STEMI and Cardiac Resuscitation EMS Barriers & Solutions

Updated:Oct 18,2012

EMS systems face a variety of barriers to achieving the ideal STEMI and Cardiac Resuscitation
However, there are solutions, as depicted in the chart below. These solutions are in addition to the STEMI systems barriers and solutions found here.

Emergency Medical Dispatch

BARRIER: Delayed Identification of the Cardiac Arrest Victim

EXAMPLES

  • Lack of formal dispatch protocols
  • Lack of training needed to recognize the need for cardiopulmonary resuscitation
  • Lack of quality improvement process

SOLUTIONS

  • Uniform training of all 911 dispatch operators consistent with AHA ECC guidelines
  • Implement a quality improvement process that includes the use of audits and feedback
  • Adopt the first recorded time that the 911 system identifies call as “time 0”
BARRIER:  Lack of Dispatch Assisted CPR

EXAMPLES

  • Lack of formal dispatch-assisted CPR protocols
  • Lack of training to instruct bystander CPR

SOLUTION

  • Dispatch instruct bystanders in Hands only CPR
  • Initial training and annual competency of all dispatch operators to instruct the lay person on CPR

Paramedic/First Responder

BARRIER: Lack of Resources to Implement Cardiac Resuscitation Systems of Care

EXAMPLES

  • Lack of understanding why change is needed
  • Lack of reallocation  of resources – High effort → Low yield activities
  • Insufficient integration of first responder training
  • Insufficient quality review or quality improvement programs for cardiac resuscitation

SOLUTIONS

  • Identify EMS champion to drive change
  • Redistribute resources to Low effort →High yield activities
  • Paramedics provide training to first responders
  • Review outcomes and provide feedback to team on all cardiac resuscitation calls
BARRIER:  Providing Uninterrupted CPR

EXAMPLES

  • Compressions are interruption for performing various interventions such as intubation and IV insertion
  • Compression interruption to move the patient

SOLUTION

  • Update CPR protocols to include new AHA CAB Guidelines (Compression, Airway, Breathing)
  • Provide continuing education for  first responder providers on excellent chest compression technique
  • Dispatch sufficient number of providers with appropriate equipment (manual defibrillators) to the scene
  • Provide effective ALS training
BARRIER:  Lack of Destination Protocols

EXAMPLES

  • Lack of cardiac resuscitation designation for hospitals
  • No national certification process to identify destination  hospitals
  • Need early alert to hospitals  of arrival of cardiac arrest patient

SOLUTION

  • Identify hospital champion to drive change
  • Develop and maintain relationship between EMS and hospitals
  • Establish a multidisciplinary approach to post cardiac arrest care
  • Identify destination centers for cardiac resuscitation develop destination plan