AHA Dallas Caruth Initiative Stakeholder Committee Agenda ...wcm/@swa/... · AHA Dallas Caruth...

AHA Dallas Caruth Initiative Stakeholder Committee Agenda March 3, 2011

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American Heart Association Dallas Office 8200 Brookriver, Classroom A

Conference Call Number 866-506-5191, Participant Pass code 335721# www.heart.org/caruth

Co-Chairs: Ray Fowler and Michael Taylor Staff Liaison: Dawn Kregel

7:00 Continental Breakfast

1. 7:30 Welcome & Introductions Ray Fowler & Michael Taylor Exhibit 1A Stakeholder Committee Voting Member Roster

Exhibit 1B DSC Minutes from December 2, 2010 meeting BackgroundIntroduction of Committee members

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• This group represents the establishment of a formal oversight committee for this initiative in Dallas County to build a coordinated regional AMI system of care.

Goals

• Implement the grant-funded initiative, including the goals, participation requirements, educational and data analysis opportunities, and available honoraria for participating hospitals and EMS agencies.

Committee members to submit edits to the committee roster to AHA staff. Approve and accept or accept with changes for the minutes.

Action:

2. 7:40 Committee Structure and Documentation Michael Taylor

Exhibit 2A Stakeholder Commission Statement Exhibit 2B Subcommittee Commission Statement Exhibit 2C Proxy Voting Exhibit 2D AHA Ethics Policy Exhibit 2E AHA Conflict of Interest Policy Exhibit 2F Committee Structure BackgroundDallas Stakeholder Committee and Subcommittee Commission documents detail respective goals, member commitment and responsibilities. Proxy Voting document is necessary if a voting member cannot attend scheduled meetings. Conflict of Interest (COI) and Ethics policy available for review.

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http://www.heart.org/caruth�


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An appraisal of the Committee structure is featured in Exhibit 2F.

Information only Action:

3. 7:45 Caruth Initiative Update Dawn Kregel

Exhibit 2A EMS Participants Exhibit 2B Hospital Participants Exhibit 2C Stipends BackgroundThe Stakeholder Committee and 5 Subcommittees have been meeting regularly. All meeting dates, notices, resources and meeting documentation are posted at

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www.heart.org/caruth. ActionInformation only

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4. 7:55 Conference Planning Subcommittee Jon Gardner, Tami Kayea &

Jennifer Ledbetter Exhibit 4A Subcommittee Report and Roster

Exhibit 4B Sample Agenda/Schedule Exhibit 4C Poster Application BackgroundSubcommittee members met and created recommendations for this committee. Members are asked to read exhibits prior to meeting.

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Committee to review and amend or approve Subcommittee recommendations.

Action:

5. 8:05 Education Subcommittee Karen Pickard & Chris Weinzapfel Exhibit 5A Subcommittee Report and Roster

BackgroundSubcommittee members met and created recommendations for this committee. Members are asked to read exhibits prior to meeting.

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Action:



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6. 8:15 EMS Resources Subcommittee Kevin Cunningham & Craig White Exhibit 6A Subcommittee Report and Roster

Exhibit 6B Application for funding BackgroundSubcommittee members met and created recommendations for this committee. Members are asked to read exhibits prior to meeting.

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Action:

7. 8:25 Protocols Subcommittee Mark Till & Chris Chiara

Exhibit 7A Subcommittee Report and Roster Exhibit 7B 12-Lead ECG Screening Guideline Exhibit 7C EMS Chest Pain/Acute Coronary Syndrome Guidelines BackgroundSubcommittee members met and created recommendation for this committee. Members are asked to read exhibits prior to meeting.

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Action:

8. 8:35 Quality Improvement Subcommittee Bob Hillert & Tom Tierney Exhibit 8 A Subcommittee Report and Roster

Exhibit 8 B EMS Data Dictionary for Required Data Fields BackgroundSubcommittee members met and created recommendations for this committee. Members are asked to read exhibits prior to meeting.

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Action:


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9. 8:50 Review Action Steps Michael Taylor Next meeting date is Thursday, June 2nd. Refer to web site for additional

information and meeting dates.

Summarize a list of action steps from today’s agenda Action:

10. 9:00 Adjourn

Ray Fowler

AHA Dallas Caruth Inititative Stakeholders Voting Member Roster March 2011 Addison Fire Department Chris Kellen

Baylor Heart and Vascular Hospital Nancy Vish

Baylor Medical Center at Garland Janice Walker

Baylor Medical Center at Irving Barry Allen

Carrollton Fire Department Ricky Vaughn

Cedar Hill Fire Department Kevin Cunningham

Coppell Fire Department Gregg Loyd

Dallas Fire Rescue Tami Kayea

Dallas Medical Center Amy Ferguson

Dallas Regional Medical Center Daniel Cervantez

DeSoto Fire Rescue James Bell

DFW Airport EMS Forrest Broom

Doctors Hospital of Dallas Bob Hillert

Duncanville Fire Department Sam Rohde

Farmers Branch Fire Department Stephen Bock

Garland Fire Department Garrett Evans

Glenn Heights Fire Department Jason Cates

Grand Prairie Fire Department Lt. J.D. Yates

Highland Park DPS Janet Sandman

Hutchins Fire Department Mike Telford

Irving Fire Department Steve Deutsch

Lancaster Fire Department Laura Hillary

AHA Dallas Caruth Inititative Stakeholders Voting Member Roster March 2011 Las Colinas Medical Center Mike Lopez

Medical City Dallas Hospital Jennifer Ledbetter

Mesquite Fire Department Bobby Muse

Methodist Charlton Medical Center Michael Seifu

Methodist Dallas Medical Center Christine Walker

Methodist Richardson Medical Center Tarah Grooms

Parkland Hospital Kelly Heathman

Richardson Fire Department Curtis Poovey

Rowlett Fire Rescue Ron Simmons

Sachse Fire Department Rick Coleman

Sunnyvale Fire Rescue Joe Plumlee

Texas Health Presbyterian Dallas Paula Spencer

Texas Regional Medical Center Sunnyvale Misty Thomas

TLC Darryl Quigley

University Park Fire Department Rusty Massey

UT Southwestern Medical Center John Warner

Wilmer Fire Department Mark Hamilton

AHA Dallas Caruth Initiative Stakeholder Committee Minutes December 2, 2010

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American Heart Association Dallas Office 8200 Brookriver, Classroom A

Conference Call Number 866-506-5191, Participant Pass code 335721# www.heart.org/caruth

Co-Chairs: Ray Fowler and Michael Taylor Staff Liaison: Dawn Kregel

Attendees: Name Organization

Allen, *Barry Baylor Medical Center at Irving Ammon, Olympia American Heart Association Bell, *James DeSoto Fire Rescue Bock, *Stephen Farmers Branch Fire Department Campbell, *Cathy Dallas Medical Center Chiara, Chris Dallas Fire Rescue Cook, Jeverly Communities Foundation of Texas Cunningham, *Kevin Cedar Hill Fire Department Davis, Duane American Heart Association Denne, Loni American Heart Association Deutsch, *Steve Irving Fire Department Dikes, Ryan Highland Park DPS Even, Tash Mesquite Fire Department Fowler, Ray UT Southwestern Medical Center French, David Baylor Healthcare System Gardner, Jon Texas Health Presbyterian Dallas Gualano, Sarah UT Southwestern Hall, Garrett NCTTRAC Hillert, *Bob Doctors Hospital of Dallas Holloway, Robert Dallas Fire Rescue Jones, Darin Addison Fire Department Kayea, Tami Dallas Fire Rescue Kellen, *Chris Addison Fire Department King, Richard UT Southwestern Kregel, Dawn American Heart Association Ledbetter, *Jennifer Medical City Dallas Hospital Lopez, *Mike Las Colinas Medical Center Poovey, *Curtis Richardson Fire Department Ramirez, Diana American Heart Association Rohde, *Sam Duncanville Fire Department Rush, Debby Texas Health Presbyterian Dallas Sanborn, Michael Baylor Health Care System Sandman, *Janet Highland Park DPS



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Segrest, Wendy American Heart Association Seifu, *Michael Methodist Charlton Medical Center Simmons, *Ron Rowlett Fire Rescue Sisneros, Andres Baylor Heart and Vascular Hospital Spencer, *Paula Texas Health Presbyterian Dallas St. Claire, Lane Medical City Children's Hospital Stricklin, John Baylor Medical Center at Irving Telford, *Mike Hutchins Fire Department Thomas, *Misty Texas Regional Medical Center Sunnyvale Tierney, *Thomas Parkland Hospital Villa, Jacquelin Doctors Hospital of Dallas Vish, *Nancy Baylor Heart and Vascular Hospital Walker, *Christine Methodist Dallas Medical Center Walker, *Janice Baylor Medical Center at Garland Weinzapfel, Chris Rowlett Fire Rescue Yates, Lt. J.D. Grand Prairie Fire Department

7:00 Continental Breakfast

1. 7:30 Welcome & Introductions Ray Fowler Exhibit 1A Stakeholder Committee Voting Member Roster

Exhibit 1B Stakeholder Commission Statement BackgroundIntroduction of Committee members

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• This group represents the establishment of a formal oversight committee for this initiative in Dallas County to build a coordinated regional AMI system of care.

Goals


Committee members to submit edits to the committee roster to AHA staff Action:

Minutes

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Information Only

2. 7:40 Caruth Initiative Update Dawn Kregel


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Exhibit 2A Payment Form BackgroundThe Stakeholder Committee and 5 Subcommittees have been established and are meeting regularly. All meeting dates, notices, resources and meeting documentation will be posted at

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www.heart.org/caruth. ActionInformation only

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MinutesInformation Only

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3. 7:45 Initial Data Ray Fowler

BackgroundA preliminary assessment was sent out in the invitation letters to the EMS Agencies and Hospitals in Dallas County. This limited baseline information will be presented briefly. Comprehensive data assessments continue.

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ActionInformation only

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Minutes

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Dr. Fowler presented the preliminary assessment to the committee in a PowerPoint presentation. There are 23 EMS agencies and 16 hospitals that were given the preliminary assessment questions below and the results are as follows:

Question Yes No 23 EMS Agencies Do you have STEMI and Non-STEMI protocols in place? 17 6 Do you bypass the ED and go straight to the cath lab for STEMI patients? 11 12

Does your EMS transmit pre-hospital 12-Lead EKGs? 11 12 Do you have a single call number to activate the cath lab from the field?

9 14

Do you have a bypass protocol to go directly to a PCI Hospital? 11 12 Do you receive feedback from hospitals on STEMI and Non-STEMI patients?

11 12

Education offered for 12-Lead ECG interpretation? 21 2 16 Hospitals Do you have STEMI order sets in place? 13 3



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Do you bypass the ED and go straight to the cath lab for STEMI patients? 3 13

Do you receive EMS or pre-hospital 12-Lead EKG transmissions? 8 8 Do you have a single call number to activate the cath lab from the field? 7 9

Does your hospital offer PCI services 24/7? 14 2 Do you have a standardized feedback process to notify EMS of quality control?

5 11

4. 7:55 Subcommittee Report: Conference Planning Tami Kayea & Jennifer Ledbetter

Exhibit 4A Subcommittee Report: Conference Planning BackgroundSubcommittee members met and created recommendations (exhibit) for this committee. Members are asked to read exhibits prior to meeting.

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Action:

Minutes

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Tami presented the recommendations for the subcommittee Conference Planning The subcommittee has been discussing what they would like to see come out of the Conference and this is in two parts one to bring everyone to the same educational level and the other is to bring ideas on how to make everything function smoothly together. These are the recommendations the voting members were asked to vote on:

1. Conference includes a panel discussion to include a 911 dispatcher, physician, pharmacist, RN, and paramedic to discuss system challenges

2. Conference attendee fee to stay under $50.00 for all North Texas

professionals

3. Conference to be scheduled on Friday morning through Saturday afternoon with some sessions repeated to allow for staff rotation at the conference


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4. Conference includes a public education session Saturday afternoon

5. Conference promotion to start in February to coincide with Heart

month

6. Conference includes invitation for each participating EMS Agency and Hospital to present a poster session on AMI best practice examples

7. Conference scheduled June 3-4, 2011 at the Westin Southeast of the intersection of 635 & 75

There were two questions asked of the Conference Planning subcommittee: Is this going to be a CE credited conference? The answer is yes, it will be. Also asked is what the name of the conference will be, which has yet to be determined. This will be an item for the next Conference Planning subcommittee to determine or come up with ideas. The voting members were asked to vote on the recommendation items and all items were approved.

5. 8:05 Subcommittee Report: Education Chris Weinzapfel Exhibit 5A Subcommittee Report: Education

BackgroundSubcommittee members met and created recommendations (exhibit) for this committee. Members are asked to read exhibits prior to meeting.

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Action:

Chris presented the recommendations for the subcommittee Education These are the recommendations the voting members were asked to vote on:

1. Start with an evaluation of current professional barriers to the optimal regional AMI system operation and outcomes

2. Evaluate programs currently offered at hospitals and EMS agencies

(with CE credit)


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3. Educational content to be developed from evaluation results with a recommendation to include advanced courses in 12-Lead ECG interpretation

4. Education methods to include: workshops, reading materials, on-line, and hands-on training

5. Consider conducting code STEMI drills in a public venue to aid in public awareness campaign while educating on EMS and hospital coordination

6. Creation of a public education awareness campaign to focus on time-sensitive items that include stroke symptoms with heart attack symptoms and address barriers to calling 911

One item that was suggested regarding barriers to calling 911 is to target middle school and high school students. As a minimum curriculum, teach them at two different times in the beginning of each school year to understand and recognize signs and symptoms of a heart attack and learn CPR. The voting members were asked to vote on the recommendation items and all items were approved.

6. 8:15 Subcommittee Report: EMS Resources Kevin Cunningham & Craig White Exhibit 6A Subcommittee Report: EMS Resources


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Action:

Kevin presented the recommendations for the subcommittee EMS Resources These are the recommendations the voting members were asked to vote on:

1. 12-lead ECG transmission by EMS Agencies on all suspected AMI patients


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2. Utilize results of EMS Needs Assessment to identify the most effective allocation of equipment funding resources

3. All participating EMS Agencies agree to a standardized dataset for all AMI patients to submit to the UT School of Public Health in Houston

There was a question as to how much of the grant is allocated for hardware and is there protection against utilizing the money? The funding for equipment is $700,000 and we have the ability over the next two years to look at where the gaps are. We will then figure out if it is not only in equipment, but the transmission and the wireless connection to get the information out. The other important piece to this is the matching of funds. The MOU contracts and payments state that every EMS agency will meet certain minimal standards to make sure the funding doesn’t get used for burn equipment, for example, or a new cooler in the truck for lunches. The voting members were asked to vote on the recommendation items and all items were approved.

7. 8:25 Subcommittee Report: Protocols Mark Till & Chris Chiara Exhibit 7A Subcommittee Report: Protocols


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Action:

Chris presented the recommendations for the subcommittee Protocols What this subcommittee has been working on is how to make a unified standardized protocol from the time someone calls 911 to EMS on scene all the way until that person is ballooned in the STEMI lab. These are the recommendations the voting members were asked to vote on:

1. Change the culture to strengthen the relationship and reliance upon EMS providers, nurses and physicians and developing a system to foster

2. Evaluate false activation rates from EMS and encourage ED staff to


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use as educational opportunity to provide feedback to EMS staff

3. Identify number of EMS agencies that activate the hospital cath lab from the field

4. Each organization send a copy of the AMI/Chest Pain Protocol for

inclusion into the assimilation process to create a proposed standardized regional set

5. Evaluate hospital AMI/STEMI checklists to encourage inclusion of additional documentation required for ACTION Registry data elements

Leilani stated the subcommittee needs more EMS agency representation and attempted to recruit more volunteers and to invite other participants outside Dallas County. The voting members were asked to vote on the recommendation items and all items were approved.

8. 8:35 Subcommittee Report: Quality Improvement Bob Hillert & Tom Tierney Exhibit 8A Subcommittee Report: Quality Improvement


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Action:

Tom presented the goals for the subcommittee Quality Improvement These are the goals the voting members asked to vote on

1. Assess internal QI process and frequency in participating organizations

2. Assess how the region or county can create a regular and sustainable QI process to measure system performance

3. Identify barriers to data collection and reporting in participating organizations

4. Identify ways to help capture and measure “system” level items like symptom onset through arterial reperfusion (SOAR)


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The voting members were asked to vote on the goals and all items were approved. Dr. Hillert presented the recommendations for the subcommittee Quality Improvement These are the recommendations the voting members were asked to vote on:

1. Collection of four additional auxiliary fields to be utilized in ACTION Registry-GWTG (AR-G) for hospital data during this grant-funded initiative:

A. EMS Agency Name B. EMS Incident # or run # C. EMS cath lab activation from field? (y/n) D. Was the availability of ECG at receiving hospital required for

activation? (y/n) 2. Defining two AMI data fields as follows in EMS and hospital

databases: A. First Medical Contact = time the first healthcare professional

is eye to eye with patient B. Symptom Onset date and time = answer to “what prompted

you to call 911 or come to ED and what time was that?”

3. Participating staff to reinforce the message that both EMS and hospital staff are accountable to ensure EMS run sheet is received at hospital as part of the patient record (i.e. collected and placed in correct location)

Steve stated the run sheet that may be given to the hospital may be a draft and that the final may be sent at a later time. Adding “Draft” to the run sheet being hand off is acceptable for the committee.

4. QI Subcommittee members discussed collecting data on STEMI and

Non-STEMI patients; however AR-G has an inclusion criteria which excludes some AMI patients from being entered if they don’t meet the criteria. Subcommittee recommends participating hospitals also collect the total number of patients that present as AMI but aren’t included in AR-G as they fall out of the inclusion criteria. This committee will evaluate data and modify recommendations as warranted in summer 2011. AHA staff will provide hospitals with


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tools to track patients that fall out of inclusion criteria. The subcommittee will decide if the data will also need to include why the patients fall out once they receive a quarters worth of data. There will be feedback given to the other subcommittees regarding this data in order to assist with recommendations. This data will include patients brought to hospitals via EMS and walk-in patients. The voting members were asked to vote on the goals and recommendation items and all were approved.

9. 8:50 Review Action Steps Ray Fowler Next meeting date is Thursday, March 3. Refer to web site for additional

information and meeting dates.

Summarize a list of action steps from today’s agenda Action:

Minutes

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AHA: • Name the Conference

o The Heart of Dallas County o Save a Ton of Broken Hearts

• Outcomes and the evaluation of education programs in the communities

• Education in the schools to teach kids how to recognize a heart attack

• Add to section 8 item 3 under the recommendations that a draft run sheet may be hand off to hospitals to place as part of the patient’s record until a finalize one is submitted

• Identify the specific EMS data fields that will be collected in order to start collecting data, Duane will be sending out as a voting email

Members: All the information will be provided in the website, www.heart.org/caruth

10. 9:00 Adjourn MinutesMeeting was adjourned at 9:05 am

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Ray Fowler


AHA Dallas Caruth Initiative Dallas Stakeholder Committee Commission 2010 - 2012 The South Central Affiliate of the American Heart Association was awarded grant funding from the W.W. Caruth Jr. Foundation to create a seamless and integrated heart attack emergency care system and to analyze and connect data sets to measure total ischemic time and evaluate system level performance. To assist us with the leadership and completion of the grant objectives, a Stakeholder Committee is established for the time period from October 26, 2010, to December 31, 2012.

These volunteers, hospital and EMS designees, in Dallas County, specialize in heart attack emergency care and will join forces to meet the deliverables of the grant to American Heart Association. This committee will strategically counsel and advise the implementation team to accelerate the STEMI and NSTEMI system of care development.

Stakeholder Committee Commitment • Each agency and hospital provide one voting representative to move processes

forward in the two year commitment • If unable to attend, the voting representative will assign one proxy for voting

purposes • The formation of the Voting assembly will strengthen the Dallas County AMI system

of care • Participate in 8-10 meetings (1-2 hours in duration) from October 2010 through

December 2012 • Members of committee agree to abide to the AHA ethics policy including,

maintaining the confidentiality of information entrusted to them in this committee and initiative except when authorized or otherwise legally obligated to disclose

Primary Goals: • This group represents the establishment of a formal oversight committee for this

initiative in Dallas County to build a coordinated regional AMI system of care. • Implement the grant-funded initiative, including the goals, participation

requirements, educational and data analysis opportunities, and available honoraria for participating hospitals and EMS agencies.

Secondary Goals: • Review AMI activities and available tools for system building. • Review data collected from the EMS and Hospital assessments for AMI care. • Establish subcommittee structure to address and implement different aspects of the

initiative: o Conference Planning o Education o EMS Resources o Protocols o Quality Improvement

AHA Dallas Caruth Initiative Dallas Stakeholder Subcommittee Commission 2010 - 2012 The South Central Affiliate of the American Heart Association was awarded grant funding from the W.W. Caruth Jr. Foundation to create a seamless and integrated heart attack emergency care system and to analyze and connect data sets to measure total ischemic time and evaluate system level performance. To assist us with the leadership and completion of the grant objectives, a Stakeholder Committee and subcommittees are established for the time period from October 26, 2010, to December 31, 2012.

These volunteers, hospital and EMS designees, in Dallas County, specialize in heart attack emergency care and will join forces to meet the deliverables of the grant to American Heart Association. This committee will strategically counsel and advise the implementation team to accelerate the STEMI and NSTEMI system of care development.

Stakeholder Subcommittee Commitment

• Any EMS and/or hospital person interested in AMI care may voluntarily serve on one or more subcommittee

• Members of committee agree to abide to the AHA ethics policy including, maintaining the confidentiality of information entrusted to them in this committee and initiative except when authorized or otherwise legally obligated to disclose

• Participate in regular meetings (1-2 hours in duration) from October 2010 through December 2012 at intervals determined by each subcommittee

Goals

• This represents the establishment of unique subcommittees that will provide recommendations regarding the grant initiative to the voting members of the oversight committee, to build a coordinated regional AMI system of care.


• The subcommittees and respective goals are as follows: o Conference Planning

Plan the content, format, and speakers for a regional professional education conference on the latest treatment and system initiatives for the management of patients with AMI.

o Education Assess AMI knowledge gaps in hospital and EMS staff and develop an

educational curriculum and delivery plan for the curriculum. o EMS Resources

Review resource gaps and develop a plan to allocate grant funding. o Protocols

AHA Dallas Caruth Initiative Dallas Stakeholder Subcommittee Commission 2010 - 2012

Establish and implement regional transport, triage and treatment protocols.

o Quality Improvement Share data and quality improvement strategies to optimize AMI care

throughout North Texas and to impact patient outcomes.

AHA Dallas Caruth Initiative Proxy Voting Form

Eligibility Proxy voting must follow these rules:

1. If you wish to vote by proxy, you must use this official form (a proxy form may be a copy or facsimile of the official proxy form, but must have an original ink signature in order to be official). The proxy form must be dated and signed to be valid.

2. The designated proxy holder must be a designated voting member of AHA Dallas Caruth Stakeholder Committee in good standing.

3. Please do not send this form to the AHA office. The proxy holder must present the proxy form for certification during meeting check-in. The proxy may be exercised only by the person named.

4. If you cannot attend the committee meeting, it is your obligation and privilege to vote by proxy.

Proxy Vote I hereby appoint (proxy name) ________________________________________________________, my proxy,

to represent me at the (date) ________________________________ AHA Dallas Caruth Stakeholder

Committee Meeting, and to act in my stead, authorizing this person fully to vote and do all

things that I could or might do to the same extent if personally present. I also authorize this

person to do every act whatsoever necessary or proper to be done in or upon all matters

that may lawfully come before said meeting or any adjournment thereof. Further, I hereby

revoke any proxy or proxies previously given by me to any person or persons.

Name: Date: (Please print name legibly).

Signature:

Organization:

AMERICAN HEART ASSOCIATION CONFLICT OF INTEREST POLICY

THE AMERICAN HEART ASSOCIATION, ITS AFFILIATES AND COMPONENTS, AND ALL OFFICERS, DIRECTORS, DELEGATES, COUNCIL AND COMMITTEE MEMBERS SCRUPULOUSLY SHALL AVOID ANY CONFLICT BETWEEN THEIR OWN RESPECTIVE PERSONAL, PROFESSIONAL OR BUSINESS INTERESTS AND THE INTERESTS OF THE ASSOCIATION, IN ANY AND ALL ACTIONS TAKEN BY THEM ON BEHALF OF THE ASSOCIATION IN THEIR RESPECTIVE CAPACITIES.

In the event that any Officer, Director, Delegate, Council or Committee member of the Association shall have any direct or indirect interest in, or relationship with, any individual or organization which proposes to enter into any transaction with the Association, including but not limited to transactions involving:

a. the sale, purchase, lease or rental of any property or other asset;

b. employment, or rendition of services, personal or otherwise;

c. the award of any grant, contract, or subcontract;

d. the investment or deposit of any funds of the Association;

such person shall give notice of such interest or relationship and shall thereafter refrain from discussing or voting on the particular transaction in which he has an interest, or otherwise attempting to exert any influence on the Association, or its components to affect a decision to participate or not participate in such transaction.

(Approved by AHA Board of Directors and Delegate Assembly, June 1986)

AMERICAN HEART ASSOCIATION Record of Abstention with Conflict of Interest Policy

As a member of the AHA or Affiliate Delegate Business Session, Board of Directors, Committee, Council, Task Force or Group, the following is a record of my disclosure of a direct or indirect conflict of interest and abstention from discussion and voting on the matter at this meeting. CONFLICT:__________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________ ________________________________________ ___________________________________ (Name of board, council, committee or group) (Signature) ________________________________________ ___________________________________ (Date) (Print Name)

[Original to be filed with minutes of the meeting.]

American HeartAssociation

Communities Foundation of Texas

AHA Caruth AMISystem Initiative

Dallas Stakeholder Committee

Raymond FowlerMichael Taylor

UT SouthwesternDallas

UT Health Science Center Houston

AHA Caruth Volunteer

Advisory BoardJames Langabeer

EMSResources

SubcommitteeKevin Cunningham

Craig White

ProtocolsSubcommittee

Chris ChiaraMark Till

EducationSubcommitteeKaren Pickard

Chris Weinzapfel

Quality ImprovementSubcommittee

Bob HillertTom Tierney

SymposiumPlanning

SubcommitteeJon GardnerTami Kayea

Jennifer Ledbetter

American College of Cardiology

Jami DelliFraine, PhD Univ. of Texas Health Science Center at Houston

Raymond Fowler, MD, FACEP Univ. of Texas Southwestern Med Center

Timothy Henry, MD Minneapolis Heart Institute Foundation

James Jollis, MD, FACC RACE-ER, Duke Univ Med Center

Richard King, PhD Univ. of Texas Southwestern Med Center

Eva Kline Rogers, MS, RN, NP University of Michigan

William Koenig, MD Los Angeles County Emergency Medical Center

James Langabeer, PhD, CMA Univ. of Texas Health Science Center at Houston

Peter Moyer, MD, MPH Emergency Medicine, Boston Univ School of Medicine

Mayme Lou Roettig, RN, MSN RACE-ER, Duke Univ Med Center

John Warner, MD, FACC Univ. of Texas Southwestern Med Center

AHA Caruth Volunteer Advisory Board

Chris Kellen Addison Fire Department Steve Deutsch Irving Fire Department

Nancy Vish Baylor Heart and Vascular Hospital Thomas Griffith Lancaster Fire Department

Janice Walker Baylor Medical Center at Garland Mike Lopez Las Colinas Medical Center

Barry Allen Baylor Medical Center at Irving Jennifer Ledbetter Medical City Dallas Hospital

Ricky Vaughn Carrollton Fire Department Bobby Muse Mesquite Fire Department

Kevin Cunningham Cedar Hill Fire Department Michael Seifu Methodist Charlton Medical Center

Gregg Loyd Coppell Fire Department Christine Walker Methodist Dallas Medical Center

Tami Kayea Dallas Fire Rescue Tarah Grooms Methodist Richardson Medical Center

Amy Ferguson Dallas Medical Center Kelly Heathman Parkland Hospital

Daniel Cervantez Dallas Regional Medical Center Curtis Poovey Richardson Fire Department

James Bell DeSoto Fire Rescue Ron Simmons Rowlett Fire Rescue

Forrest Broom DFW Airport EMS Rick Coleman Sachse Fire Department

Bob Hillert Doctors Hospital of Dallas Joe Plumlee Sunnyvale Fire Rescue

Sam Rohde Duncanville Fire Department Paula Spencer Texas Health Presbyterian Dallas

Stephen Bock Farmers Branch Fire Department Misty Thomas, Texas Regional Medical Center Sunnyvale

Garrett Evans Garland Fire Department Darryl Quigley TLC

Jason Cates Glenn Heights Fire Department Rusty Massey University Park Fire Department

J.D. Yates Grand Prairie Fire Department John Warner UT Southwestern Medical Center

Janet Sandman Highland Park DPS Mark Hamilton Wilmer Fire Department

Mike Telford Hutchins Fire Department

AHA Caruth Dallas Stakeholder CommitteeRaymond Fowler & Michael Taylor

Co-Chairs

EMS ResourcesSubcommittee

Kevin CunninghamCraig White

ProtocolsSubcommittee

Chris ChiaraMark Till

EducationSubcommitteeKaren Pickard

Chris Weinzapfel

Quality ImprovementSubcommittee

Bob HillertTom Tierney

SymposiumPlanning

SubcommitteeJon GardnerTami Kayea

Jennifer Ledbetter

Bob Hillert

Chris Fason

Christine Walker

Daniel Cervantez

Debby Rush

Dyron Tyler

John Warner

Juliet Horne

Karen Pickard

Rocky Galvan

Ryan Wolford

Tamara McCrary

Tarah Grooms

Thomas Tierney

Tracy Campbell

Andres Sisneros Mark Till

Barry Allen Misty Thomas

Carrie Hecht Nancy Vish

Chad Hardin Nestor Zenarosa

Chris Chiara Patti Cantu

Chris Fason Paula Spencer

Daniel Cervantez Robert Stoler

David Pillow Ronnie Ikeler

Don Timm Rusty Massey

Eric Eichhorn Ryan Dikes

Gregg Loyd Ryan Wolford

Janet Sandman Sean Black

Janice Walker Terry Fowler

Jennifer Ledbetter

Thomas Tierney

John Stricklin Todd Peele

John Warner Todd Gray

Juliet Horne Tracy Campbell

Kristi Marino

Bobby Muse J.D. Yates

Chris Weinzapfel

Mark Till

Chris Fason Mike Telford

Craig White Paula Spencer

Curtis Poovey Rick Coleman

Forrest Broom Ricky Vaughn

Garrett Evans Robert Holloway

Gregg Loyd Ron Simmons

James Bell Ronnie Ikeler

Janet Sandman Ryan Dikes

Joe Plumlee Sam Rohde

Keith Carter Steve Deutsch

Kevin Cunningham

Susan Conn

Lane St. Claire Thomas Tierney

Laura Hillary

Bob Brockie

Bob Hillert

Chris Weinzapfel

Christine Walker

David French

Jacquelin Villa

Joe Plumlee

Jon Gardner

Karen Pickard

Karen Yates

Kristine Nichols

Liz Fagan

Lynn Perdue

Nikki Rupe

Richard King

Rick Coleman

Rob Spranger

Rocky Galvan

Ryan Wolford

Sean Black

Stephen Bock

Steve Deutsch

Thomas Tierney

Andres Sisneros

Annabelle Zakarian

Art Signo

Craig White

Curtis Poovey

Jennifer Ledbetter

Jon Gardner

Laura Hillary

Steve Deutsch

Tami Kayea

Tammy Chung

Tarah Grooms

Thomas Tierney

Todd Gray

AHA Dallas Caruth Initiative EMS Agency Participants February 2011

Addison Fire Department EMS Agencies (23)

Carrollton Fire Department Cedar Hill Fire Department Coppell Fire Department Dallas Fire/Rescue Dallas/Ft. Worth Airport EMS DeSoto Fire Rescue Duncanville Fire Department Farmers Branch Fire Department Garland Fire Department Glen Heights Fire Department Grand Prairie Fire Department Highland Park Department of Public Safety Hutchins Fire Department Irving Fire Department Lancaster Fire Department Mesquite Fire Department Richardson Fire Department Rowlett Fire Department Sachse Fire Department Sunnyvale Department of Public Safety TLC for Seagoville University Park Fire Department

AHA Dallas Caruth Initiative Hospital Participants February 2011

Baylor Heart and Vascular Hospital Hospitals (15)

Baylor Medical Center at Garland Baylor Medical Center at Irving Dallas Medical Center Dallas Regional Medical Center Doctors Hospital Las Colinas Medical Center Medical City Dallas Hospital Methodist Charlton Medical Center Methodist Dallas Medical Center Parkland Health and Hospital System Richardson Regional Medical Center Texas Health Resources Presbyterian Dallas Texas Regional Hospital Sunnyvale UT Southwestern St Paul Hospital

AHA Dallas Caruth Initiative Stipend Report March 3, 2011

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Organization Payment Type Payment Amount Participants: Cedar Hill Fire Dept Initial Stipend $ 5,000 Duncanville Fire Dept Initial Stipend $ 5,000 Farmers Branch Fire Dept Initial Stipend $ 5,000 Mesquite Fire Dept Initial Stipend $ 5,000

AHA Dallas Caruth Initiative Subcommittee Report: Conference Planning March 3, 2011

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Subcommittee Co-Chairs: Jon Gardner, Tami Kayea, and Jennifer Ledbetter Conference Planning Subcommittee Goals

1. Plan the content and schedule of a regional professional education conference for June 2011 and 2012.

2. Format the regional professional education conference on the latest STEMI/NSTEMI treatment and system initiatives.

Conference Planning Subcommittee Recommendations Stakeholder Committee vote needed to amend or approve

1. Exhibit B Sample Agenda/Schedule with most of the topics and speakers confirmed.

2. Keep the cost the same for each discipline.

3. Keep the cost at a low registration fee - either $25.00 or $30.oo per day. Allow one day registration to allow for rotating attending staff.

4. Guest attendance fee of $50 for the dinner presentation.

5. Poster session for any participating hospital or EMS Agency to promote their facility or highlight their AMI care services. Draft application provided. We welcome hospitals and EMS agencies to co-present.

6. Listing all participating agencies and hospitals on the www.heart.org/caruth website.

7. Each subcommittee to present for 10 minutes on goals and updates at the June

conference.


AHA Dallas Caruth Initiative Subcommittee Report: Conference Planning March 3, 2011

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Conference Planning Subcommittee Roster Baylor Heart and Vascular Hospital Art Signo

Baylor Heart and Vascular Hospital Andres Sisneros

Baylor Heart and Vascular Hospital Annabelle Zakarian

Dallas Fire Rescue Tami Kayea

Denton Regional Medical Center Todd Gray



Medical City Dallas Hospital Craig White


Parkland Hospital Thomas Tierney

Richardson Fire Department Curtis Poovey

Texas Health Presbyterian Dallas Tammy Chung

Texas Health Presbyterian Dallas Jon Gardner

AHA Dallas Caruth Initiative Sample Agenda Subcommittee: Conference Planning February 2011

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1300 1315 Welcome & intro

Todd Gray & Michael Taylor

EMS stuff – ECG refresher, tough calls, etc break AR-G stuff for hospitals

M:L

1700 1730 Networking reception 1730 1900 Caruth Overview

Keynote and dinner Dr Cook & Monica RACE or Lessons from North and South

0730 0800 Registration & continental breakfast 0800 0815 Welcome & intro Todd Gray & Ray

Fowler 0815 0915 Keynote RACE or Lessons from

North and South 0900 1000 Initiative overview & Subcommittee Reports Co-Chairs and Dawn

Kregel 1000 1030 Break and snack – in exhibits & posters 1030 1100 Baseline Dallas Data (or could slot with panel

later) Jim Langebeer

1100 1145 Concurrent Sessions • M:L • Guidelines • Hypothermia • Post MI care

Chris Bjerke Dr. Robert Wozinak Dr. David Marks Paul St. Laurent

1145 1300 Lunch – in exhibits & posters 1300 1345 Concurrent Sessions

• M:L • Guidelines • Hypothermia • Post MI care

Chris Bjerke Dr. Robert Wozinak Dr. David Marks Paul St. Laurent

1345 1430 Panel Discussion Continuum of Care – reps by discipline (i.e. MD, RN, EMT, etc) or by pt care area (i.e. dispatch, EMS, ED, Cath lab, etc)

1430 1445 Closing remarks Todd Gray/Dawn Kregel

AHA Dallas Caruth Initiative Poster Presentation Subcommittee: Conference Planning

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Information and Guidelines for AHA Dallas Caruth Initiative Regional AMI Conference Poster Presenters

THE PRESENTATION Display Facilities

• Each institution or agency is available to display one poster. • The posters must not exceed 90 inches wide x 44 inches high. • Electrical outlets will not be provided in the poster presentation area. • The poster area is sufficiently lit, so no spotlights are required.

Preparation of a Poster

• Prepare the poster on material that is lightweight. The material can be on one sheet so that it can be rolled up for easy transport or on separate panels for individual mounting.

• Posters should be readable from a distance of 6 feet. • For adequate visibility, capital letters should be at least 3/8 inch high after enlargement

to full poster size. • Photographs should be a minimum of 12 x 15 inches. • You may prepare handouts for distribution at the meeting. The handouts should be

directly related to the topic of the poster and may not contain any advertising. • An envelope for collection of business cards from poster viewers will be provided by

AHA. • Your poster should be self-explanatory so that you are free to supplement and discuss

particular • points raised by enquiry. • It is your responsibility to include the poster number, “AHA Dallas Caruth Initiative

Regional AMI Conference” heading, poster title, author(s) name(s), and their affiliations. • It may also include:

Diagrams and charts Reaction schemes Tables recordings, graphs, etc. Photographs Written text, such as abstract or summary, introduction, method, results, and

conclusions • Some effects that may be used in a poster include:

Colors (very effective in diagrams and charts) Transparent overlays Samples of materials, models, etc.

• Arrange the material in main sections, each of them without too many details but with a common thread.

• On the top left side of your poster please include your poster number, which you will receive from the AHA Caruth Team.

• Avoid overcrowding figures and cramming too many numbers into tables.

• Legends and titles should accompany all figures, tables, photographs, etc., for identification


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Questions? Dawn Kregel Phone: 214-712-1347 [email protected] www.heart.org/caruth Poster Presenters Application attached.

mailto:[email protected]�



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Poster Presentation from Organization

Name

Organization

Address

Credentials

Contact Phone number

Email Address

AHA Dallas Caruth Initiative Subcommittee Report: Education March 3, 2011

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Subcommittee Co-Chairs: Karen Pickard and Chris Weinzapfel Education Subcommittee Goals

1. Professional a. Assess AMI emergency care knowledge gaps b. Develop an education curriculum – content and structure c. Evaluate educational outcomes

2. Public a. Identify a public awareness campaign strategy and timeline for promotion of

“911” for heart attack symptoms via third party evaluation

Education Subcommittee Recommendations Stakeholder Committee vote needed to approve or amend

1. Survey to be initiated to all participating EMS Agencies and Hospitals regarding professional education needs to strengthen regional AMI patient care.

2. Invite all educators from the participating EMS Agencies and Hospitals to meet and

help develop the plan for professional education content, delivery process, and evaluation.


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Education Subcommittee Roster Carrollton Fire Department Chris Malvik

Denton Regional Medical Center Lynn Perdue


Doctors Hospital of Dallas Jacquelin Villa

Farmers Branch Fire Department Stephen Bock


Las Colinas Medical Center Mike Lopez

Las Colinas Medical Center Kristine Nichols

Methodist Dallas Medical Center Rob Spranger


Methodist Mansfield Medical Center Karen Yates

Methodist Richardson Medical Center Liz Fagan


Rowlett Fire Rescue Chris Weinzapfel


Sunnyvale Department of Public Safety Joe Plumlee

Texas Health Presbyterian Dallas Bob Brockie

Texas Health Presbyterian Dallas Jon Gardner

UT Southwestern St. Paul Hospital Rocky Galvan


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UT Southwestern Medical Center Richard King

UT Southwestern Medical Center Karen Pickard

AHA Dallas Caruth Initiative Subcommittee Report: EMS Resources March 3, 2011

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Subcommittee Co-Chairs: Kevin Cunningham and Craig White EMS Resources Subcommittee Goals Identify equipment requirements for successful transmission of 12-lead ECG on

suspected AMI patients for all EMS Agencies - completed

Identify requirements for data submission to be analyzed by third party - completed

Identify requirements for hospitals to obtain transmission of 12-lead ECG from EMS Agencies - completed

4. Identify additional equipment and training requirements for EMS Agencies to optimally treat AMI patients

EMS Resources Subcommittee Recommendations

1. Extending the deadline for agencies to submit additional equipment requests.

2. Schedule a teleconference for voting members before the next June Stakeholder Committee meeting to review equipment purchase and allocation recommendations.


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EMS Resources Subcommittee Roster Carrollton Fire Department Ricky Vaughn

Cedar Hill Fire Department Kevin Cunningham


Dallas Fire Rescue Robert Holloway

Denton Regional Medical Center Susan Conn

DeSoto Fire Rescue James Bell

DFW Airport EMS Forrest Broom

Duncanville Fire Department Sam Rohde

Garland Fire Department Garrett Evans

Grand Prairie Fire Department Lt. J.D. Yates

HCA-North Texas Division Ronnie Ikeler

Highland Park DPS Ryan Dikes


Hutchins Fire Department Chris Fason

Hutchins Fire Department Mike Telford


Medical City Children's Hospital Lane St. Claire

Medical City Dallas Hospital Craig White

MedicOne Medical Response Keith Carter



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Rowlett Fire Rescue Ron Simmons


Sunnyvale Department of Public Safety Joe Plumlee

Texas Health Presbyterian Dallas Sean Black


Texas Health Presbyterian Dallas Mark Till

AHA Dallas Caruth Initiative Application for EMS AMI Equipment Funding February 2011

A specific goal of the AHA Dallas Caruth Initiative is to ensure every EMS Agency in Dallas County has the minimal equipment necessary to ensure delivering optimal care for Acute Myocardial Infarction (AMI) patients. Grant funding is available for current equipment and capability gaps and the EMS Resource Subcommittee will review applications to determine most appropriate and effective use of grant resources. Please note this funding is available for a limited time and all applications must be received by Tuesday, February 14 (8 pm CST), with all requested information completed for consideration. The application and allocation process and timeline is available from AHA staff or at www.heart.org/caruth.

EMS Agency Name: MOU submitted? Yes No*

Application Submitted by: Application Date: / / * note that the MOU must be submitted to be eligible for additional equipment funding Verification of Minimally Required Equipment and Capabilities

The initial honorarium was provided for EMS agency to purchase, repair or update the following essential equipment that must be in good working order and in place by January 31, 2010 (and which must remain in good working order throughout the term of this agreement). By submitting this document, the Applicant attests that the EMS Agency listed has the following equipment in good working order and the capabilities as listed (please initial):

Working 12 lead EKG on every EMS Agency truck

Transmission of 12 lead EKG for 100% of all suspected AMI patients to intended receiving Hospital

Equipment capable of capturing and storing electronic patient medical records compliant with the NEMSIS data set.

Additional Equipment Requested

Please list below in order of priority.

Total Cost* Equipment Description of Need

* Total Cost includes if this is a one-time purchase or recurring fees – please describe


AHA Dallas Caruth Initiative Subcommittee Report: Protocols March 3, 2011

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Subcommittee Co-Chairs: Chris Chiara and Mark Till Protocol Subcommittee Goals: Assess how many of the 39 participating organizations have existing AMI protocols –

completed. 2. Identify process to review individual organization and system needs for a

standardized regional assessment, treatment and transport protocol set. 3. Identify elements required for a standardized regional protocol set. Identify process to review different protocols and start assimilating – completed. 5. Identify process to evaluate implementation of and outcomes of new standardized

regional protocol set. Protocol Subcommittee Recommendations Stakeholder Committee vote needed to amend or approve

1. STEMI Criteria for EMS to activate the cath lab: ST segment elevation of > 1mm in 2 contiguous leads with or without signs and symptoms of ACS.

2. 12 Lead ECG Screening Guideline (i.e. who gets a 12 lead ECG) as detailed in Exhibit 7B.

3. EMS Chest Pain/Acute Coronary Syndrome Guidelines as detailed in Exhibit 7C.


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Protocols Subcommittee Roster Baylor Heart and Vascular Hospital Andres Sisneros

Baylor Heart and Vascular Hospital Nancy Vish

Baylor Heart and Vascular Hospital Robert Stoler

Baylor Medical Center at Garland Janice Walker

Baylor Medical Center at Irving Barry Allen

Baylor Medical Center at Irving John Stricklin

Baylor University Medical Center Nestor Zenarosa

Coppell Fire Department Chad Hardin


Dallas Fire Rescue Chris Chiara

Dallas Medical Center Don Timm

Dallas Medical Center Patti Cantu


Dallas Regional Medical Center Juliet Horne

Denton Regional Medical Center Todd Gray

Doctors Hospital of Dallas Tracy Campbell

Garland Fire Department Todd Peele

HCA-North Texas Division Ronnie Ikeler


Highland Park DPS Ryan Dikes




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Medical City Dallas Hospital/Heart Hospital of Baylor Plano

Eric Eichhorn

Methodist Charlton Medical Center Kristi Marino

Methodist Dallas Medical Center Ryan Wolford

North Central Texas Trauma Regional Advisory Council

Carrie Hecht


Texas Health Presbyterian Dallas Mark Till


Texas Health Presbyterian Dallas Sean Black

Texas Regional Medical Center Sunnyvale Misty Thomas

University Park Fire Department Rusty Massey

University Park Fire Department Terry Fowler


UT Southwestern University Hospital - St. Paul David Pillow

AHA Dallas Caruth Initiative 12 Lead ECG Screening Guideline

Patients > 20 years of age experiencing any of the following: • Chest pain (any pain between the navel and jaw) • Chest pressure, discomfort, or tightness • "Heartburn" or epigastric pain • Complaints of “heart racing” or “heart too slow” • Syncope • Severe weakness • New onset stroke symptoms • Difficulty breathing (with no obvious non-cardiac cause)

Above patients require ECG in 5 minutes! Patients (regardless of age) with any of the above symptoms and history of: • Prior cardiac disease such as heart attack • A family history of early heart disease • Diabetes mellitus • Severe obesity • Recent recreational drug use

These patients also require an ECG within 5 minutes!

Present ECG for immediate interpretation! Remember:

• Women and diabetic patients are more likely to present with atypical symptoms

• Elderly patients may have symptoms such as generalized weakness, altered mental status, nausea/vomiting, shortness of breath, diaphoresis, or syncope as their only sign of acute heart attack

• Atypical pain can be in jaw, neck, arm, or upper back.

When in doubt, do the ECG!

Legend F First Responder F B EMT-Basic B

I EMT-

Intermediate I

P Paramedic P M Medical Control M

If C/P is thought to be stimulant induced:

P

Diazepam 2.5-5mg slow IVP max 10mg

OR Midazolam 2.5-5mg slow IVP max 5mg or IN max 10mg

P

F Minimize patient exertion

F

F Apply Oxygen to maintain SPO2 > 94%

F

B 324 mg Aspirin PO Chewed, not swallowed

B

B Obtain 12 Lead ECG within 5 minutes of patient contact

B

P

If STEMI Criteria met, activate CATH LAB & immediately initiate

transport to appropriate PCI capable hospital

P

I Establish IV access at TKO rate or saline lock

I

SBP > 110 mmHg

P

0.4 mg nitroglycerin SL tablet or SL spray q 5 minutes until pain is gone or max 3 doses. Maintain SBP > 110 mmHg

P

P

Pain unrelieved by Nitro: Morphine 2-4mg slow IVP max 20mg

OR Fentanyl 1mcg/kg q 15 minutes max 200 mcg

P

SBP < 110 mmHg F Shock position F

I 250ml NS bolus to achieve SBP≥110mmHg. Max 1 L NS, monitoring breath sounds

I

M Morphine or Fentanyl analgesic per medical control M

If SBP falls < 110 mmHg in response to treatment:

P Discontinue standing

nitroglycerin & analgesic treatments

P

ACS Signs & Symptoms Chest pain- any non-traumatic pain

between the jaw & umbilicus Chest pressure, discomfort or tightness Complaints of “heart racing” or

palpitations Bradycardia Syncope Severe weakness in patients > 45 years

old New onset stroke symptoms Difficulty breathing (without obvious

cause i.e. asthma or CHF)

12 Lead ECG Criteria Patients > 20 years old experiencing any

ACS signs & symptoms OR

Any age patient with ACS signs & symptoms AND a history of:

HTN Cardiac disease Smoking Diabetes mellitus Severe Obesity High Cholesterol Recent recreational drug use When in Doubt, Obtain an ECG

STEMI Criteria ST segment

elevation of ≥ 1 mm in 2 contiguous leads with or without signs & symptoms of ACS

AHA Dallas Caruth Initiative DRAFT Chest Pain / Acute Coronary Syndrome

PEARLS: • Females, diabetics and geriatric patients often have atypical signs/symptoms, or only generalized complaints • Remember Erectile Dysfunction drugs are now being used to treat pulmonary hypertension • Do not administer Nitroglycerin in any patient who has used Viagra (sildenafil) or Levitra (vardenafil) in the past 24 hours or

Cialis (tadalafil) in the past 36 hours due to potential severe hypotension • If possible, establish a second IV on STEMI patients DURING TRANSPORT ONLY

AHA Dallas Caruth Initiative Subcommittee Report: Quality Improvement March 3, 2011

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Subcommittee Co-Chairs: Bob Hillert and Tom Tierney Quality Improvement Subcommittee Goals

1. Assess internal QI process and frequency in participating organizations

2. Assess how the region or county can create a regular and sustainable QI process to measure system performance

Identify barriers to data collection and reporting in participating organizations (EMS)

4. Identify ways to help capture and measure “system” level items like reperfusion to recognition (R2R) or symptom onset through arterial reperfusion (SOAR).

Quality Improvement Subcommittee Recommendations Stakeholder Committee vote needed to approve or amend

1. Approval of EMS Data Dictionary for Required Data Fields in Exhibit 8B.

2. Ensuring every EMS agency documents hospital activation of STEMI (via phone or ECG transmission) in EMR narrative.

3. Establishing a new award to the EMS agency and hospital with the best “SOAR” time

after each quarter of data is reported.

AHA Dallas Caruth Initiative Subcommittee Report: Quality Improvement March 3, 2011

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Quality Improvement Subcommittee Roster Dallas Fire Rescue Dyron Tyler


Dallas Regional Medical Center Juliet Horne


Doctors Hospital of Dallas Tracy Campbell



Methodist Dallas Medical Center Ryan Wolford



South Hampton Community Hospital Tamara McCrary

Texas Health Presbyterian Dallas Debby Rush


UT Southwestern Medical Center Karen Pickard

UT Southwestern University Hospital - St. Paul Rocky Galvan

AHA Dallas Caruth Initiative EMS Data Dictionary for Required Data Fields March 3, 2011

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Coding Instructions: Indicate patient’s primary chief complaint for calling 911 Chief Complaint

Coding Instructions: Indicate patient’s presenting symptoms. Symptoms may include jaw pain, arm pain, shortness of breath, nausea, vomiting, fatigue/malaise, or other equivalent discomfort suggestive of a myocardial infarction.

Patient Presenting Symptoms

Coding Instructions: Answer to “what prompted you to call 911 and what time was that?”

Symptom onset date/time

Note: May use OPQRST (onset, provoking factors, quality, radiation, severity, time). If the patient had intermittent ischemic symptoms, record the date and time of the most recent ischemic symptoms prior to EMS presentation.

Coding Instructions: Indicate time of dispatch and ambulance arrival time on scene. First medical contact is defined as time the first healthcare professional is eye to eye with patient

Times: Dispatch, Ambulance arrival on scene, First Medical Contact

Hospital activation

Coding Instructions: Indicate whether hospital was activated by phone or ECG transmission for STEMI patient

– Did EMS activate hospital (call or transmit ECG)?

Coding Instructions: Indicate if patient was found in cardiac arrest or experienced cardiac arrest during transport

Cardiac Arrest

Coding Instructions: Indicate any procedures performed prior to arrival at receiving facility

Procedures: IV, O2, etc

Coding Instructions: Indicate the date and time of the first ECG. Indicate if the ECG findings demonstrate either new or presumed new ST-segment elevation, symptomatic chest pain with LBBB, history of heart blocks, or isolated posterior myocardial infarction

First 12 lead ECG date/time and finding

Coding Instructions: Indicate the date and time that aspirin was administered Medication(s) given including ASA date/time

AHA Dallas Caruth Initiative EMS Data Dictionary for Required Data Fields March 3, 2011

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Coding Instructions: Indicate the patient’s date of birth DOB

Coding Instructions: Indicate if the patient is White, African American, Asian, American Indian or Alaskan Native, Native Hawaiian or Pacific Islander, Hispanic or Latino Ethnicity

Race

Coding Instructions: Indicate the patient’s sex at birth Gender

Coding Instructions: Indicate all pertinent medical history Medical history

Note: If unable to obtain, do not delay transport

Coding Instructions: Indicate the date and time the patient arrived at the receiving facility

ED arrival time

Coding Instructions: Indicate the number created and automatically inserted by the software that uniquely identifies this patient

Incident #/Run #

Coding Instructions: Indicate the patient’s Unites States Postal Service zip code of their primary residence

Patient Zip Code

Note: If the patient does not have a US residence, or is homeless, leave blank and check ‘No Zip Code’

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