Mission: Lifeline Wyoming Meeting 30, 2014wcm/@swa/...arrest through the Mission: Lifeline Wyoming...

Mission: Lifeline Wyoming Stakeholder Committee Meeting January 30, 2014

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Teleconference / Webinar Conference Call Number 877‐686‐1381, Participant Pass Code 2997862852#

www.heart.org/mlwyoming [email protected]

Co‐Chairs: Dr. Michael Eisenhauer, Casper Dr. Muhammad Kahn, Cheyenne

Dr. Daniela Gerard, Gillette Dr. Chris Krell, Kemmerer Staff Liaison: Scott Nelson and Ben Leonard

1. 11:05 am Welcome Exhibit 1A 2013.11.06 MLWY Meeting Minutes

Exhibit 1B MLWY Stakeholder Roster Exhibit 1C MLWY Voting Proxy Form Exhibit 1D AHA Ethics Policy Exhibit 1E AHA Conflict of Interest Policy Background: Review roster and update as needed. Action: Vote to approve Meeting Minutes

2. 11:10 am Sustainability Task Force Background:

This task force will be challenged with identifying strategies needed to ensure the Mission: Lifeline Wyoming System of Care program continues after June 2015. The meetings with this task force will start with identifying co‐chairs and developing goals and a timeline. Action: Open invitation for the task force. Please send an email of interest to [email protected]

3. 11:20 am Participation Updates Diana Ramirez Exhibit 3A Eligible EMS Participants

Exhibit 3B Eligible Hospital Participants Background:

The current status of participating hospitals and agencies and their business document status. Action: Information only.


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4. 11:25 am EMS Recognition Overview Ben Leonard Exhibit 4A EMS Recognition Overview

Exhibit 4B EMS Recognition Guide Background: The American Heart Association recently launched a program that recognizes EMS agencies for their excellence in guideline based care. Information Only

6. 11:35 pm Equipment Advisory Council Scott Murphey / Jennifer Rasp‐Vaughn

Co‐Chairs: Scott Murphey (EMS) and Jennifer Rasp‐Vaughn (Hospital) Exhibit 6A EAC Goals and Responsibilities Exhibit 6B Equipment Grant Agreement Background: Goals of the EAC include assessment and distribution of the equipment necessary to ensure a statewide AMI/SCA system is adequately addressed. Information Only

7. 11:45 pm Conference Planning and Education Cindy Osborne / Lori Terwilliger Co‐Chairs: Cindy Osborne (EMS) and Lori Terwilliger (Hospital)

Exhibit 7A CPE Goals and Responsibilities Exhibit 7B Save the Date Wyoming! Background: Goals of the CPE include assessment of the educational needs of each discipline and the development, planning, and implementation of the educational curriculum and statewide educational conferences. Action:

8. 11:55 pm Protocols and Quality Improvement

Russ Christiansen / Colleen Rodgers/Jim Langabeer/Derek Smith

Co‐Chairs: Russ Christiansen (EMS) and Colleen Rodgers (Hospital) Exhibit 8A PQI Goals and Responsibilities Exhibit 8B MLWY System Reports (to be presented) Exhibit 8C MLWY Non‐PCI data report (to be presented) Exhibit 8D MLWY EMS WATRS data report (to be presented) Exhibit 8E MLWY ER Poster


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Background: Goal of the PQI is to collect EMS and Hospital STEMI/N‐STEMI and Sudden Cardiac Arrest data and identify opportunities for improvement. Action:

9. 12:25 pm Next Meeting Date Action:

Committee members to ensure upcoming meetings are on their schedule ‐ and accept calendar notices sent from AHA staff by email

Next Dates

April 23, 2014

July 31, 2014

October 22, 2014

January 22, 2015

April 22, 2015

10. 12:30 pm Review of Action Steps Michael Eisenhauer Information only

11. 12:35 pm Updates AHA Staff Background:

Staff and MLWY Stakeholders will provide updates and to announce local meetings and conferences

Information only o Statewide AHA happenings: o http://mlnetwork.heart.org/groups/home/1086 o www.yourthecure.com

12. 12:40 pm Adjourn

TOGETHER

BRINGINGTHE COMMUNITY

www.heart.org/mlwyoming facebook.com/ahawyoming

Together, we’re working to help Wyoming residents improve their odds for surviving a heart attack or sudden cardiac arrest through the Mission: Lifeline Wyoming initiative. The $7.1 million project, funded in part by a $5.9 million grant from The Leona M. and Harry B. Helmsley Charitable Trust, seeks to close the gaps separating heart attack patients from timely access to the most appropriate care.

The American Heart Association is proud to lead this community-based approach toward improving the cardiac system of care. By bringing together hospitals, EMS agencies and others from across the state to coordinate and to streamline protocols, we can save time and ultimately save lives.

Together, we are building a stronger and healthier Wyoming.

Other Generous Support Provided By:Anonymous Donors

Cheyenne-Laramie County Joint Powers Board, Emergency Medical ServicesFirst Interstate Bank Foundation

Wyoming Community Foundation, Working for Wyoming FundWyoming Community Foundation, Wallick Family Fund

Wyoming Hospital AssociationWyoming Medical Society

Wyoming Department of Health

Mission: Lifeline Wyoming Stakeholder Committee Meeting November 6, 2013

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**DRAFT: Until approved by committee**

Teleconference / Webinar Conference Call Number 877-686-1381, Participant Pass Code 2997862852#

www.heart.org/mlwyoming [email protected]

Co-Chairs: Dr. Michael Eisenhauer, Casper Dr. Muhammad Kahn, Cheyenne

Dr. Daniela Gerard, Gillette Dr. Chris Krell, Kemmerer Staff Liaison: Scott Nelson and Ben Leonard

Organizations Attendees

Albin Rescue Cindy Osborne (proxy for Carrie Deselms)

American Heart Association Abbey Dobler

American Heart Association Ben Leonard

American Heart Association Diana Ramirez

American Heart Association Kathy Hill

American Heart Association Loni Denne (teleconference)

American Heart Association Scott Nelson

American Heart Association Stephanie Elsea

American Heart Association Tammy Gregory

American Heart Association Wendy Segrest

American Medical Response Cindy Osborne

Billings Clinic Jennifer Rasp-Vaughn (proxy for Beth Degenhart)

Campbell County EMS Gregg Mentzel

Campbell County EMS - Campbell County Memorial Hospital

Daniela Gerard (teleconference)

Campbell County Memorial Hospital Gregg Mentzel (proxy for Deb Tonn)

Carbon Co. EMS Candice Hofmann

Casper College Russ Christiansen

Castle Rock Ambulance Service Ron Gatti (proxy for John Taylor)

Centennial Valley Ambulance Andrea Kern (teleconference)

Cheyenne Regional Medical Center Colleen Rodgers

Cheyenne Regional Medical Center Jeffrey Robins

Cheyenne Regional Mecical Center Lori Terwilliger

Cheyenne Regional Medical Center Melissa Zamora

City of Torrington EMS Christy Gutierrez

City of Torrington EMS Darin Yates

Crook County Medical Services District Jan Van Beek (teleconference)

Dayton Rescue Unit Marc Ketcham (proxy for Jonathan Miles)

Eastern Idaho Regional Medical Center Scott Lambertsen (teleconference)

Eastern Wyoming Ambulance Service Khery Otero (proxy for Wade Wells)

EMS Advocots Mark Meyer

Evanston Regional Hospital Angie Foster (teleconference)

Fremont County Ambulance Todd Smith (proxy for Larry Allen)

http://www.heart.org/mlwyoming

mailto:[email protected]


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Guernsey Volunteer Ambulance Service Sharon Holloway

Hulett EMS Keith Noback

Jackson Hole Fire EMS Mike Moyer

Marbleton-Big Piney Clinic – Sublette County Rural Health Care District

Vicky Marshall

Medcor at Yellowstone Luanne Freer (proxy for Deborah Brown)

Medical Center of the Rockies Carol Mackes

Medical Center of the Rockies Jerre Johnson

Memorial Hospital of Carbon County Candi Hofmann (proxy for Christine Midget)

Memorial Hospital of Carbon County Gretchen Paul

Memorial Hospital of Converse County Toni Harms(proxy for Robynn Scheehle)

Memorial Hospital of Converse County Toni Harms

Memorial Hospital of Converse County EMS Carlos Mesa

Memorial Hospital of Sweetwater County Phil Reints

Mills Fire Department EMS Jake Bigelow

Moorcroft Volunteer Ambulance Service Keith Noback

Mortimore’s Ambulance Service Mark Mortimore

Mountain Pacific Quality Health Nickola Bratton

Natrona County Fire Protection District Rick Ratcliff

Newcastle Ambulance Service Roger Hespe

North Big Horn Hospital Janet Ward

North Big Horn Hospital Ambulance Service Scott Murphey (teleconference)

Osage Volunteer FD-EMS Keith Noback

Pinedale Clinic – Sublette County Rural Health District

Vicky Marshall

Platte County Memorial Hospital Khery Otero

Rapid City Regional Hospital Julie Poppe (teleconference)

Rocky Mountain Ambulance Service LLC Rick Ballard

Salt Creek Emergency Services Jaime Jones

Sheridan Area Rural Fire Department Marc Ketcham

Sheridan Fire Rescue Rick Ballard (proxy for Terry Lenhart)

Sheridan Memorial Hospital Chrystal Rhone

Sheridan Memorial Hospital Jennifer Rasp-Vaughn

Sheridan Memorial Hospital Sharon Krueger

South Big Horn Hospital James Thomas (proxy for Jackie Claudson)

South Central Wyoming EMS Candi Hofmann (proxy for Bill Dahlke)

South Lincoln County EMS Chris Krell

South Lincoln County EMS Jessie Kramer

South Lincoln Medical Center Kathi Parks (proxy for Eric Boley)

St. John’s Medical Center Cheryl Hewitt

St. Mark’s Hospital & Lone Peak Emergency Michelle Pola

St. Mark’s Hospital Pawan Sharma

St. Vincent Healthcare Luanne Freer (proxy for Theresa Ketterling)

Star Valley Medical Center Amy Johnson

Star Valley Medical Center Mike Kentner


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Star Valley Medical Center EMS Mike Kentner (proxy for Mike Fleming)

Sublette County EMS Mike Straw

Sublette County Rural Health District Vicky Marshall

Sundance EMS Ken Maston (teleconference)

Sweetwater Medics LLC Ron Gatti

Torrington Community Hospital Darin Yates (proxy Peggy Jolovich)

Town of Burns EMS Cindy Osborne (proxy for Erica Maddison)

Town of Pine Bluffs EMS Shannon Weller

Town of Pine Haven Ambulance Service Keith Noback

University of Iowa Marcia Ward (teleconference)

University of Texas Health Science Center Jim Langabeer

University of Utah Hospital and Clinics Taylor Rose (proxy for Dawn Young)

University of Wyoming Derek Smith

Veterans Affairs in Cheyenne Jerry Zang

Washakie Medical Center Jane Pomeroy

Washakie Medical Center Nan Sutherland

Weston County Health Services Roger Hespe (proxy for Piper Orsborn)

Wyoming Cardiopulmonary Services, P.C. Adrian Fluture

Wyoming Cardiopulmonary Services, P.C. Michael Eisenhauer

Wyoming Department of Health Office of EMS Andy Gienapp

Wyoming Medical Center Deb Giles

Wyoming Medical Center Lisa Jackson

Wyoming Medical Center EMS Eric Evenson

Yellowstone National Park – EMS Luanne Freer (proxy for Daniel “Boone” Vandzura)

Yoder Ambulance Becky Halfhill

1. 11:05 am Welcome Daniela Gerard Exhibit 1A July 11, 2013 MLWY Meeting Minutes

Exhibit 1B MLWY Stakeholder Roster Exhibit 1C MLWY Voting Proxy Form Exhibit 1D AHA Ethics Policy Exhibit 1E AHA Conflict of Interest Policy Exhibit 1F MLWY Initiative Update Background: Review roster and update as needed. Action:

Collect Proxy Forms

Vote for Meeting Minutes

Reviewed minutes from July 11, 2013 approved as is

Reviewed participant list, asked those that still need to submit paperwork in order to receive stipend


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2. 11:10 am Wyoming EMS Advocates Mark Meyer

Background: The Wyoming EMS Association has recently undergone an overhaul, and is now called the Wyoming EMS Advocate Committee. We will give a brief update on the overview of this organization.

Professional nonprofit organization

Mission: Promote Pre-hospital and EMS agencies within the communities

Tasked with outreach items

Working with EMTs volunteer retirement board, had a legislation pass to go to the House bill???

Please email Mark Meyer at [email protected] for registration forms

Membership fees are $20 (in-state) and $30 (additional EMT joint membership) for a total of $50 per year

There is a meeting set for November 15

3. 11:20 am Communication and Marketing Stephanie Elsea

Background: A goal of the MLWY initiative is to expand the scope of the system of care involvement beyond the EMS and hospital professionals to include public awareness. Action:

Information only. The public awareness campaign will focus primarily on

o The warning signs of a heart attack or sudden cardiac arrest o Importance of dialing 911

We are planning to repurpose the work that was done with the North Dakota campaign “Your life is on the line”, using

o Newpaper ads o Billboards o Marketing items (i.e.magnets)

The budget for the campaign’s first year (which is year two of our budget) is $100,000 and second year (which is year three of our budget) is $85,000 (this is matching funds)

o RFPs will be sent to communications firms in WY next week We are proposing $85,000 for the first year and $25,000 for

the second year Looking at agencies who can use our nonprofit status For every ad we purchase we’re looking to get one or two

for free If you know of any agency you would like to recommend,



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please send Stephanie Elsea an email [email protected]

Will be accepting proposals until 1st part of December Should have a decision made by 1st park of January Should begin to launch the program in Spring and will run

through June 15, 2015 How will this campaign tackle the three barriers of SOAR

time 1) Symptom recognition 2) Don’t delay, and 3) Trust the medical community

This may be done more over as social media where we can control the messaging, placing this complex of a message in a 10 second air time or billboard may not work

The PowerPoint will be sent to the committee via our website

4. 11:30 am EAC Subcommittee Scott Murphey/Tom Richards Co-Chairs: Scott Murphey (EMS) and Tom Richards (Hospital)

Exhibit 4A EAC Goals and Responsibilities Exhibit 4B EAC Application for Funding Background: Goals of the EAC include assessment and distribution of the equipment necessary to ensure a statewide AMI/SCA system is adequately addressed. Information Only

Tom Richards has resign as co-chair and we are looking for hospital representation nominees

There are a few added items on these cycle 2 application for funding, you must have completed the following

o MOU o E1 (aka Credit Worthiness from) o Survey o There is a statement in the application stating the equipment must

be able to transmit Those that received equipment from Philips or Zoll in cycle

one may not be transmitting at this time as due to some additional items that must be purchase in order to transmit

Those agencies will be given an opportunity to submit for additional funds

Those that receive this funding will also need to sign an addendum to your current equipment agreement

o Make sure to get the base price quotes from vendors

You may submit your applications as of today, the deadline is January 30th



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o There will be two meetings once applications are closed 1) to discuss EMS equipment and 2) to discuss hospital equipment in order to establish a list for voting members to vote on

o Once list is approved notices of the approved equipment funding will be sent by end of February 2014, equipment agreement and invoices must be submitted within 60 days of notices sent

Subcommittee will be working on AED assessment survey, we will be asking Stakeholders to review what AEDs are available in your communities, where the needs are, there will a process to identify who will be responsible for maintaining the AEDs

Those that still have outstanding request for reimbursement funds in cycle 1, due to missing 1) Equipment Agreement 2) E1 Form and/or 3) Invoices are hear by notified you have surrendered your funds and will not be given priority in cycle 2 funding

Those that have not completed an MOU or E1 Form you will not qualify for cycle 2 funding

You will need to submit another application, even if you had one in cycle 1

You will also need to submit another Equipment Agreement, even if you had one for cycle 1

5. 11:55 am Vendor Break

Background: The sales representatives from Philips, Physio and Zoll will be here to work with hospital and EMS agencies to begin the process of building quotes. Please use this time to connect with the vendor you are going to be working with to begin the process of building the equipment package that will best suit the needs of your respective affiliation. Please remember, the cycle 2 funding is designated to “fill the gaps” for 12 lead acquisition and transmission capabilities for EMS and Hospitals.

6. 12:30pm Lunch

Please meet with the members of your Trauma Region for a networking lunch. This time will be used to discuss topics, set future Trauma Region meeting dates, and whatever else you may want to discuss.

7. 1:00 pm Protocols and Quality Improvement Russ Christiansen/Colleen Rodgers Co-Chairs: Russ Christiansen (EMS) and Colleen Rodgers (Hospital)

Exhibit 7A PQI Goals and Responsibilities Exhibit 7B MLWY Proposed Hospital Protocol Exhibit 7C MLWY Proposed Pre Hospital Protocol Exhibit 7D MLWY Hospital Data Presentation (To Be Presented at the meeting) Background: Goal of the PQI is to collect EMS and Hospital STEMI/N-STEMI and Sudden Cardiac Arrest data and identify opportunities for improvement.


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Action:

Vote to approve or amend hospital protocol

Vote to approve or amend pre hospital protocol

If the vote is not clearly defined, address the next step for a voting process with AHA staff

Reviewed the Hospital protocols, if approved o These protocols will change as guidelines change

Send feedback if there is anything that needs editing o This will be sent as an editable document so you may add your

hospital’s logo

Stakeholder approved the hospital protocols and flow chart

These protocols will be given to the CPE subcommittee to start educating the hospital’s staff and asking hospital administration to start promoting them

o Also to promote these protocols, the subcommittee will be developing posters to show the flowchart so they may be placed in ERs

Reviewed the Pre-Hospital protocols o Question: Looking at the middle section stating “*If time allows

during transport, complete Reperfusion Checklist”, what Reperfusion Checklist?

That is a separate document which follows the standard fibrinolytics checklist, which will be included with the approved protocols

o Question: Is it possible for BECs to be able to transmit and acquire the EKG?

DOH asked the Board of Medicine for permission to allow EMTs to do just that, however at this time they do not want to go lower they want to keep it at EMT Basic and above

o Question: Could we make a recommendation to that Board as a Stakeholder committee to ask they consider allowing BECs to transmit and acquire the EKG?

If we do we would have to provide how we would educate and assure the quality

Consider this a task for the education subcommittee

Stakeholder approved the pre-hospital protocols

There will be a letter sent to our participating agencies and hospitals promoting the equipment that has been funded and these protocols in order to ask that they continue to support the process

Reviewed the Mission Lifeline System report o Includes participating WY PCI and Border PCI hospitals o We will only review two points, because patients at the Border PCI

hospitals cannot be determine if they originated in WY o We will be asking all PCI hospitals to scrub PHI data from their


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reports and submit it to us for review o If you would like the full report please contact Scott Nelson

Reviewed the WATRS data o The report will be provided for review o You may still include past data into the system, if at all possible from

the quarter 1 of 2013

Reviewed the Wyoming Referring Hospital Cardiac Database o The incident rate for WY is unknown, but we estimate 100 STEMIs

for every 100,000 population o We estimate 600-1800 STEMI per year, that said the 33 patients

shown on the Mission Lifeline System report and the 53 patients shown on this report do not provide an accurate statistic view on the STEMI patients in Wyoming

o On slide “Treatments Provided” Question: What is the exclusion criteria for these patients? Are we excluding those that may have contraindications?

No exclusion at this time, but will change Statement was made by an abstractor, who stated if the

patient took aspirin prior to EMS arrive they were not given aspirin again therefore the answer would be no the patient was not given aspirin

o Question: Is this coming from Action/NCDR? No we created this database for Non-PCI hospitals (CAH and

ACH) to use to enter data, however the same criteria should be used from what NCDR includes/excludes

o Question: What do you do with a roaming population (Tourist State)?

We need to determine how many heart attacks to expect in a day

How long will they stay o We want to continue measuring Thrombolytics administration, this

is part of core measures o Focus on our Door In/Door Out times o Make sure you ask what you want to see in the data presentation

8. 1:45 pm Conference Planning and Education Cindy Osborne / Lori Terwilliger

Co-Chairs: Cindy Osborne (EMS) and Lori Terwilliger (Hospital) Exhibit 8A CPE Goals and Responsibilities Exhibit 8B CPE Education Assessment Report Exhibit 8C CPE Proposed Education Objective timeline (To Be Presented at the meeting) Background: Goals of the CPE include assessment of the educational needs of each discipline and the development, planning, and implementation of the educational


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curriculum and statewide educational conferences. Information Only.

Reviewed the results from our education assessment o There were 213 responses, however looking at the number of

agencies and hospitals in our system of care this looks to be a low number

o Made some changes to try and increase the volume Presented a timeline for educating each Trauma Region

o It did give us a starting point on what items need to be address as far as education and training

o Also being active in the Protocols and Equipment subcommittees we are given some ideas of what the needs are

Next steps will be to develop a Conference that will tie into our education to be presented the week of our April 2014 stakeholder meeting, keep an eye out for Save the Dates information

9. 1:55 pm Mission: Lifeline Recognition Scott Nelson/ Ben Leonard

Background: American Heart Association Mission: Lifeline Recognition program is one that is designed to recognize the outstanding work that is done for the care of the cardiac patient in the pre hospital, and hospital environment. The goal of this program is directed at encouraging system of care ideals with the involvement of post incident evaluations and quality processes that involve EMS agencies and their hospital counterparts.

Information only.

Presented Wyoming Medical Center with a Bronze Action Registry award and Medical Center of the Rockies with a Gold Action Registry award

10. 2:20 pm Review of Action Steps Michael Eisenhauer Information only

Turn in your documents in order to be a participant (i.e. MOUs)

Go back into previous quarters and enter your data to help improve our outcome presentation

Consider becoming a member of the Wyoming EMS Advocate Committee

There are still outstanding items from cycle 1 of the equipment funds, please turn in those items in order to receive the funds by end of the week, you are hereby notified that items not received will be considered forfeited

Cycle 2 for equipment funds starts today, you must complete an application by January 30, 2014 to be considered

If you purchased Philips or Zoll equipment during cycle 1 we need an


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amended equipment agreement and a copy of the first bill from the data plan purchased, AHA has agreed to pay this bill for the duration of the grant in one lump sum

PQI subcommittee will be developing posters of the protocols

Challenges for next quarter o Data abstractor conference take place o Data analysis or review task force setup o Public awareness campaign started o Asked Wyoming Stakeholder Committee to Friend our AHA

Wyoming Facebook page, would like to see over 100 friends by end of week

Once you received your award notification please let us know so we can order the items to present

We will start assessment of AED needs, so start thinking about where the needs are in your community

o Be aware of Abbey Dobler is going out asking for matching funds for AED equipment, if you know of any public areas (i.e. banks) that are considering AED equipment we would like to talk to them

Consider where we can utilize our public awareness campaign in your area

11. 2:25 pm Updates and Next Meeting Dates AHA Staff Background:

Staff and MLWY Stakeholders will provide updates and to announce local meetings and conferences

Information only o Statewide AHA happenings: o http://mlnetwork.heart.org/groups/home/1086 o www.yourethecure.org

Stakeholder Approved New Dates

January 30, 2014

April 23, 2014

July 31, 2014

October 22, 2014

January 22, 2015

April 22, 2015

12. 2:30 pm Adjourn Adjourned 2:30 pm

http://mlnetwork.heart.org/groups/home/1086

http://www.yourethecure.org/

AHA MLWY Inititative

Stakeholders Voting Member Roster

January 2014

Institution1 First Name Last Name

Albin Rescue Carrie Deselms

Alpine Fire Department Jeremy Larsen

American Medical Response Cindy Osborne

Atwood’s Family Ambulance Del Atwood, Jr.

Big Horn Fire Dist #4 Ambulance

Bighorn Airways Inc

Billings Clinic Beth Degenhart

Bozeman Deaconess Hospital

Buffalo‐Johnson Co. EMS

Burgess Junction Rescue

Campbell County EMS Gregg Mentzel

Campbell County Memorial Hospital Deb Tonn

Carbon County EMS Candice Hofmann

Castle Rock Ambulance Service John Taylor

Centennial Valley Ambulance Andrea Kern

Cheyenne Fire & Rescue

Cheyenne Regional Medical Center Melissa Zamora

Chugwater Ambulance

City of Casper Fire ‐ Casper Fire Department



January 2014


City of Torrington EMS Darin Yates

Classic Lifeguard April Larsen

Crook County Medical Services District Jan Van Beek

Dayton Rescue Unit Jonathan Miles

Eastern Idaho Regional Medical Center

Eastern Wyoming Ambulance Service, Inc Wade Wells

Eden Valley Ambulance Service

Evanston Regional Hospital Angie Foster

Evansville Emergency Service Matt Gacke

Fort Laramie FD EMS

Fremont County Ambulance Larry Allen

Glendo Volunteer Ambulance Elizabeth VanBuskirk

Greybull EMS

Guardian Flight Keith Finch

Guernsey Volunteer Ambulance Service Sharon Holloway

Hawk Springs FD EMS Lou Hubbs

Hot Springs County Memorial Hospital

Hulett EMS Keith Noback

Ivinson Memorial Hospital Sandy Knapton



January 2014


Jackson Hole Fire EMS Mike Moyer

Johnson County EMS

Johnson County Healthcare Center

LaGrange Rescue Unit

Lander Regional Hospital Brad Langdorf

Laramie County Fire District 8

Laramie Fire Department EMS Jim Hoflund

Lingle Volunteer FD

Little Snake River EMS

Lusk Ambulance Service Amber Keller

Marbleton‐Big Piney Clinic Vicky Marshall

Medcor, Inc. dba Medcor at Yellowstone Deborah Brown

Medical Center of the Rockies Brad Oldemeyer

Memorial Hospital of Carbon County Christine Midget

Memorial Hospital of Converse County Robynn Scheehle

Memorial Hospital of Converse County EMS Carlos Mesa

Memorial Hospital of Sweetwater County Phil Reints

Mills FD EMS Jake Bigelow

Moorcroft Volunteer Ambulance Service Keith Noback



January 2014


Mortimore’s Ambulance Service Mark Mortimore

Natrona County Fire Protection District Rick Ratcliff

Newcastle Ambulance Service Roger Hespe

Niobrara Health & Life Center Cindy Treffer

North Big Horn Hospital Janet Ward

North Big Horn Hospital Ambulance Service Scott Murphey

Osage Volunteer Ambulance Service Cynthia Crabtree

Pinedale Clinic ‐ Sublette County Rural Health District Vicky Marshall

Platte County Memorial Hospital Khery Otero

Powell Valley Healthcare June Minchow

Powell Valley Healthcare ‐ EMS Scott Bagnell

Rapid City Regional Hospital Julie Poppe

Riverton Memorial Hospital Beth Metcalf

Rock Springs Fire Dept.

Rocky Mountain Ambtac

Rocky Mountain Ambulance Service LLC Rick Ballard

Salt Creek Emergency Services Jamie Jones

Sheridan Area Rural Fire Department Marc Ketcham

Sheridan Fire Rescue Terry Lenhart



January 2014


Sheridan Memorial Hospital Jennifer Rasp‐Vaughn

South Big Horn Hospital Jackie Claudson

South Central WY EMS ‐Saratoga/Encampment/Medicine Bow Bill Dahlke

South Lincoln County EMS Jessie Kramer

South Lincoln Medical Center Eric Boley

St. John's Medical Center AJ Wheeler

St. Mark's Hospital Pawan Sharma

St. Vincent Healthcare Theresa Ketterling

Star Valley Medical Center Mike Kentner

Star Valley Medical Center EMS Mike Fleming

Sublette County EMS Mike Straw

Sublette County Rural Health District Vicky Marshall

Sundance EMS Ken Maston

Sweetwater Medics LLC Ron Gatti

Ten Sleep Ambulance

Thayne Ambulance Service

Torrington Community Hospital Peggy Jolovich

Town of Burns EMS Erica Maddison

Town of Pine Bluffs EMS Brenda Armstrong



January 2014


Town of Pine Haven Ambulance Service Keith Noback

Uinta County EMS

University of Utah Hospital and Clinics Dawn Young

Upton Fire Department James Sindlinger

Veterans Affairs in Cheyenne Jerry Zang

Veterans Affairs in Sheridan

Wamsutter EMS

Washakie County EMS Mike Bryant

Washakie Medical Center Jane Pomeroy

West Park Hospital District

West Park Hospital EMS

Weston County Health Services Piper Orsborn

Wyoming Life Flight

Wyoming Medical Center Deb Giles

Wyoming Medical Center EMS Eric Evenson

Yellowstone National Park Daniel "Boone" Vandzura

Yoder Ambulance Becky Halfhill

AHA Mission Lifeline Wyoming 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 Mission Lifeline Wyoming 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 Mission Lifeline

Wyoming 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:__________________________________________

EXHIBIT C

Revised 10/2012

AMERICAN HEART ASSOCIATION ETHICS POLICY

The purpose for this Ethics Policy is to support a culture of openness, trust, and integrity in all American Heart Association management and business practices. A well-understood ethics policy requires the participation and support of every AHA employee and volunteer. At the American Heart Association we are dedicated to working with our employees, volunteers, partners, vendors and customers to reduce disability and death from cardiovascular disease and stroke. We are committed to conducting all of the AHA’s affairs and activities with the highest standards of ethical conduct. Our AHA Code of Conduct, outlined in our Human Resource Policy Manual, provides guidance for decisions and actions during our daily work. We are committed to the responsible use of AHA assets, to provide accurate, complete and objective information, to respect the confidentiality of financial and other information, to act in good faith and exercise due care in all we do, to comply with all rules and regulations and to proactively promote ethical behavior. The American Heart Association’s Code of Ethics is built on AHA values. As such, we acknowledge our individual responsibility to ensure our collective success by practicing and promoting the following values: Integrity, Inclusiveness, Dedication, Excellence, Sensitivity, and Vision. These values reflect a shared view of how we want to operate and be seen by others. Code of Ethics The summary code of ethics includes the following provisions:

American Heart Association employees and volunteers must: o Proactively promote ethical behavior as a responsible partner among peers in the work

environment. o Deal fairly with AHA Customers, suppliers, competitors, volunteers, and employees. o Provide constituents with information that is accurate, completely objective, relevant, timely,

and understandable. o Comply with applicable government laws, rules and regulations. o Maintain the confidentiality of information entrusted to them by the AHA or its Customers

except when authorized or otherwise legally obligated to disclose. o Accept responsibility for preventing, detecting, and reporting all manner of fraud. o Be honest and ethical in their conduct, including ethical handling of actual or apparent

conflicts of interest between personal and professional relationships. o Protect and ensure the proper use of company assets. o Prohibit improper or fraudulent influence over the External Auditor.

A link to a copy of the entire American Heart Association Ethics Policy may be found at the bottom of the homepage at www.americanheart.org and the AHA Intranet. Reporting Ethics Violations If you have questions or concerns about compliance with the subjects described in this policy, or are unsure about what is the “right thing” to do, we strongly encourage you to first talk with your supervisor, another AHA leader or the leader in the Human Resource department. If you are uncomfortable talking to any of these individuals for any reason, call the AHA ethics hotline at (866) 293-2427, or log on to: www.ethicspoint.com to report your concerns. Your calls to the toll free hotline or contact through the Internet site are facilitated by a third party, Ethics Point, Inc. Reporting of ethics violations will be treated as confidential information and can be communicated anonymously. No director, trustee, officer, employee or volunteer who in good faith reports an action or suspected action taken by or within the AHA that is illegal, fraudulent, or in violation of any adopted policy will suffer intimidation, harassment, discrimination or other retaliation.

http://www.americanheart.org/

http://www.ethicspoint.com/

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.]

EMS

Institution1 Received MOU E1 Form

Classic Lifeguard 2/27/2013 NEED

Glendo Volunteer Ambulance 2/20/2013 NEED

Guardian Flight 2/28/2013 NEED

Hulett EMS 11/15/2012 NEED

Lusk Ambulance Service 11/20/2012 NEED

Osage Volunteer Ambulance Service 4/8/2013 NEED

Powell Valley Healthcare ‐ EMS 12/17/2012 NEED

Uinta County EMS 2/26/2013 NEED

West Park Hospital EMS 12/7/2012 NEED

Institution1 Received MOU E1 Form

Big Horn Fire Dist #4 Ambulance NEED NEED

Bighorn Airways Inc NEED NEED

Buffalo‐Johnson Co. EMS NEED NEED

Burgess Junction Rescue NEED NEED

Cheyenne Fire & Rescue NEED NEED

Chugwater Ambulance NEED NEED

City of Casper Fire ‐ Casper Fire Department NEED NEED

Fort Laramie FD EMS NEED NEED

Greybull EMS NEED NEED

Johnson County EMS NEED NEED

LaGrange Rescue Unit NEED NEED

Lingle Volunteer FD NEED NEED

Little Snake River EMS NEED NEED

Rock Springs Fire Dept. NEED NEED

Rocky Mountain Ambtac NEED NEED

Wamsutter EMS NEED NEED

Wyoming Life Flight NEED NEED

MLWY EMS Need E1 Forms

MLWY EMS Need E1 Forms

Hospital

Institution1 Hospital Type Received MOU E1 Form HR Form DRC Form SDRC Form

Johnson County Healthcare Center CAH NEED NEED Not Req'd Not Req'd Not Req'd

MLWY CAH Need Forms

21/28/2014 ©2013, American Heart Association

Presenters:Ben Leonard, EMT-Paramedic

Mission Lifeline DirectorAmerican Heart Association

I. Review the EMS Recognition Program

I. What are the measures we are looking to report

II. What are the patient volume requirements

III. The timeline for the project

II. Provide a walk through process for EMS Recognition Application

I. How do you collect the data?

II. Entering the data into the application

Objectives for this presentation

1/28/2014 ©2013, American Heart Association 3

Mission: Lifeline®:

AHA’s national initiative to advance the systems of care for STEMI patients and

Out of Hospital Cardiac Arrest.

Goal: Reduce mortality and morbidity for STEMI and OOHCA patients to and improve their overall quality of care



2013 Recognition Highlights

309 Hospitals Achieved 2013 Mission: Lifeline Recognition

• Submit Data into ACTION Registry-GWTG

• Registered with M:L• Meet M:L recognition

Criteria


http://circ.ahajournals.org/search?fulltext=Improvements+in+door+to+balloon+times&submit=yes&x=6&y=8

• Focus on Quality

– New Formal Process

– Generally seen as lower priority

– QI processes are difficult for low resource agencies

– Culture change

• Data Collection

– Self Reporting Expectation

• System Fragmentation

– Competition of Agencies

– Continuum of Care

– Patient Documentation

– Protocol Diversity & Equipment Variability

Challenges Specific to AHA EMS Recognition

7

1. Percentage of patients with non-traumatic chest pain > 35 years treated

by EMS who get a pre-hospital 12-lead electrocardiogram

2. Percentage of STEMI patients with first (pre-hospital) medical contact to

device time within 90 minutes (non-transfer)

3. Percentage of STEMI patients taken to a referral hospital who

administers fibrinolytic therapy with a door to needle time within 30

minutes.

What are the Achievement Measures?


Transport Destination Protocols determine achievement measures required to complete:

Must all 3 measures be reported?


Agencies with STEMI patients transported to STEMI Receiving Centers only

Reporting Measures #1 and #2 required

Agencies with STEMI patients transported to STEMI Referring Centers only


Agencies with STEMI patients transported to both STEMI Receiving Centers and STEMI Referring Centers

Reporting Measures #1, #2, and #3 required

• BRONZE eligibility = At least 2 STEMI patients in the reporting quarter with a minimum of 4 total for the year

What is the volume requirement for EMS Recognition?


Q1 = Eligible for Bronze

Q2 = Not Eligible for Bronze



Annual – Q1 Bronze

2

1

1

0

4

• SILVER eligibility = At least 2 STEMI patients in EACH reporting quarter with a minimum of 8 total for the year. Each quarter must meet achievement criteria.

What is the volume requirement for EMS Recognition?






Annual – Q1 Eligible for SILVER or BRONZE

2

2

2

2

8

• Self reported summary

• Web based submission

How will AHA collect the Pre-Hospital Data?


Demographics

Online Mission: Lifeline System Registration Information

Data Summary/Submission

Affirmation of truth of statement

• No (AHA Staff will not validate, but all applications will be subject to audit)

• Person submitting data is requested to be

• Qualified and appropriately designated staff person of the EMS

Agency

• Training Officer

• Administrative Leadership

Will the validity of the Data be verified?


What is the cost for EMS Agencies participating in the M:L EMS Recognition Program?


• Achievement levels of

• Bronze – 1 Calendar Quarter

• Silver – 1 Calendar Year

• Gold – 2 Calendar Years (Start in 2015)

• Submit recognition application annually for the previous calendar year of

data using a web based self entry portal.

• Submitted data summary will be reviewed by AHA Staff

• Awards issued in Spring

How will the EMS recognition program be structured?


What is the Timeline for the EMS Recognition Program?


17©2013, American Heart Association

“OK, I understand the program, it’s measures and requirements…

• Where do I start?

• What data do I need?

• Who am I?

• How do I get the data?

• What do I do with the data, once I get it?

• Who can I call when I need help?

• What day is it today?

• Where am I?DON’T PANIC!

Let’s start with the website,


www.heart.org


NOW OPEN JAN1 –FEB 28

Access Tools

For More Information Contact


SWA MWA

Ben Leonard Robin Hamaan

Loni Denne Mindy Cook

GRA GSA

Alex Kuhn Kathy Fenelon

MAA WSA

John Dugan Melissa Juarez

FDA National Center

Amanda Graver, Sam Cole and Lisa Bemben Chris Bjerke, Paula Feather and Lori Hollowell

Hold On --- Preparing for Walk Through


1 | P a g e D e c e m b e r 2 0 1 3

What is Mission: Lifeline ® EMS Recognition? Mission: Lifeline® Emergency Medical System (EMS) Recognition is a new platform added to the Mission: Lifeline STEMI recognition program. It seeks to acknowledge the work, training and commitment by EMS agencies to improve overall quality of care for the STEMI patient, by directly influencing the STEMI System of Care. What role does EMS play in Mission: Lifeline? The Emergency Medical System providers are vital to the overall success of Mission: Lifeline STEMI Systems of Care. EMS agencies with education in STEMI identification, access to 12 lead ECG machines and follow protocols derived from ACC/AHA STEMI Guidelines are agencies that are driving improvements in the care of STEMI patients. The correct tools and training allow EMS providers to rapidly identify the STEMI, promptly notify the destination Center and trigger an early response from the awaiting hospital personnel. Collaboration among pre-hospital and hospital providers is the essence of Mission: Lifeline. What are the recognition levels that can be awarded and the volume requirements for each?

BRONZE: At least 1 calendar quarter achieving a minimum of 75% compliance for each required measure. o Volume: at least 2 patients per reporting quarter with at least 4 patients in the calendar year.

SILVER: 1 calendar year achieving a minimum of 75% compliance for each required measure in all 4 quarters. o Volume: at least 2 patients in each of the 4 calendar quarters and at least 8 patients in the calendar

year.

GOLD (Not available for 2014 award cycle): 2 calendar years achieving a minimum of 75% for each required measure compliance in all 4 reporting quarters of each year (8 consecutive quarters total).

What are the Mission: Lifeline EMS recognition measures that will be reviewed for compliance?

1. Percentage of patients with non-traumatic chest pain > 35 years old, treated and transported by EMS who get a pre-hospital 12 lead ECG

2. Percentage of STEMI patients transported to a STEMI Receiving Center, with pre-hospital First Medical Contact (FMC) to Device (PCI) < 90 Minutes

3. Percentage of STEMI patients transported to a STEMI Referring Center, with Arrival (to Referring Center) to Fibrinolytic Therapy administered in < 30 Minutes (Door to Needle)

Agencies are required to submit their data based on transport destination as cited below:

Agencies with STEMI patients transported to STEMI Receiving Centers only


Agencies with STEMI patients transported to STEMI Referring Centers only


Agencies with STEMI patients transported to both STEMI Receiving Centers and STEMI Referring Centers

Reporting Measures #1, #2, and #3 required

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Mission: Lifeline EMS measures explained Percent of non-traumatic chest pain patients, treated and transported by EMS that are 35 years of age and over that receive a pre-hospital 12 Lead ECG The pathway to early recognition of a STEMI begins with 12 Lead ECG acquisition. This measure looks at the total number of patients treated AND transported AND with a complaint of non-traumatic chest pain, who receive a 12 lead ECG in the field. Early suspicion early acquisition early notification early intervention. Percentage of STEMI patients transported to a STEMI Receiving Center, with pre-hospital First Medical Contact (FMC) to Device (PCI) < 90 Minutes The patient population for this measure includes patients with a STEMI identified by pre-hospital ECG acquisition AND transported directly to the STEMI Receiving center by Ambulance AND who had Percutaneous Intervention (PCI) as the reperfusion strategy. First Medical Contact (FMC) Clarified This Mission: Lifeline EMS recognition measure utilizes the time of pre-hospital “First Medical Contact”. First Medical Contact (FMC) is broadly defined as the time of eye to eye contact between STEMI patient and caregiver, when definitive STEMI care, such as 12 lead acquisition and/or additional advanced care, can be initiated. Important Note: In calculating FMC to PCI, identifying the appropriate time of FMC is imperative. The earliest time a health care provider makes eye to eye contact with the STEMI patient in a pre-hospital setting is the time of FMC. The scenarios below can assist in determining the correct time of FMC. Although the following scenarios apply to STEMI patients transported to a STEMI Receiving Center, the essence of FMC can also be applied to the same scenario but with the patient being transported to a STEMI Referring Center. Scenario 1 – 0800 Patient arrives to an urgent care center (where ACS care is initiated) 0820 EMS is called for transport 0830 EMS arrives to the patient’s side FMC = 0800 – The time the patient arrived to the urgent care center Rationale – ACS care for the STEMI was initiated by the urgent care center Scenario 2 – 0900 Patient arrives to their primary physician’s office (no 12 lead ECG capabilities) 0915 EMS is called 0930 EMS arrives to the patient’s side FMC = 0930 – The time EMS arrived to the patient’s side Rationale – Primary physician is not capable of identifying the STEMI and is unable to initiate ACS care Scenario 3 – 0200 Patient calls EMS for chest pain 0210 Paramedic staffing Quick Response Vehicle (QRV) arrives to the patient’s side and begins ACS care through 12 Lead ECG acquisition, IV initiation and medication administration 0220 Transporting paramedics arrive to the patient’s side FMC = 0210 – The time QRV paramedic arrived to the patient’s side Rationale – ACS care for the STEMI patient was imitated by the paramedic staffing the QRV

3 | P a g e D e c e m b e r 2 0 1 3

Scenario 4 - 0400 Patient calls EMS for weak and dizzy complaint 0430 Basic Unit arrives on scene, acquires a 12 lead and notifies receiving center of STEMI through transmission, machine interpretation or any other acceptable means of STEMI recognition 0450 Advanced unit intercepts and takes over ALS care of the STEMI patient FMC = 0430 – The time the basic unit arrived to the patient’s side Rationale – ACS care for the STEMI patient was initiated by the Basic EMT crew Scenario 5 – 0630 Patient calls EMS for chest pain 0640 Ambulance crew arrives to the patient’s side 0700 Patient arrives to STEMI Receiving Center Emergency Department 0730 ECG completed in Emergency Department 0815 Documentation of first device activation (PCI) FMC = Patient not included in measure Rationale – Although the patient was transported directly to the STEMI Receiving Center and PCI was performed, the STEMI was not identified in the pre-hospital setting

Percentage of STEMI patients transported to a STEMI Referring Center, with Arrival to the referral center to Lytic administration < 30 Minutes

The patient population for this measure includes patients with a STEMI identified by pre-hospital ECG acquisition AND transported directly to the STEMI Referring Center by Ambulance AND who had Lytic Administration as the reperfusion strategy. The pathway to early reperfusion of the STEMI patient begins with early 12 Lead ECG acquisition. This measure looks at the STEMI patients transported by EMS to the referring center and the percentage of those of who receive lytic therapy within the recommended time of 30 minutes or less. EMS agencies directly affect achieving this goal. Early suspicion of a possible STEMI patient early acquisition of the 12 lead ECG early notification to the referring center timely lytic administration.

What data should be collected to prepare for the Mission: Lifeline EMS recognition application? The EMS agency transporting the STEMI patient to the STEMI Receiving and/ or STEMI Referring Center is the agency that should submit data on the patient for the purpose of Mission: Lifeline EMS recognition. Pre-hospital data and follow up data is required for Mission: Lifeline® EMS Recognition application submission. The following data elements are necessary to be collected by each agency: EMS Data

Number of patients 35 years or over with non-traumatic chest pain that received a 12 lead ECG AND were transported

Time of First Medical Contact (FMC)

Time of arrival to destination facility (STEMI Receiving and/or STEMI Referral Center)

4 | P a g e D e c e m b e r 2 0 1 3

Follow Up with the Hospitals

Time of fibrinolytic administration (patients transported to a STEMI Referring Center)

Time of device activation (PCI) (Patients transported to a STEMI Receiving Center)

Any non-system reason for delay in PCI as documented in the inpatient record o The delay is for a duration of at least 30 minutes o The delay occurs between the time of arrival at the STEMI Receiving Center and the time of device

activation (PCI) o The delay is documented by the STEMI Receiving hospital in the in-patient record o Delay may be one or more of the following:

Difficult vascular access Delay in patient or family providing consent Patient experiences cardiac arrest or need for intubation Difficulty crossing lesion Other – as documented by STEMI Receiving Center

How does the pre-hospital provider connect with the destination hospital to collect follow-up data? The FMC to Device <90 minutes and Arrival at Referring Center to lytic administration <30 minutes measures require follow up with the destination hospitals. Many hospitals are collecting robust data specific to the STEMI population and are engaging a multidisciplinary team to identify process improvements and successes. If there is interest in participating with such a multidisciplinary team, contact the hospital’s STEMI and/or outreach coordinators to learn how to become involved with this effort. The Mission: Lifeline Hospital Recognition Program relies on data collected from STEMI Receiving and Referring Centers through their participation in ACTION Registry®-GWTG™. Hospitals participating in ACTION Registry-GWTG are able to readily access and provide the data elements stated above for quality improvement purposes. Hospital data collection by means of ACTION Registry-GWTG is not a requirement for Mission: Lifeline EMS Recognition Organizing the Data Summary for Mission: Lifeline EMS Recognition Application Submission Agencies are advised to collect and organize data prior to beginning the online recognition application. Each agency should become familiar with the data elements that pertain to the Mission: Lifeline EMS recognition criteria and develop a system to engage the destination hospitals in follow up. The AHA has tools available to aid in the follow up process with the destination hospitals and to prepare for the actual web-based application submission. The tools are available via the following link: www.heart.org\EMSrecognition

EMS/Hospital Data Worksheets

Pre-Application Workbook – PDF versions of the actual online application

Mission: Lifeline EMS Recognition Criteria Document

Mission: Lifeline EMS Recognition Glossary (attached at the end of this document)

http://www.heart.org/EMSrecognition

5 | P a g e D e c e m b e r 2 0 1 3

Completing the Mission: Lifeline EMS Recognition Application

The data submission period is JANUARY 1, 2014 – FEBRUARY 28, 2014

Data is submitted by completing the online Mission: Lifeline EMS Recognition Application Mission: Lifeline EMS Recognition Announcement EMS agencies meeting the Mission: Lifeline EMS Recognition criteria will be notified of recognition achievement no later than April 30, 2014. The notifications will be made directly by AHA staff and made to the point of contact identified in the application.

For More Information about Mission: Lifeline, please visit the www.heart.org/missionlifeline.

Email [email protected] or [email protected] for questions.

http://www.heart.org/HEARTORG/HealthcareResearch/MissionLifelineHomePage/Mission-Lifeline-Home-Page_UCM_305495_SubHomePage.jsp


http://www.heart.org/HEARTORG/HealthcareResearch/MissionLifelineHomePage/Register-Your-System-of-Care_UCM_437494_Article.jsp

http://mlnetwork.heart.org/

http://www.heart.org/HEARTORG/HealthcareResearch/MissionLifelineHomePage/Access-Tools-and-Resources_UCM_438835_Article.jsp

http://www.heart.org/HEARTORG/HealthcareResearch/MissionLifelineHomePage/Get-The-Latest-News-and-Hot-Topics_UCM_437490_Article.jsp

6 | P a g e D e c e m b e r 2 0 1 3

Mission: Lifeline EMS Recognition Glossary of Terms

TERM PAGE

ACTION Registry®-GWTG™ 10

Application Submission Deadline 7

Application Submission Period 7

Arrest Intubation (Delay) 10

Arrival (to Referral Center) to Fibrinolytic Administration 9

Arrival (to referral center) to Fibrinolytic Administration <30 Minutes Denominator

9

Arrival (to referral center) to Fibrinolytic Administration <30 Minutes Numerator

9

Consent (Delay) 10

Data/Application Review Period 7

Data Summary/EMS Recognition Application Submission 7

Denominator 7

Destination Hospital 7

Difficult Access (Delay) 10

Difficult Lesion (Delay) 10

EMS Agency ID 7

EMS Agency/System 7

Exclusion Criteria 7

Fibrinolysis 8

Fibrinolytic 9

Fibrinolytic Administration Time 9

First Device Activation Time 8

First Medical Contact(FMC) to Device Activation (PCI 9

FMC (First Medical Contact) 9

FMC to Device < 90 Minutes Numerator 9

FMC to Device <90 Minutes Denominator 9

Healthcare Process Improvement 6

Healthcare Quality Improvement 6

Inclusion Criteria 7

Mission: Lifeline® 6

Multidisciplinary Team 6

Non-System Reason For Delay 10

Numerator 6

Other Documented Delay 10

PCI (Percutaneous Coronary Intervention) 8

Percent Patients >35yo Who Receive ECG Denominator 9

Percent Patients >35yo Who Receive ECG Numerator 10

Pre-Hospital 12 Lead ECG 8

Quality 6

Reperfusion 8

STEMI (ST Elevated Myocardial Infarction) 8

7 | P a g e D e c e m b e r 2 0 1 3

Mission: Lifeline® -

The American Heart Association's national initiative to advance the systems of care for patients with ST segment

elevation myocardial infarction (STEMI) and Out of Hospital Cardiac Arrest. The overarching goal of the initiative is to

reduce mortality and morbidity for the STEMI and/or Out of Hospital Cardiac Arrest patients and to improve the overall

quality of care. For more information: www.heart.org/missionlifeline

AHA Circulations to support STEMI Systems of Care:

2007 The Emergency Services and Emergency Department Perspective

2007 The Primary PCI Perspective

2009 Focused Update: ACC/AHA STEMI Guideline Update

2012 A Report From the AHA's Mission: Lifeline

2011 ACCF/AHA/SCAI PCI Guidelines

2013 ACC/AHA Guidelines for Management of Patients with STEMI

Quality -

The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

Healthcare Quality Improvement-

The process of maintaining what is good about the existing health care system while focusing on the areas that need improvement. Improving the quality of care and reducing medical errors are top priorities.

Healthcare Process Improvement-

A group of healthcare professionals coming together (Multidisciplinary team) to identify a process goal, identify the steps needed to create change, identify how the team will know when the change becomes an improvement through implementation of the Plan, Do , Study, Act (PDSA) cycle.

Multidisciplinary Team -

Diverse group of healthcare professionals, such as ED physicians, cardiologists, nurses, cath lab, ED and radiology leadership, pharmacists, dieticians, health educators, administration and may include EMS leadership, collaborating in an effort to provide effective and efficient care to patients.

Numerator -

Part of a fraction above the line, it is the number of occurrences (the count) of an item, element or selection that meet the criteria.

http://www.heart.org/HEARTORG/HealthcareResearch/MissionLifelineHomePage/Mission-Lifeline-Home-Page_UCM_305495_SubHomePage.jsp

http://circ.ahajournals.org/content/116/2/e43.full.pdf+html

http://circ.ahajournals.org/content/116/2/e55.full.pdf+html

http://circ.ahajournals.org/content/120/22/2271.full.pdf+html?sid=56c3a039-efc1-4c26-ada0-47e450006cc7

http://circoutcomes.ahajournals.org/content/early/2012/05/22/CIRCOUTCOMES.111.964668.full.pdf+html

http://circ.ahajournals.org/content/124/23/e574.full.pdf+html?sid=7198ac04-6cd9-40e2-967d-972d19f6edf7

http://circ.ahajournals.org/content/110/5/588.short?rss=1&amp%3bssource=mfr

8 | P a g e D e c e m b e r 2 0 1 3

Denominator -

Part of a fraction below the line, it is the total number of treatment opportunities among all eligible patients.

Inclusion Criteria -

A set of conditions that must be met in order for the patient record to be incorporated in a specific measure.

Exclusion Criteria -

A set of standards used to determine whether a patient record is not included in a specific measure.

Destination Hospital -

The Hospital the patient was transported to. This will either be a STEMI Receiving Center or a STEMI Referral Center.

EMS Agency/System -

For EMS recognition, EMS is defined as personnel who respond to the medical emergency in an official capacity as a part of an organized medical response AND are the designated transporter of the patient to the hospital.

EMS Agency ID -

For Mission: Lifeline EMS Recognition, the EMS Agency ID is the state-assigned provider number for the Emergency Medical Service responding (transporting) agency. Only ONE recognition application submission per State ID number is allowed.

Data Summary/ EMS Recognition Application Submission -

Official submission for the summary of data based on the Mission: Lifeline EMS Recognition Criteria. This is a web-based process; no individual patient level data is requested or required.

Application Submission Period -

The period of time, beginning January 1, 2014, through the Data Submission Deadline, February 28, 2014, where the data summary submission form will be open for EMS agencies to submit the data summaries required for MISSION: LIFELINE EMS Recognition.

Application Submission Deadline -

The absolute latest Date/Time the recognition application can occur to be eligible for Mission: Lifeline EMS recognition review. (February 28, 2014 for 2014 awards)

Data/Application Review Period -

The period of time after the application submission deadline through April 15, 2014, when the recognition applications will be reviewed by AHA National Center Mission: Lifeline staff, for recognition achievement.

9 | P a g e D e c e m b e r 2 0 1 3

STEMI (ST Elevated Myocardial Infarction) -

A Myocardial infarction where a 12 Lead ECG shows ST-segment elevation, usually associated with a recently closed coronary artery. Patients suffering this type of myocardial infarction are more likely to survive if their coronary artery is opened within 12 hours of onset.

Pre-Hospital 12 Lead ECG -

A recorded tracing of the electrical activity of the heart using a 12 Lead ECG monitor in the pre-hospital environment.

Reperfusion -

The restoration of blood flow to an organ or tissue that has had its blood supply cut off, as after a myocardial infarction.

PCI (Percutaneous Coronary Intervention) -

A procedure used to open or widen narrowed or blocked blood vessels supplying the heart. Usually, the blood vessels are accessed through the skin over the leg (femoral) or arm (radial or brachial) arteries. A thin catheter is advanced over a soft-tipped guide-wire through the arterial tree to the base of the heart where the coronary arteries arise. A smaller guide-wire is then advanced into the coronary artery and across the blockage, followed by balloon-dilation catheters, stents, and other artery opening devices as needed. This includes balloon angioplasty (PTCA), stenting, rotablader, arthrectomy, or laser intervention.

First Device Activation Time -

A data element field in the ACTION Registry-GWTG forms. First Device Activation can be documented as

a) Time of first balloon inflation

b) If no balloon was inflated, the documented time the first stent was deployed

c) The time of the first treatment of lesion (Anjiojet or other thrombectomy aspiration device, laser, rotational atherectomy).

Fibrinolysis -

The breakdown of fibrin, usually by the enzymatic action of plasmin. Fibrin is a protein necessary for blood clotting that forms a web-like mesh that traps red blood cells and platelets thus holds clots together. In the case of myocardial infarction, the administration of drugs that facilitate fibrin breakdown is referred to as “fibrinolysis.”

Fibrinolytic - An agent used to facilitate fibrin breakdown.

Fibrinolytic Administration Time -

Time the destination hospital administers either the first bolus of a fibrinolytic or the beginning of the thrombolytic infusion. (May reference Seq3 8023 in ACTION Registry-GWTG Data entry)

10 | P a g e D e c e m b e r 2 0 1 3

FMC (First Medical Contact) -

Time when the patient was first evaluated by either emergency medical services, trained first responders or another healthcare professional (clinic, urgent care, etc.) prior to arrival at the destination hospital. May reference Seq # 3105/3106 in ACTION Registry-GWTG data entry)

FMC (First Medical Contact) to PCI (First Device Activation) -

The time elapsed from the first medical contact including emergency medical service scene arrival or emergency department registration arrival to the first inflation of the PCI balloon or first device activation.

Arrival (to referral center) to Fibrinolytic Administration -

The time elapsed from emergency department registration arrival to the initial infusion of fibrinolytic medication.

FMC to PCI equal to or < 90 Minutes Numerator -

Of the number of patients identified in the denominator, the number of patients that were transported directly to a STEMI Receiving Center from the field, and have a documented STEMI via pre-hospital ECG and meet Time of FMC to reperfusion < 90 Minutes, where the reperfusion strategy was PCI.

FMC to PCI equal to or <90 Minutes Denominator -

The total number of patients transported directly to the STEMI Receiving Center, and have a STEMI noted on a pre-hospital 12 lead ECG, after all exclusions are applied.

Arrival (to referral center) to Fibrinolytic Administration equal to or <30 Minutes Numerator -

Of the number of patients identified in the denominator, the number of patients that are transported to a STEMI Referral Center from the field, and have a documented STEMI via pre-hospital 12 lead ECG and met time of arrival to reperfusion < 30 Minutes, where the reperfusion strategy is fibrinolysis.

Arrival (to referral center) to Fibrinolytic Administration equal to or <30 Minutes Denominator -

The total number of patients transported to the STEMI Referral Center, and have a STEMI noted on a pre-hospital 12 lead ECG, after all exclusions are applied.

Percent Patients 35 years of age or over who receive 12 Lead ECG Denominator -

The total number of (EMS) pre-hospital patients, over 35 years of age, with a complaint of non-traumatic chest pain.

Percent Patients 35years of age or over who receive 12 Lead ECG Numerator -

The number of (EMS) pre-hospital patients over 35 years of age, with a complaint of non-traumatic chest pain who have a 12 lead ECG.

11 | P a g e D e c e m b e r 2 0 1 3

Non-System Reason For Delay -

A delay in patient care (>30 minutes) that occurs in between the time of arrival at the destination hospital and the time the patient arrives in the cath lab. This non-system reason for delay must be documented in the patient record at the destination hospital and be categorized as one of the following: difficult access delay, consent delay, arrest/ intubation delay, difficult lesion delay or other documented delay (reference Seq # 8025 and #8035 in ACTION Registry-GWTG data entry). Note: Any delay that occurs before or during transport is not considered a non-system reason for delay.

Difficult Access (Delay) -

Documented in the inpatient medical record, this is a delay of 30 minutes or longer due to difficulty in arterial access needed to perform the PCI procedure.

Consent (Delay) -

Documented in the inpatient medical record, this is a delay of 30 minutes or longer due to the patient or family not giving immediate consent for PCI treatment.

Arrest Intubation (Delay) -

Documented in the inpatient medical record, this is a delay of 30 minutes or longer due to the need for emergent intubation and/or cardiac arrest care that occurs between the time the patient arrives at the destination hospital and prior arrival to the cath lab.

Difficult Lesion (Delay) -

Any documented (in hospital patient record) delay of 30 minutes or longer that is due to difficulty in crossing the identified lesion.

Other Documented Delay -

Documented in the inpatient medical record, this is a delay of 30 minutes or longer that occurs between the time the patient arrives at the destination hospital and prior arrival to the cath lab that was due to a delay other than difficult access delay, consent delay, arrest intubation delay or difficult lesion delay.

ACTION Registry®-GWTG™ -

ACTION Registry®-GWTG™ is risk-adjusted, outcomes-based, quality improvement program that focuses exclusively on high-risk STEMI/NSTEMI patients. It helps hospitals apply ACC/AHA Clinical Guidelines recommendations in their facilities, and provides invaluable tools to assist them in achieving their goal of quality improvement. Participating in this program helps hospitals improve their adherence to ACC/AHA Clinical Guidelines recommendations as they satisfy the data collection and reporting requirement of regulatory and contracting organizations. The registry’s real-time quarterly reports will support efforts to reduce procedural complications, identify areas of excellence and opportunities for improvement, and document the results of QI efforts. For more information go to www.NCDR.com.

Mission: Lifeline Wyoming Equipment Advisory Subcommittee October 29, 2012

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Equipment Advisory Goals and Responsibilities Goal of this subcommittee is to review EMS and hospital resource gaps and develop a plan to allocate grant funding.

Identify equipment requirements for successful transmission of 12-lead ECG for all EMS Agencies.

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

Identify additional equipment and training requirements and address.

Mission: Lifeline Wyoming Equipment Grant Agreement

American Heart Association, Inc. – the Dallas office of the Southwest Affiliate (“AHA”), 8200 Brookriver, Suite N 100 Dallas, TX, hereby awards a grant to _________________________ (“COMPANY”), at the street address ____________________________, subject to the following terms and conditions:

1. The grant funding this equipment is for the period from June 1, 2012 through June 30, 2015. Upon receipt by AHA of this signed Grant Agreement, COMPANY may arrange to purchase approved equipment or software for delivery within 30 days and payment with a 60 day payment arrangement in accordance with the Equipment Grant Agreement provided by AHA. Upon successful delivery and installation of the equipment and receipt of the final invoice, COMPANY must deliver to AHA the signed Equipment Grant Agreement, a copy of their original application for EMS & Hospital Equipment Funding AHA agrees it will pay COMPANY the amount for the approved equipment ordered within thirty (30) days of receipt (see Attachment A for dollar amount).

2. COMPANY is legally incorporated in WY, SD, MT, ID, UT, CO (please circle one), is a corporation in good standing with their respective State and the AHA Mission: Lifeline Wyoming initiative at the time of this grant Agreement, and agrees it will maintain this status throughout the term of this Agreement. If COMPANY is a non-profit organization; COMPANY confirms further it is not a Type III supporting organization within the meaning of IRC Section 4943(f)(5)(A).

3. COMPANY will use grant funds only for activities that are consistent with its grant application submitted to the AHA and as outlined in Attachment A. COMPANY will not use the grant funds for political support or to carry on lobbying efforts of propaganda, or to otherwise attempt to influence any legislation, within the meaning of IRC Section 4945 and the Treasury Regulations thereunder. Further, COMPANY will not use grant funds to engage in, support or promote violence, terrorist activity or related training of any kind.

4. No substantial variances, including the timing of expenditures, will be made from the grant application without the AHA’s prior written approval.

5. COMPANY will inform the AHA immediately, in writing, of (i) any change in or challenge to its corporate status, adverse change in its standing with their regulating state or if it becomes a Type III supporting organization, (ii) any change in its organizational leadership or key personnel, or (iii) any material change or adverse development relative to its financial condition, operations, activities or affairs. No payment hereunder shall be required to be made at any time after COMPANY ceases to be a legal corporate entity, has an adverse change in its standing with the State of Texas or if it becomes a Type III Supporting Organization.

6. COMPANY will have full control of the disposition of the grant and accepts responsibility for complying with this Agreement’s terms and conditions. This grant is earmarked for COMPANY and may not be transferred to any other entity or person, except as may be specified in Attachment A. COMPANY will maintain a separate accounting of the use of grant funds to enable confirmation of its proper expenditure of the grant funds.

7. COMPANY will submit an annual report using the template provided by AHA and outlining its progress towards the plans detailed in the grant application and a summary of how the grant funds have been expended. These reports are due 60 days after the end of each calendar year starting with the year ended December 31, 2013.

8. COMPANY acknowledges and agrees that any equipment provided hereunder by AHA will, upon delivery, be owned by COMPANY, and COMPANY solely will be responsible for the upkeep, maintenance, repairs, safety, insurance and operability of such equipment. COMPANY also acknowledges and agrees that the AHA does not endorse, impliedly or expressly, any brand or manufacturer of any equipment that may be provided hereunder.


9. COMPANY agrees to respond within 30 days of request to interim inquiries and requests for information from the AHA regarding uses of the grant funds, compliance with the terms of the grant and progress made towards achieving the goals of the grant.

10. COMPANY acknowledges that the AHA and its representatives have made no actual or implied promise of funding or renewal of funding in addition to amounts provided under this Agreement.

11. It is understood that by signing this grant Agreement, COMPANY agrees that it will conduct all activities to be funded by this grant in compliance with all applicable United States, state and local laws, as well as in compliance with the laws of any location or jurisdiction in which COMPANY is operating, including applicable anti-terrorist financing and asset-control laws, statutes and executive orders.

12. COMPANY agrees to ensure that all potential recipients and participants of COMPANY’s programs and services have access to programs and receive equitable services without regard to race, sex, education, ethnicity, socio-economic status, religion, ability/disability, sexual orientation, gender self-identification, age, country of origin, first language, marital status, citizenship or immigration status.

13. If COMPANY wishes to publicize this grant, COMPANY must contact the AHA at least 2 weeks before the desired date of the publicity for review and approval by the AHA and The Leona M and Harry B. Helmsley Charitable Trust (“TRUST”). COMPANY shall not issue any press releases or otherwise make any public statement referring to this grant or using the AHA, or TRUST’S logo without the prior written consent of the AHA and TRUST. The text of all press releases, public announcements, statements, campaign reports or materials that mention the grant must be approved in advance in writing by the AHA and the TRUST. COMPANY shall provide the AHA with copies of any and all final press releases, public announcements and/or publications related to this grant. The AHA and the TRUST may make information about this grant public at any time on their websites or in presentations or as part of their public reports or documents.

14. COMPANY hereby agrees, to the fullest extent permitted by law, to defend, indemnify and hold harmless the AHA, the TRUST, their officers, directors, volunteers, employees and agents from and against all claims, liabilities, losses and expenses (including reasonable attorney’s fees), directly or indirectly, wholly or partially arising from or in connection with any act or omission of COMPANY, its directors, employees or agents in obtaining or accepting the grant from the AHA, in expending or applying the proceeds of the grant from the AHA, in operating the equipment provided hereunder, or in carrying out the project or programs funded with grant funds from the AHA.

15. If the AHA terminates this grant for cause, or if COMPANY ceases to be a legal corporate entity, or ceases to be in good standing in their respective state, or becomes a Type III Supporting Organization, COMPANY shall immediately repay the full amount of grant funds that are unspent and surrender any equipment purchased with grant funds as of the date of the termination or date its corporate status changes. In addition to the circumstances cited above, the AHA shall have cause to terminate the grant if the purpose of the grant has been fully completed; COMPANY becomes unable to carry out the purposes of the grant; COMPANY uses the grant funds for a purpose other than those set forth in this Agreement, unless the AHA has consented in writing to such modification; or COMPANY is in breach of any term of the grant. The AHA reserves the right to request immediate reimbursement of any grant funds used for purposes other than those for which the grant was made or to which the AHA has consented.

16. COMPANY acknowledges and agrees to be responsible for the upkeep, maintenance, repairs, safety, insurance and operability of such equipment not only for the term of the grant, but for as long as COMPANY owns such equipment. The COMPANY will be required to retain records to attest to upkeep, maintenance, repairs, safety, insurance and operability and should be readily available upon the request of the AHA for verification.


For American Heart Association, Inc. – Southwest Affiliate: Signature Name/Title Date On behalf of COMPANY, I understand and agree to the foregoing terms and conditions of the AHA’s grant and hereby certify my authority to execute this Agreement. By: Signature Name/Title/Company Date


Attachment A

Funding was approved by the Mission: Lifeline Wyoming Committee as follows:

Approved and received by COMPANY Equipment – Brief Description

Total Cost Requested (to include applicable sales tax

and S&H charges) $600.00 to be used for 3 years of data

package service from a cell phone provider for each (1) 12-lead EKG monitor ($ 600.00 per each MLWY awarded unit)

Note: If you received funds for data packages from cycle 1 of MLWY funding, you will receive a stipend that will total $600.00 per machine. (EX: you received a data package for one 12 lead and was reimbursed for $199 from cycle 1, you will receive a stipend for $401.00)

The goal is to provide cell data service for a total of 3 years.

1 6 20.00%

2 7 23.33%

3 6 20.00%

4 6 20.00%

5 5 16.67%

30 100.00%

# Answer Bar Respo nse %

Trauma Region (TRAC) 1





Total

1 5 2.90 1.96 1.40 30 30

Min Value Max Value Average Value Variance St andard Deviat io n T o t al Respo nses T o t al Respo ndent s

Trauma Region (TRAC)

1 26 86.67%

2 4 13.33%

30 100.00%


Yes

No

Total

1 2 1.13 0.12 0.35 30 30


Does local law enforcement respond to cardiac arrest /cardiac related medical calls, as directed by MedicalPriority Dispatch guidelines?

1 5 20.00%

2 10 40.00%

3 8 32.00%

4 2 8.00%

25 100.00%


Yes, all patrol cars carry AEDs

Yes, some patrol cars carry AEDs

No

Not sure

Total

1 4 2.28 0.79 0.89 25 25


Does your local law enforcement off icers carry AED's in their patrol cars?

1 4 13.79%

2 9 31.03%

3 7 24.14%

4 0 0.00%

5 2 6.90%

6 1 3.45%

7 1 3.45%

8 2 6.90%

9 3 10.34%

29 100.00%


None

1

2

3

4

5

6

7

8 or more

Total

1 9 3.76 7.12 2.67 29 29


How many non-transporting f ire departments are in your area (to include Search and Rescue agencies)?

1 5 20.83%

2 7 29.17%

3 4 16.67%

4 1 4.17%

5 0 0.00%

6 2 8.33%

7 3 12.50%

8 2 8.33%

24 100.00%


None

1

2

3

4

5

6

8 or more

Total

1 8 3.50 6.00 2.45 24 24


How many non-transporting f ire agencies have AED capabilit ies?

1 10 40.00%

2 11 44.00%

3 3 12.00%

4 0 0.00%

5 1 4.00%

25 100.00%


None

All

25%

50%

75%

Total

1 5 1.84 0.89 0.94 25 25


Of those non-transporting f ire agencies, how many respond to cardiac related EMS calls, as directedby Medical Priority Dispatch guidelines?

1 6 20.69%

2 16 55.17%

3 6 20.69%

4 1 3.45%

29 100.00%


None

1

2

3 or more

Total

1 4 2.07 0.57 0.75 29 29


How many public libraries are in your community?

2 16 69.57%

3 6 26.09%

4 1 4.35%

5 0 0.00%

6 0 0.00%

23 100.00%


< 5 min

5-10 min

10-15 min

> 15 min

Unsure

Total

2 4 2.35 0.33 0.57 23 23


What is your average response t ime to the closest library in your area?

2 6 50.00%

3 2 16.67%

4 2 16.67%

5 2 16.67%

6 0 0.00%

12 100.00%


< 5 min

5-10 min

10-15 min

> 15 min

Unsure

Total

2 5 3.00 1.45 1.21 12 12


What is your average response t ime to the farthest library in your area?

1 10 43.48%

2 2 8.70%

3 3 13.04%

4 8 34.78%

23 100.00%


Unsure

All

Some

None

Total

1 4 2.39 1.89 1.37 23 23


Does the library (libraries) currently have at least one AED?

2 6 28.57%

3 2 9.52%

4 1 4.76%

5 1 4.76%

6 2 9.52%

8 4 19.05%

9 2 9.52%

10 3 14.29%

21 100.00%


1

2

3

4

5

10-15

15-20

>20

Total

2 10 5.67 9.93 3.15 21 21


How many churches are in your community?

1 19 65.52%

2 8 27.59%

3 2 6.90%

4 0 0.00%

29 100.00%


< 5 min

5-10 min

10-15 min

> 15 min

Total

1 3 1.41 0.39 0.63 29 29


What is you average response t ime to the closest church?

1 4 14.29%

2 15 53.57%

3 2 7.14%

4 7 25.00%

28 100.00%


5-10 min

10-15 min

> 15 min

Total

1 4 2.43 1.07 1.03 28 28


What is your average response t ime to the church farthest away?

1 10 34.48%

2 0 0.00%

3 2 6.90%

4 17 58.62%

29 100.00%


Unsure

All

Some

None

Total

1 4 2.90 2.02 1.42 29 29


Do the churches in your community currently have at least one AED?

1 4 13.79%

2 5 17.24%

3 4 13.79%

4 16 55.17%

29 100.00%


None

1

2

3 or more

Total

1 4 3.10 1.31 1.14 29 29


How many community centers do you have in your area? (ex. senior cit izens center, Boys & Girls club, multi-event center, recreation center, town hall, theater, etc.)

1 18 69.23%

2 6 23.08%

3 1 3.85%

4 1 3.85%

26 100.00%


< 5 min

5-10 min

10-15 min

> 15 min

Total

1 4 1.42 0.57 0.76 26 26


What is your average response t ime to the closest community center?

1 7 26.92%

2 10 38.46%

3 3 11.54%

4 6 23.08%

26 100.00%


< 5 min

5-10 min

10-15 min

> 15 min

Total

1 4 2.31 1.26 1.12 26 26


What is your average response t ime to the farthest community center?

1 8 30.77%

2 4 15.38%

3 10 38.46%

4 4 15.38%

26 100.00%


Unsure

All

Some

None

Total

1 4 2.38 1.21 1.10 26 26


Do the community centers currently have at least one AED?

1 14 48.28%

2 8 27.59%

3 2 6.90%

4 5 17.24%

29 100.00%


Industrial complexes only

None

Mines only

Both industrial complexes and mines

Total

1 4 1.93 1.28 1.13 29 29


Are there industrial complexes or mines in your response area?

1 8 44.44%

2 5 27.78%

3 3 16.67%

4 2 11.11%

18 100.00%


5-10 min

10-15 min

>15 min

Total

1 4 1.94 1.11 1.06 18 18


What is your average response t ime to the closest industrial complex?

1 2 11.11%

2 6 33.33%

3 3 16.67%

4 7 38.89%

18 100.00%


5-10 min

10-15 min

>15 min

Total

1 4 2.83 1.21 1.10 18 18


What is your average response t ime to the farthest industrial complex?

1 5 27.78%

2 5 27.78%

3 6 33.33%

4 2 11.11%

18 100.00%


Yes, all have a response brigade

Yes, some have a response brigade

No

Unsure

Total

1 4 2.28 1.04 1.02 18 18


Do the industrial complexes have a f ire/ems response brigade?

2 4 22.22%

3 5 27.78%

4 6 33.33%

5 3 16.67%

18 100.00%


All

Unsure

Some

None

Total

2 5 3.44 1.08 1.04 18 18


Do the industrial complexes have at least one AED?

1 3 15.79%

2 0 0.00%

3 1 5.26%

4 15 78.95%

19 100.00%


5-10 min

10-15 min

>15 min

Total

1 4 3.47 1.26 1.12 19 19


What is your average response t ime to the closest mine?

1 0 0.00%

2 3 15.79%

3 0 0.00%

4 16 84.21%

19 100.00%


5-10 min

10-15 min

>15 min

Total

2 4 3.68 0.56 0.75 19 19


What is your average response t ime to the farthest mine?

1 4 21.05%

2 3 15.79%

3 6 31.58%

4 6 31.58%

19 100.00%


Yes, all have a response brigade

Yes, some have a response brigade

No

Unsure

Total

1 4 2.74 1.32 1.15 19 19


Do the mines have a f ire/ems response brigade?

1 5 26.32%

2 2 10.53%

3 11 57.89%

4 1 5.26%

19 100.00%


All

Some

Unsure

None

Total

1 4 2.42 0.92 0.96 19 19


Do the mines have an at least one AED?

1 Location 1 12 -

2 Location 2 10 2

3 Location 3 3 4

4 Location 4 2 1

5 Location 5 1 2

6 Location 6 - -

7 Location 7 - -

8 Location 8 - -

9 Location 9 - -

11 Location 10 - 1

# Answer Highest Prio rit y Lo w Prio rit y

Location 1 1.25 -

Location 2 1.8 2

Location 3 2.67 1

Location 4 3.5 2

Location 5 2 1

Location 6 - -

Location 7 - -

Location 8 - -

Location 9 - -

Location 10 - 2

Answer Highest Prio rit y - Mean Rank Lo w Prio rit y - Mean Rank

Do you have any other public/community locations that would benefit from AED placement? Priorit ize yourselections by dragging your entry into the "Highest Priority" box or to the "Lowest Priority" box.

4

20

47

20

7

6

2

12

14

4

View More

T ext Ent ry

Respondents 28

St at ist ic Value

& 170+ @ Aeds Airport Appears Athletic Bldgs Buses Carry C a rs Cc Centers C h u rc h City Community Couple Courthouse Coverage Dentist Dept Emts Energy Fd Fire Group Health H o m e Hours Hs L i b ra ry Limited Million Mines Offices Pd Personal Police

Public Pwder Recs River S c h o o l S tation Total Trucks Unknown Visitors Year 0 1 2 3 4 5 6 7 9 10 12 14 20 21 30 34 38 47 100

Based on your best out of hospital cardiac arrest location assessment, how many AED's would be needed toprovide ideal public access coverage in your area?

1,100

10300

1000

40,000

750

40,000

450

5000

5500

3000

View More

T ext Ent ry

450 25000 4685.29 35835238.97 5986.25 17 30

MinValue

MaxValue

AverageValue

#Repo rt T ableCo lumnHeaders,Variance#

#Repo rt T ableCo lumnHeaders,St dDev#

T o t alRespo nses

T o t alRespo ndent s

000 1 2 12 13 14 40 45 55 95 100 450 500 623 700 750 775 1000 1500 3000 3500 5000 5500 6000 8000 10300 25000

What is the population your service area?

300

5,000

2200

4,000

150

5,300

300

2000

2000

120

View More

T ext Ent ry

2.6 4200 1211.41 1787788.20 1337.08 21 30

MinValue

MaxValue

AverageValue

#Repo rt T ableCo lumnHeaders,Variance#

#Repo rt T ableCo lumnHeaders,St dDev#

T o t alRespo nses

T o t alRespo ndent s

000 2 4 5 6 70 75 100 120 150 219 231 232 300 364 400 1600 1700 2000 2200 3000 3472 4200

How many square miles are in your service area?

1 27 96.43%

2 1 3.57%

28 100.00%


Yes

No

Total

1 2 1.04 0.04 0.19 28 28


Will you be willing to work with AHA staff to assist in contacting the potential recipients such as policedepartments, non-transporting f ire departments, libraries, schools, churches, community centers, mines andindustrial complexes, mentioned above regarding AED assessment questions and awards?

1 25 89.29%

2 3 10.71%

28 100.00%


Yes

No

Total

1 2 1.11 0.10 0.31 28 28


Will you be willing to be a point of contact for your region regarding MLWY AED specif ic questions?

James Sindlinger

Mike Straw

Gard Ferguson

Mike Moyer

Jaime Jones

Richard Ratclif f

Becky Half hill

Wade Wells

[email protected]

Michael J. Phelps

View More

E Signat ure

Respondents 28

St at ist ic Value

Andrea Bagnell Ballard Becky Bigelow Boone Candace Christy Evenson Ferguson Fleming Gard Gutierrez Halfhill Hoflund Hofmann Holloway Jaime Jake James Jeremy Jim Jon Jones Kern Larsen Les Mark Melissa Mentz el MichaelMike Miles Mortimore Moyer Org Phelps Ratcliff Rhespe@vcn Richard Robert S chanefelt S cott S haron S indlinger S nyder S traw Tom Vandz ura Wade Wells Z amora@crmcwy

* Please type your name below:

Mission: Lifeline Wyoming Conference Planning and Education October 29, 2012

Conference Planning and Education Subcommittee Goals and Responsibilities

1. Plan the content and schedule of a regional professional education conference for 2014

2. Plan the content and schedule of a regional professional education conference for 2015

3. Format the regional professional education conference on the latest STEMI and sudden cardiac arrest treatment and system initiatives

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

5. Public

a. Identify a public awareness campaign strategy and timeline for promotion of “911” for heart attack symptoms via third party evaluation

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Save the Date!

Wyoming 12 Lead Conference - 2014

Conference Dates: April 21st – April 22nd Ramada Inn Hotel – Casper

Conference Agenda Information Coming Soon!

This is a FREE event for Mission: Lifeline Wyoming participants!

Mission: Lifeline Wyoming Protocols and Quality Improvement Subcommittee October 29, 2012

Protocols and Quality Improvement Goals and Responsibilities

• Assess how many of the participating organizations have existing AMI protocols

• Identify process to review individual organization and system needs for a standardized regional assessment, treatment and transport protocol set

• Identify elements required for a standardized regional protocol set

• Identify process to review different protocols and start assimilating

• Identify process to evaluate implementation of and outcomes of new standardized

regional protocol set

• 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)

• Identify ways to help capture and measure “system” level items like reperfusion to

recognition (R2R) or symptom onset through arterial reperfusion (SOAR)

• Assess internal QI process and frequency in participating organizations

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Criteria: ST Elevation Myocardial Infarction with onset of symptoms less than 12 hours

Door In Door Out goal is less than 30 minutes with a less than 60 minute transport time.

If unable to transfer patient for Primary PCI, then door to needle time for fibrinolytic time is less than 30 minutes.If unable to transfer patient for Primary PCI, then door to needle time for fibrinolytic time is less than 30 minutes.

Activate Ambulance or Flight Transfer Crew.

Contact Receiving PCI Center _SEE BELOW_. Tell them you have a Transfer STEMI, they will then connect you with the Cardiologist for fur-

ther discussion.

ALL PATIENTS MUST RECEIVE: (Refer to STEMI Order Sheet and complete)

12-lead ECG within 10 minutes of arrival

Monitor/ hands free defibrillator pads

Oxygen

IV with saline in upper extremity (Second IV, saline locked– As time allows… do not delay transport to

complete this)

DRAW CBC, CMP, Troponin, PT/INR– DO NOT DELAY TRANSPORT WHILE WAITING FOR THE RESULTS—fax to

receiving facility

Aspirin—81mg x 4 chewed

Heparin bolus and drip per order sheet

Contact Receiving Cardiologist regarding oral anti-platelet

Complete fibrinolytic checklist

<GRAPHIC place

holder Defib pads>

ALSO CONSIDER:

Nitroglycerin 0.4 mg SL (repeat as needed or IV)

Morphine Sulfate as needed for pain

Consider antiemetic for nausea

Prepare Transfer Documents

FAX Patient Information Sheet (face sheet), 12-LEAD ECG, LABS, and any other documents to the receiving facility ASAP.

PLEASE NOTE: This facility transfers to more then one PCI Center. Below is the list of our affiliated facilities: PCI Center 1: __________________(phone) ______________________ (fax)____________________ PCI Center 2: __________________(phone) ______________________ (fax)____________________ PCI Center 3: __________________(phone) ______________________ (fax)____________________ PCI Center 4: __________________(phone) ______________________ (fax)____________________ PCI Center 5: __________________(phone) ______________________ (fax)____________________

Mission: L i fe l ine Wyoming

STEMI Care Guidel ine

DRAFT

1/28/2014 10:00 AM

Once STEMI is

identified, Contact

Receiving Facility

and arrange

ground or air

transport

Administer Morphine and

oral anticoagulant

as requested by

receiving Cardiologist

0 minutes

(patient arrives) 30 minutes

Admit pt,

attach

ECG, VS,

Oxygen

Run 12-Lead

Draw Labs Prepare Transfer Documents

Apply Defib

pads (A/P)

15 minutes

Begin fibrinolytic. If Primary

PCI IS NOT INDICATED or

if receiving Cardiologist

requests

Transfer

patient to

receiving

facility

Administer

ASA and

Heparin.

QuickCombo ® pad

placement . Wires towards head of patient.

Proper 12-lead ECG patch placement

Step 1

Has the patient experienced chest discomfort for greater than 15 minutes and less than 12 hours?

Yes No

Step 2

Are there any contraindications to fibrinolysis? If ANY of the below are checked “Yes”, fibrinolysis

is contraindicated. Consider direct transport to a PCI facility.

Yes No Absolute Contraindications: Yes No Absolute Contraindications:

Any prior intracerebral hemorrhage? Active bleeding or bleeding diathesis (excluding menses)

Known structural cerebral vascular lesion (eg, ar-

teriovenous malformation?

Significant closed-head or facial trauma within 3 months

Known malignant intracerebral neoplasm

(primary or metastatic)

Intracranial or intraspinal surgery within 2 months

Ischemic stroke within 3 months EXCEPT acute

ischemic stroke within 4.5 hours

Severe uncontrolled hypertension (unresponsive to emer-

gency therapy)

Suspected aortic dissection For streptokinase, prior treatment within the previous 6

months

STOP

Mission: Lifeline Wyoming Meeting 30, 2014wcm/@swa/...arrest through the Mission: Lifeline Wyoming...

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