The Journal of the Arkansas Medical Society Med Journal Feb 2019 Final 2 | Page 13

AFMC: A CLOSER LOOK AT QUALIT Y
The STAC has three subcommittees
to improve the state’s STEMI systems
of care: data, protocols and educa-
tion. The subcommittees work to link
the three components of a system
of care — the community, EMS and
hospitals — to minimize patient treat-
ment time.
The data and protocols subcom-
mittees analyze registry data to
identify areas for improvement and
help develop policies, procedures
and pathways for the STEMI Sys-
tems of Care. The group has recently
approved the Arkansas STEMI Sys-
tems of Care Best Practice and Oper-
ations Manual, accessible at healthy.
arkansas.gov/programs-services/
topics/stemi-advisory-council-stac
The education subcommittee pro-
motes community health education,
including heart attack warning signs
and risk factors, lifestyle changes and
the importance of calling 9-1-1 when
heart attack symptoms first occur.
Earlier this year, the ADH launched
its “Dial Don’t Drive” campaign, urging
those with heart attack symptoms
to call 9-1-1 immediately. About half
of all patients experiencing a heart
attack drive themselves to the ED, not
realizing the potential harms, includ-
ing cardiac arrest with no one to
perform CPR, causing an accident or
not going to the appropriate hospital.
The public often views EMS as
only a “quick ride” to the hospital.
However, treatment begins in the
ambulance and EMS personnel know
which facility is most appropriate to
provide primary coronary interven-
tion. Not all hospitals have interven-
tional cardiologists on staff or the
equipment to perform these proce-
dures. Paramedics start treatment
upon arrival at the patient’s location,
including assessing vital signs, per-
forming a 12-lead ECG immediately,
starting an IV and performing other
life-saving treatments. Pre-hospital
providers are essential to the chain
of survival for heart attack patients.
The receiving hospital must be
notified by EMS within five minutes
of STEMI recognition. The receiving
hospital can activate Code STEMI
and call in the catheterization lab
team, consisting of an interventional
cardiologist, two nurses, and a cathe-
terization lab technician. If not already
at the hospital, these team members
must arrive at the hospital within 30
minutes of activation time. When the
process goes as planned, the team is
set up and ready before the patient
arrives. The patient bypasses the ED,
going directly to the catheterization
lab to reduce time to treatment.
The public needs to understand
that early recognition equals early
treatment and a better chance of
survival. All health care professionals
should impress upon their patients
and the public the importance of
taking immediate action when
heart attack symptoms first occur.
Heart attack warning signs can differ
between men and women. Men usu-
ally experience classic warning signs:
chest pain/discomfort, squeezing/
pressure, shortness of breath, cold
sweat, and pain that spreads to back,
shoulders, neck, jaw or arm(s). Women
can experience the classic symptoms,
but the signs are often milder. Women
may also experience indigestion,
palpitations, dizziness, fatigue over
several days, anxiety, sleep distur-
bances, nausea/vomiting or mild
flu-like symptoms.
The American College of Cardi-
ology Foundation designed a heart
attack recognition program, the Early
Heart Attack Care (EHAC). It is being
publicized statewide by the STAC edu-
cation subcommittee. All Arkansas cit-
izens are invited to go online, take the
course and become a “deputy in heart
attack” at http://dha.acc.org/. The pro-
gram teaches early signs/symptoms
of a heart attack, heart disease risk
factors, different symptoms between
men and women and the importance
of calling 9-1-1. Becoming a “deputy”
provides confidence in understanding
how to recognize and treat people
before heart damage occurs. EHAC is
also promoted on the ADH’s Facebook
(facebook.com/arhealthdept) and
Twitter (twitter.com/ADHPIO) web
pages. It is hoped that sharing this
educational information with friends
and family will start a ripple effect
across our state and help save lives.
FOR MORE INFORMATION:
• 2013 ACCF/AHA Guideline for
the Management of ST-elevation
Myocardial Infarction: www.
onlinejacc.org/content/accj/64/24/
e139.full.pdf
• 2014 AHA/ACC Guideline for the
Management of Patients With
Non-ST-Elevation Acute Coronary
Syndromes: www.onlinejacc.org/
content/accj/64/24/e139.full.pdf
• 2017 AHA/ACC Clinical
Performance and Quality Measures
for Adults With ST-Elevation and
Non-ST-Elevation Myocardial
Infarction: www.onlinejacc.org/
content/accj/early/2017/09/14/j.
jacc.2017.06.032.full.pdf
Ms. Meyer is STEMI nurse coordinator
with the Arkansas Department
of Health.
AFMC WORKS COLLABORATIVELY WITH PROVIDERS,
COMMUNITY GROUPS AND OTHER STAKEHOLDERS TO
PROMOTE THE QUALITY OF CARE IN ARKANSAS THROUGH
EDUCATION AND EVALUATION. FOR MORE INFORMATION
ABOUT AFMC QUALITY IMPROVEMENT PROJECTS,
CALL 1-877-375-5700 OR VISIT AFMC.ORG.
FEBRUARY 2019
NUMBER 8
FEBRUARY 2019 • 181