HOW TO IMPROVE PRE-HOSPITAL TRANSPORTATION JORGE MARQUES

Transcrição

1 HOW TO IMPROVE PRE-HOSPITAL TRANSPORTATION JORGE MARQUES

2 NATIONAL HEALTH PLAN CHD Standardized mortality rate reduction under 65 years from 16,1 (2001) to 11,0( 2010); CHD in-hospital death rate reduction from 6,6% (2001) to <5% (2010); In the NHP the increase of admissions through EMS is a considered a major goal in the improvement in the care of Cardiovascular Diseases; The NHP aimed at an increase from 2% to 80% of such admissions.

3 Primary PCI in Portugal Region Population Minho Grande Porto Trás-os-Montes e Alto Douro Viseu/Guarda Coimbra Grande Lisboa Évora Algarve

4 AMI Reperfusion ESC/EACTS guidelines European Heart Journal (2010) 31,

5 Time to Reperfusion Symptoms 5 Help Call Transportation or EMS arrival 30 min Door (FMC) ECG and full Transfer if needed (non PCI capable center) diagnostic work 10-20min máx 80min EMS / first hospital or first emergency department 90 min 120 min Cath-Lab arrival Reperfusion 30 min

6 Reperfusion and incidence of STEMI - Portugal Annual incidence of AMI 1040/million P. Widimsky et al. Eur. Heart.J. 2010;31:

7 Incidence of STEMI in Portugal Annual incidence of AMI 1370/million José Ferreira Santos et al. Rev Port Cardiol 2009;28:

8 AMI incidence (admissions in Acute Coronary Care Units) , 55% 3968, 45% 4308, 45% 5320, 55% STEMI NSTEMI STEMI NSTEMI Vias Verdes Coronária e do AVC Indicadores de actividade. Coordenação Nacional para as Doenças Cardiovascularees

9 STEMI Primary PCI National/million Minho/million

10 Referral Area for Primary PCI in Minho Área Hospitalar Concelho População* Urgência Hospital de Braga Centro Hospitalar Alto Minho Hospital de Barcelos Centro Hospitalar Médio Ave Centro Hospitalar Alto Ave Amares Braga Póvoa Lanhoso Terras Bouro Vieira do Minho Vila Verde Arcos de Valdevez Caminha Melgaço Monção Paredes de Coura Ponte da Barca Ponte de Lima Valença Viana do Castelo Vila Nova Cerveira Barcelos Esposende Famalicão Santo Tirso 0 Trofa 0 Guimarães Fafe Cabeceiras de Basto Celorico de Basto Vizela UCIC ICPP * Dados dos Censos 2011

11 EMS referral in Minho 2010 INEM INEM sec Serv.Urg INEM INEM sec Serv.Urg. 10% 1% 14% 1% 89% 85%

12 Admissions by EMS in Algarve ED EMS Veloso Gomes et al. Rev. Port. Cardiol. 2012(3):

13 FMC to reperfusion times in Minho

14 Time from symptoms to FMC

15 Media campaign for patient education

16 STENT FOR LIVE in Portugal

17 EMS referral - National Contact with the EMS (112) EMS Other Arriving with EMS to PCI EMS Other 12% 29% 71% 88% Stent For Live Momento Zero

18 EMS orientation in Minho (on scene) Other 21% Other 16% PCI centre 79% PCI centre 84% n=25 n=37

19 ECG transmission

20 EMS and Emergency Departments Valença Monção Arcos Valdevez Hospital de Braga Viana do Castelo Ponte de Lima SUMC SUB SU privados Esposende Barcelos Braga Famalicão Póvoa Lanhoso Guimarães Fafe Cabeceiras VMER SIV Vizela Felgueiras

21 Transportation time n=24 n=10 n=12 n=13 n=11 n=61 n=28 n=45 n=82 n=126 n=61

22 EMS collaboration with inter-hospital transfer INEM National Minho Daily Calls 2009 Daily Calls 2010 VMER ,8 3,4 SIV ,7 2,5 Ambulâncias SBV ,6 4,3 INEM Relatório de Atividades 2009 INEM Relatório de Atividades 2010 To reach 450 PCI s per year, 350 transportations would be needed; 100 patients per year are already either transported by INEM or enter Hospital de Braga directly; INEM would have to do more one transportations per day; Each VMER would have to do one more transportation in 5 days.

23 Progaliam Sud Galicia ICP No ICP

24 STMI referral Primary Care Patient SUB Private Practices Private Hospitals ED 112 CODU SUMC SU Polivalente sem ICPP P-PCI unit Acute Cor. Care U.

25 Patient already in EMS stretcher when ambulance and transfer team arrives

26 Vascular Access P-PCI in Minho 2010 Radial Femoral Femoral (conv.) Braquial 0% 8% 9% 2011 Radial Femoral Femoral (conv.) Braquial 5% 0% 6% 83% 89%

27 Conclusions To increase and improve primary referral via EMS Maintenance / reinforcement of campaign to population Review with de EMS the decision flowcharts Ensure permanent availability and systematic use of ECG transmission Active formation of EMS professionals in diagnosis workup EMS arriving to an local hospital with a patient with chest pain without clear ST elevation, wait to confirm diagnosis. Information to all clinicians (mainly primary care physician) and other health professionals about the collaboration with de EMS in case of STEMI suspect

28 Conclusions To increase and improve inter-hospital transport (secondary referral) Establish a national protocol with the EMS Ensure permanent availability of ECG transmission between ED and the EMS (e.g. FAX transmission) STEMI patients for transfer to reperfusion must have priority. Patient already in EMS stretcher when ambulance and transfer team arrives Maintain regular contact and exchange of information between local EMS, STEMI-referral hospital, STEMI-receiving hospital (PCI capable).