Missouri heart attack patients now sent to best-equipped hospital — not always the closest

A revised emergency response system in Missouri that directs how responders care for serious heart attack patients is ensuring they receive treatment at the best-equipped facility — which isn't always the closest hospital, KBIA reports.

Seven things to know:

1. Missouri's Department of Health and Senior Services designated nine St. Louis County hospitals as priority heart attack centers to ensure the most at-risk patients receive care as quickly as possible.

2. On May 15, the department designated 23 hospitals statewide as the most comprehensive centers for the most serious heart attacks. This list — called STEMI centers — is part of a state effort to develop the Time-Critical Diagnosis System.

3. Missouri legislators voted to establish the system in 2008, which is already in place for trauma and stroke patients. Beginning in May, the system began directing how emergency responders care for ST-elevation myocardial infarctions, a type of heart attack in which an entire artery is plugged.

4. The system coordinates how ambulances, paramedics and hospitals respond based on the severity of a patient's symptoms. Traditionally, emergency responders only accounted for distance when deciding where to transport a patient, said Michael Lim, MD, a cardiologist at St. Louis University Hospital.

"Before this law, EMS was mandated to go to the closest hospital, and you couldn't bypass, you couldn't drive 5 more miles, even if you knew it was a better place for that patient," Dr. Lim said.

5. Instead, with the Time-Critical Diagnosis System, emergency responders would transport patients to the nearest qualified hospital. The patients with the most critical conditions will go to hospitals best-equipped to treat these serious heart attacks.

6. The highest-level STEMI centers have around-the-clock lab capabilities and a high volume of heart attack patients while lower level centers can stabilize more serious patients if necessary, Dr. Lim said. Hospitals need to apply to receive a STEMI designation, which is voluntary.

7. The expertise and quick thinking of emergency responders allows the system to be successful, Ryan Barker, vice president of policy for the Missouri Foundation for Health, told KBIA. "Sometimes, if the nearest hospital … can provide the appropriate level of care for what's going on with that individual, that's where they'll take a patient," Mr. Barker said. "A lot is driven by what's going on in the field with that individual and making the decision of what hospital to go to."

"After a heart attack or stroke, receiving the right care in the right place during that first hour is just so important." Mr. Barker said.  "It saves heart tissue, it saves brain tissue. There's so much riding on it."

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