MIEMSS CARES Implementation - The National Association of State

MIEMSS
CARES Implementation
Richard Alcorta, MD
Standing in for
Executive Director Kevin Seaman, MD
Overview
• Must Measure Performance to Improve
• CARES Implementation Strategy
* Software
* Education and Personnel
* Recruitment
• Maryland’s Cardiac Arrest Steering
Committee (CASC)
• Single National Database
MEASURE
IMPROVE
“Lean” Approach
• Define the Problem
• Measure
• Analysis
• Improve
• Control
CARDIAC ARREST SURVIVAL:
A TIME TO ACT
Measure
• CARES has established both an
EMS and Hospital dataset that will
all the nation, each state, each EMS
operational program and hospital to
benchmark their performance using
the revised Utstein template.
Maryland’s Process for
Implementation of CARES
• Standing on the shoulders of Giants
•
•
•
* Dr. Robert Bass
* Dr. Kevin Seaman
Preparing the EMS Operational
Programs and Hospitals
Regional Councils
Recruiting Existing System Champions
MOU with CARES
• HIPAA compliance
• Getting Assistant Attorney General
•
•
Support and approval
Multiple constructive conversation
Dr. McNally
Confirmation as CDC recognized
Medical Oversight Body
Developing the Electronic
Patient Record
• MIEMSS, Image Trend and CARES
•
Collaboration
CARES data set integrated into
Image Trend software –
Developing the Electronic
Patient Record
• Made every attempt to align with
•
NEMSIS 2.2.1. There ended up
being 11 additional fields identified
and Image trend implemented IT
codes to meet this request and
Established export bridging software
to CARES.
State CARES Coordinator
• MIEMSS is lucky to have a data analysist
•
who manages the State Trauma Registry
and whom stepped up and has taken on
the State CARES Coordinator position.
This is an essential link to Emory and
CARES but also provides support to EMS
and Hospital CARES Coordinators
Beta Tests Software
• Howard County Department of Fire
•
•
and Rescue Services
* Then “EMS Medical Director”
Kevin Seaman, MD
Howard County General Hospital
Education of EMS Providers and
Coordinators
Providing Updates on Progress
• Cardiac Arrest Steering Committee
•
* Chaired by Kevin Seaman
Annual EMS Medical Director
Symposium
Ground Swell
• Annual Base Station Coordinator
Meeting
* Straw poll and later site visit
surveys of base stations
* Huge ground swell of support and
interest
* Especially the designated Cardiac
Intervention Centers (STEMI)
Early Cardiology
Interventionalist Problem
• One of the barriers we were able to
•
overcome was the post arrest patient
who does not have STEMI EKG yet
should have cardiac cath, as many of
these patients have stent able lesions.
Cardiologists and state compensation
regulators agree it is the right thing to
do for these “unstable” patients.
State Protocol
• Optional Supplemental protocol for
•
High Performance CPR based on
evidence from the Resuscitation
Academy
Post Arrest ROSC patients
preferentially directed to Cardiac
Intervention Centers
Statewide CARES Conference
• Held Statewide EMS Operational
Program and Hospital CARES
orientation and training conference
where EMSOPs and hospitals sent
future CARES Coordinators from
their entity.
CARES Conference
CARES EMS ePCR
• MIEMSS has completed statewide
•
•
education on the EMEDS (ePCR)
through annual protocol roll out.
Anticipate turning it on statewide
January 2016.
Meanwhile getting letters of intent to
participate in CARES from hospitals
Measurement and Oversight
• Cardiac Arrest Steering Committee
•
* Public
* Dispatch
* EMS
Hope to have > 90% of hospitals
voluntarily participating with in a
year.
Maryland Cardiac Arrest
Steering Subcommittees
* Public
+ Public Service Announcements (Radio)
+ Bus poster boards
* Dispatch –
+ Dispatch directed compressions earlier
( ID agonal respirations)
* EMS
+ High performance CPR (Protocol moving to
mandatory)
Single National Database
• Challenges – NAEMSP subspecialty
text references three critical
databases: National Trauma
Database Registry, CODES (Crash
Outcomes Data Evaluations System),
and CARES.
Single National Database
• AHA is interested in establishing a
separate or parallel Mission Life
Line Cardiac Arrest registry. There
needs to be a single national cardiac
arrest registry so it is essential that
we do not fragment this very
important data repository.
Single National Database
• Maryland views the CDC recognized
medical oversight body of CARES as
that registry.
Summary
• Must Measure Performance to Improve
• CARES Implementation Strategy
* Software
* Education and Personnel
* Recruitment
• Maryland’s Cardiac Arrest Steering
Committee (CASC)
• Single National Database