There were no combat boots or drill sergeants present, but some 100 doctors, nurses,technologists and emergency medical services (EMS) workers reported for boot camp one bright January day in Fairfield, California. Make that STEMI Boot Camp. It was all part of NorthBay Healthcare’s first venture into providing regional training for medical workers and in this case, preparing outlying facilities to be prepared when someone arrives in their emergency departments experiencing an ST-segment elevation myocardial infarction (STEMI). The workshop headliner was Dr. David Burt, creator of Project UPSTART, a free, quality-improvement program focused on helping hospitals and systems improve their system of care for STEMI patients. NorthBay Healthcare, a not-for-profit two-hospital system that serves Solano County, launched efforts to establish itself as a STEMI Receiving Center in 2010, and continues to work toward that goal. NorthBay learned of Dr. Burt’s program and initially invited him to do a short presentation to staff in January 2010. Cath Lab and Heart & Vascular program staff were so impressed that they invited him back for more. “We decided if our staff could benefit from the work and lessons of Dr. Burt, other hospitals in this area could, too,” explained Diana Sullivan, service line director for NorthBay’s Heart & Vascular Program. “We had seven hospitals, seven EMS providers, a number of doctors, chest pain centers, emergency departments and cath lab staff from all over Northern California join us for this amazing one-day opportunity.” “The collaboration, yes, even with our purposed competition, was astounding,” says Diana, referring to breakout sessions that had participants joining in roundtable discussions. “There was a collegial, community-centric collaboration of giving all day, because we were all focused on figuring out how to work together to save lives.” The key to addressing a STEMI is to have a thorough set of protocols and procedures in place, and making sure staff knows exactly what needs to happen and what comes next, according to Dr. Burt, who practices emergency medicine at the University of Virginia in Charlottesville, where he is the director of the UVA Chest Pain Center. He is actively involved in cardiovascular-related outreach at the local, state and national levels, and focuses his research on reducing reperfusion times in STEMI care. His message is to work smarter, not harder. “You need to learn where to apply your time, focusing on select points,” he explained. Once a STEMI is identified, it must trigger a clear response downstream, Burt explained. With mantras of “time is (heart) muscle” and “60 is the new 90,” Burt explained that the goal is to move as quickly as possible, and that while 90 minutes used to be considered ideal, faster is better, when it comes to delivering a patient to a facility capable of percutaneous coronary intervention (PCI) within 60 minutes. The goal of the workshop was to support the work of a number of organizations all focused on saving lives. Among them:
- Mission: Lifeline, the American Heart Association’s campaign to decrease door-to-balloon (D2B) time, and improve the system of STEMI care.
- The D2B Alliance (www.d2balliance.org), which hopes to provide hospitals with key, evidenced-based strategies to decrease D2B times.
- The Society of Chest Pain Centers (SCPC), which hopes to share best practices and bridge the gap between EMS, emergency medicine, cardiology, nursing and other medical staff.
- Project Upstart (www.projectupstart.com), which aims to hardwire the nuts and bolts of STEMI care, and teach the “5 Rs of Reperfusion”: 1. Recognition; 2. Reperfusion; 3. Real-time data collection; 4. Reassessment and Refinement; and 5. Relationships.