WK16 Novais Wales

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The North Carolina EMS Stroke Toolkit:Improving Patient Outcomes and EMS Systems HDSP State Program Training Tuesday Sept 18, 2007 Ishmael Williams MA CDC Division for Heart Disease and Stroke Prevention

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North Carolina EMS Stroke Toolkit Collaborators and partners: Michael Matters, DHDSP – HSRRT Margaret O. Casey, NACDD Marcus Plescia, NC Chronic Disease Director Anita Holmes, NC CVH Program Greg Mears, UNC & NC EMS Medical Director Cindy Raisor, EMSPIC Drexdal Pratt, NCOEMS Staff of DHDSP

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NEMSIS National EMS Information System Developed by NASEMSO & federal partners: Implements a national standard for recording pre-hospital medical emergency care. Establishes a central database for national reporting. www.NEMSIS.org

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NEMSIS National EMS Information System

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NEMSIS National EMS Information System

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Building on NEMSIS with Toolkits

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NEMSIS EMS Toolkits North Carolina EMS toolkits: Local EMS System Delivery SMARTT Trauma Cardiac Arrest Pediatric Care Airway Management Acute Coronary Syndrome Stroke (CDC – DHDSP Sponsored)

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North Carolina EMS Stroke Toolkit One year project with NCOEMS & UNC-Chapel Hill Dept. of Emergency Medicine. Develop report tool for emergency care of stroke using NC’s EMS database. Utilizes PreMIS (Prehospital Emergency Medical Information System) used by all 100 NC counties. Designed by panel of EMS and Stroke care experts.

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North Carolina EMS Stroke Toolkit Objectives: Implement emergency pre-hospital stroke care best practices, Facilitate incremental improvement of emergency stroke care, Support NEMSIS compliant EMS databases, Develop stroke care database with potential for collaborative partnership with Coverdell Stroke Register, Strategic partnership in a model state for stroke treatment.

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http://www.nccep.org/content/ems/standards/protocols.htm Stroke EMS Toolkit & North Carolina State Stroke Protocol

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North Carolina EMS Stroke Toolkit Public Education Community Awareness Community Education Stroke Recognition Access 911 E911 Implementation

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North Carolina EMS Stroke Toolkit EMS Dispatch - Emergency Medical Dispatch (EMD) implementation Stroke Recognition Quality Management Call Location Dispatch Time Benchmarks (90 Seconds)

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EMS Response - Stroke Care requires less EMS intervention or care than other acute EMS events Key interventions Quick Response First Responders Appropriate Timely Transport North Carolina EMS Stroke Toolkit

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EMS Dispatch Center Time EMS “Chute” Time or “Wheels Rolling” Time EMS Response Time EMS Total Response Time EMS Scene Time EMS Transport Time Total EMS Patient Contact Time EMS Response Delays EMS Scene Delays EMS Transport Delays North Carolina EMS Stroke Toolkit

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EMS Skills - Documentation Time of Onset Contact Information Stroke Scale Glucose Vital Signs Rhythm is capable Thrombolytic Screen North Carolina EMS Stroke Toolkit

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Patient Care Scene Time limited to 10 minutes Low probability of Airway compromise IV if > 15 minutes transport time Stroke Screen Oxygen if <97% Assessment Neurologic Exam Mental Status Exam NPO North Carolina EMS Stroke Toolkit

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Transport and Destination - Stroke Plan/ Policy Thrombolytic drugs if 2 hours or less Invasive intervention in 6 hours or less Scene Times less than 10 minutes If Transport Times greater than 15 minutes consider Specialty Center Specialty Care Transport Services North Carolina EMS Stroke Toolkit

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Concluding remarks NEMSIS establishes a common EMS data standard and national database. Toolkits track EMS performance, monitor patient outcomes, and facilitate improvement in both. Linkage of EMS and hospital registries will become an important next stage of development in tracking CVD from EMS to hospital release. Interlinked datasets like these will provide a vehicle for assessment of local health service delivery and identification of disparities in emergency health care. These tools will help EMS stakeholders recognize interventions that work and focus improvement efforts where most needed .

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Questions?