMI EVENTS TO MONITOR & CAPTURE