2017 EMS Recognition Application Transcript

Operator: Welcome and thank you for standing by. At this time all participants will be in listen-only mode until the question and answer portion of today's conference. At that time, if you would like to ask a question, you may press star followed by the number one on your phone and record your name clearly when prompted. As a reminder today's call is being recorded. If you have any objections you may disconnect now. Now I would like to introduce your host, James Lugtu. You may now begin.

James Lugtu: Thank you, operator. Welcome everyone to our 2017 EMS Recognition Webinar. My name is James Lugtu. To begin this conference I'd like to introduce our EMS National Program Manager, David Travis, who'll be leading our call. David?

David Travis: Thank you, James. On behalf of the American Heart Association and Mission: Lifeline, we thank everyone for joining us today to talk about EMS Recognition. This is the second webinar we've had in support of EMS Recognition for 2017 and the previous webinar is available within our resources page, our Mission: Lifeline webpage.

Our objectives today are to provide you with an overview of the 2017 Mission: Lifeline EMS Recognition criteria which is, as far as achievement goes, the same as the previous years but we do have a new 'plus' measure and reporting measures. To provide you with an overview of the data collection worksheet and to provide you with a walk-through of the 2017 EMS recognition application, which is an online application. Then of course, at the end, we'll answer any questions you may have about the Mission: Lifeline EMS Recognition Program.

Our speakers today are Tami Swart, who's a Senior Director for Quality Systems Improvement with our Western States Affiliate; Ben Leonard, who's an AHA EMS Director and Quality Systems Improvement Director for the Mid-West Affiliate; and myself, Dave Travis. I'm the Program Manager for EMS out of the National Center.

The goal of this EMS Recognition Program with Mission: Lifeline, is to recognize the EMS agencies for their role in a system of care for patients who have these time-sensitive conditions. We've been focusing primarily on STEMI for the first few years and we're now expanding to include stroke and post-resuscitation with our recording measures this year.

2017 will be the fourth year of the American Heart Association's Mission: Lifeline EMS Recognition Program. This year for 2016 we had more than 540 EMS agencies that did receive an award. We had an additional 400 more team agencies who are included in applications towards those awards. The participation has grown steadily each year and we love to see that.

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This year's award list in the JEMS magazine was more than eight pages long. Our plan is to continue to publish the lists of award recipients in JEMS and we're hoping we'll have an even larger ad for 2017.

This year we had 266 agencies receive gold awards, 147 received silver, and 133 received a bronze recognition. This map displays the number of awards by state with Texas, Ohio, and Pennsylvania leading the way. Also a lot of participation in Virginia and North Carolina and some of the other states within the Mid-West.

An important date to remember with regards to EMS Recognition is when the application period opens up and when it ends. It will open on January 1st and remain open through March 31st. I will say that agencies tend to wait until the very end to make their applications. Last year I think we had about half of the applications done and entered into the system around March 10th, with the whole half being received after that time. The problem with that is if you make a mistake or if you need to go back and make a correction, you don't leave yourself a lot of time. We advise agencies, the sooner they can apply, the better. As I mentioned previously, the criteria for award achievement for 2017 is the same as it was last year and in previous years. However, we do have a new 'plus' measure this year for higher award distinction. As I said there are also new recording measures this year as well. Those recording measures do now include two for stroke and two for resuscitation, which is something new.

As far as resources go, on the Mission: Lifeline home page which is Heart.org/missionlifeline, there's an EMS provider tab. If you click on that tab it will bring you to a list of information for EMS providers including this link for Mission: Lifeline EMS Recognition resources. We have an FAQ back there, different types of resources including the worksheet that Ben will speak about in a little bit. We have a PDF that the application that Tami is going to go through, and other resources there as well to help answer any questions you might have about the program.

The achievement measures for an award are, again, the same as they've been. Achievement measure one is the percentage of patients with non-traumatic chest pain who are 35 years or older who were treated and transported by EMS, and who received a pre-hospital 12-lead ECG. Then, you have to either report on achievement measure two or achievement measure three, depending on where you transport your STEMI patient. If you transport to a STEMI receiving center, you would report on achievement measure two and that's the percentage of STEMI patients treated and transported directly to a STEMI receiving center with a pre-hospital first medical contact to device on less than or equal to 90 minutes. If you transport to a referring hospital that is non-TCIP [inaudible 00:06:51] it's the percentage of living eligible STEMI patients, treated and transported to a STEMI referring hospital for fibrinolytic therapy with a door-to-needle time of less than or equal to 30 minutes. If you transport to both types of hospitals of STEMI patients, you need to include measures two and three.

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It's been our experience the last few years that most of the agencies who are applying are recording on achievement measures one and achievement measure two but we still do have some reporting on measure three as well.

This year we have a new 'plus' measure and the 'plus' means that you can get a distinction on your award. If you get a bronze you can get a bronze 'plus' award or silver or gold 'plus' et cetera if you report on an achievement of 75% performance on this measure. This measure is the percentage of 12-lead ECGs performed on patients in this field, who had an initial component of non-traumatic chest pain, 35 years or older, who received that 12-lead ECG within 10 minutes of the EMS arrival to the patient. The inclusion part here, I guess, is patients with non-traumatic chest pain, 35 years of age or older who were transported; and then the numerator is the total number of those patients in the denominator that received a pre-hospital 12-lead within 10 minutes of EMS arrival. Please note it is within EMS arrival, not first medical contact. For this award only, the definition is EMS contact with a 12-lead, and that's explained a little further in the guide and other resources.

All right, so the reporting measures are optional. We have eight of them this year. Though they are optional, they are encouraged. Some agencies may not collect data on all of these or some of these. We are asking if you do collect data and can report on these measures, that you do so. The first reporting measure is the percentage of hospital notifications or 12-lead transmissions suggesting a STEMI alert or [inaudible 00:09:01] activation, that are performed within 10 minutes of the first STEMI positive 12-lead that was performed in the field. The inclusion criteria, patients assessed and transported by EMS who had a STEMI positive ECG; and then the numerator is the total number of those patients to whom a successful notification of STEMI, or, transmission of the 12-lead occurs within 10 minutes of the first STEMI positive ECG. Tami will be going through the application, this one is set up in the application just like the achievement criteria where you actually enter the patients.

Reporting measure two, this is the first of our stroke measures also this year. Again, it's an optional reporting measure. This is the percentage of patients with a suspected stroke for whom EMS provided advance notification to the receiving hospital. The inclusion criteria is, patients who are accepted and transported by EMS and had an EMS inspected stroke; and the numerator is the total number of those patients for whom an advance notification of stroke was provided to the destination hospital. You can call it a stroke alert, a [co-stroke 00:10:15], however you term it, whether or not that was performed for a suspected stroke patient.

Reporting measure three is also a stroke measure. This is the percentage of patients with a suspected stroke who, evaluated by EMS, had an EMS documented 'Last Known Well' time. Some places call that the 'time of symptom onset for stroke' and we like to consider the last time the patient was seen well without symptoms, so it's very important with regard to administration of

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[fibrinolytic 00:10:50] and other procedures to know, when that time was. This is the measure. The inclusion criteria of patients who were set and transported by EMS who had an impression of suspected stroke; and then the numerator would be the total number of patients among those for whom EMS documented the 'Last Known Well' time.

Reporting measure four is the percentage of out of hospital cardiac arrest patients with sustained ROSC, maintained to arrival, at the emergency department, who had a 12-lead ECG performed. This is the first of our reporting measures in the out of hospital cardiac arrest realm. It's beneficial for those patients to get a 12-lead. On many times they are STEMIs and need to go to the [inaudible 00:11:42] so, this is our new reporting measure and the first for resuscitation. The inclusion criteria are, patients without a hospital cardiac arrest who have ROSC that was maintained until arrival of the [ECG 00:11:57]. If you just have transient [inaudible 00:12:00] pumping and circulation, that doesn't count. The numerator, the total number of those patients for whom EMS performed, a [inaudible 00:12:08].

Reporting measure five is another resuscitation measure. This is the percentage of out of hospital cardiac arrest patients with sustained ROSC, maintained to the arrival to the emergency department, who were transported to a PCI capable hospital. Now we know that this isn't possible in all areas of the country but if there's an opportunity, it's better for these patients to go to a PCI hospital, if possible. The inclusion criteria of patients without a hospital cardiac arrest or the return of spontaneous circulation, maintained to arrival of the ECG; the numerator is the total amount of those patients transported to a hospital that is PCI capable.

All right, reporting measure six is very similar to our first achievement measure. This is the percentage of 12-lead ECGs performed on patients in the field who had an initial complaint consistent with acute coronary syndrome. It's taking it a step further beyond just [inaudible 00:13:14] patients, so our inclusion criteria are patients 35 years of age or older, who have had symptoms consistent with acute coronary syndrome. Those are defined by age, chest pain, discomfort, pressure and tightness of [inaudible 00:13:31], pain or discomfort in one or both arms, the jaw, neck, back, or stomach, shortness of breath, dizziness or lightheadedness, nausea, and diaphoresis. Those are symptoms that comprise acute coronary syndrome. We know that this may be a little bit difficult for some agencies to clearly screen out but we feel that this is an important activity that is not limiting 12-lead ECGs in chest pain patients, so this is a reporting measure for this year. The numerator would be those patients in that group who did receive a 12-lead ECG.

Reporting measure seven, is the percentage of patients who initially transported to a referring hospital, a non-PCI hospital, who were later transported by the same agency to a receiving center with an EMS first medical contact, a PCI time of less than or equal to 120 minutes. This is a measure for agencies who

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routinely transport to referring hospitals, maybe there is no PCI hospital within their service area, yet they have good agreements between those facilities so that those patients are transported out; and we recognize that EMS has a role in that. We would like to see how agencies can report on this measure as well. The inclusion criteria is, the percentage of STEMI patients initially transported to a non-PCI or referring hospital who are later transported to a STEMI receiving hospital that is capable of PCI. The numerator is the total number of those patients with first method of contact time by EMS, the device activation, and the primary PCI, within 120 minutes. That is reporting measure seven and won't apply to all agencies, but we're looking to see if agencies can report on that as well.

Our last reporting measure is reporting measure eight. Which is, the percentage of patients with non-traumatic chest pain 35 years or older who were treated and transported by EMS who received Aspirin; and this was decided by EMS Administration, Dispatch Inspection, or patient self-administration prior to the call et cetera. The inclusion criteria would be, patients with non-traumatic chest pain 35 years of age or over and transported by EMS for whom Aspirin was indicated. The numerator is the number of those patients who received Aspirin either by self-administration, dispatch assisted instruction, or EMS provided administration. The Aspirin was actually documented in the EMS report.

These reporting measures, as I said, are optional; however, we are looking at these and other measures to become achievement measures in the future. If you are able to report on these or think about being able to collect the data, so that you're able to report on these in the future, it might be good if you want to participate in EMS recognition; because these could become achievement measures in the future.

Something that is new with the program for 2017, is that agencies who are unable to meet the [volume 00:17:10] requirements for a bronze award with all of your 2016 data; remember with EMS Recognition for 2017 we're using 2016 data, if agencies don't meet that volume requirement which is four a year or two patients in any one quarter with a total of four in a year, they can use quarters from 2015 as well. For example, if the volume of criteria is not met using quarters one to four for 2016 they can go back to 2015 using quarters four, three, two, and one; whichever quarters they need up to the full year, to achieve the sufficient volume requirements. That's new. When Tami goes through the new application in just a moment, you'll see how we've set that up so you can report that. Again, most agencies will not be using 2015 data at all, they'll just be using 2016; however, those who need that extra time frame to achieve volume, this is one way we're trying to facilitate those agencies that are very low volume. The only other caveat I should mention is that those patients cannot have been used in a previous EMS Recognition application which did result in an award. That's the criteria for that.

For the actual awards, 75% is our threshold for [all awards 00:18:46]. For bronze

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you need a 75% compliance and again, you need at least two patients that are reporting and four total STEMI patients in a year. Those low volume agencies can use 2015. For silver, we have aggregated annual score achieving a minimum 75% compliance for each required measure, so for silver it's aggregated and the volume you have to have at least eight STEMI patients in 2016. For gold award, it's the same criteria as the silver, however, you must have achieved a silver award in 2016. To achieve the bronze, silver or gold 'plus', you must meet the perspective threshold for the award and you must report on the 'plus' measure with at least a 75% compliance.

We have three application types. We have the individual application, a joint application, and the individual with the team options. The individual application is for agencies that do the 12-lead and transport. The joint application is for two agencies where, one does the 12-lead and one does the transport, and then they apply on the data on those patients that both agencies touch together. Then there is an individual application with the team options, which is the same as an individual application but it gives you the opportunity to name those medical first responders, non-transport, and agencies et cetera, who respond to your calls but don't have 12-lead or transport.

Again, our website is Heart.org/missionlifeline or if you just Google EMS Recognition Mission: Lifeline, it will get you there. My e-mail is david.travis@heart.org or you could e-mail missionlifeline@heart.org

I'll be happy to answer any questions as we move along. I'm going to now give you to Ben Leonard, who is a Senior Quality Systems Improvement Director for the Mid-West.

Ben Leonard: Thanks Dave!

David Travis: Ben, you should have control now.

Ben Leonard: All right, I'll get my screen up here. David, is this coming up okay?

David Travis: Yes it is Ben.

Ben Leonard: Okay, great. Thanks.

Well thanks Dave, appreciate the intro and the opportunity to talk again on this webinar. If you all have been on any of the previous EMS Recognition webinars, this will be pretty familiar to you; it's just kind of a review. We understand that one of the biggest challenges that show up with the EMS Recognition Program is collecting the data and doing it in a manner that is less burdensome as can be; so with every year that we come out and the measures change, or we are looking to expand and improve our program, this feed also expands/improves as well.

If you guys look at this format of this, the way it's laid out, it's a simple Excel

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spreadsheet. The tabs on the bottom give us the different options as far as navigating. We have an awards summary sheet that really summarizes the information that Dave just described. We have two different methods of actually entering patient data. If we have services that are entering the data manually by their patient, this patient entry tab is going to be helpful to them.

One of the things that we did this year is, to go to the column headings with each one of these fields, we went through to add the [Memphis 00:23:11] field definitions, whether it's version two or version three. If you look at column A here, the version three definition would sit under the line 'patient identifier'. If they had a version two, we'd put that definition in there as well, when you're going to pull your reports out of your UPCR.

Pretty self-explanatory as you go across, 'Date of the incident'. When you get into these columns that are asking for the date and the time, our format is mm/dd/yy and then the hh:mm format. As we're learning the programming and how some different functions work in Excel, that's going to be less burdensome with our next version that comes out; so just bear with it on that. We also look at the date and time of emergency department arrival for the patients. The time that the patient departs the emergency department, and that's for that reporting measure seven for [inaudible 00:24:15] PCI in 120 minutes with the transfer.

Chief complaint non-traumatic chest pain, like I said these are self-explanatory. The drop down box goes into the clarifications for the patients with acute coronary syndrome as Dave explained. These are all yes or no boxes. The patient experienced cardiac arrest, was ROSC achieved pre-hospital and remained to the arrival to the emergency room, stroke, this is going to capture the reporting measures of our stroke patients, and [inaudible 00:24:49] describes which hospital you're going to. If it's a PCI capability or a non-PCI capability.

The yellow colored screen, we get into 12-lead acquired, or if it's a stroke patient, if they had a pre-hospital stroke screen completed by the EMS agency. The patient received Aspirin. The date and time for that stroke or 12-lead screening. If it was positive, meaning that, if they had positive signs and symptoms of a stroke or a STEMI, yes or no, field here. Did you activate the hospital team based off of that positive screening, whether it a STEMI or a stroke activation. If you did, the date and time for that activation. The re-profusion strategy, primary PCI or direct presentation for transfer, and then the date and time for that re-profusion strategy.

Column X here, addresses the exclusion criteria. Once again, we have a drop down box that really gets into that exclusion criteria specifically for STEMI patients on this sheet. If you have any questions with the patients, if you're tracking these folks and you do have the time gold metric, if you will, has exceeded; whether it be 90 minutes or 120 minutes, and you have questions whether or not that patient has an exclusion criteria, I would encourage you all to reach out to your hospital counterparts or your AHA representative to help

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identify to see if that patient does meet the exclusion criteria.

That's the field that we need to enter for our patients, in treatment tab. If you, by chance, are already collecting this data and you want to go through and enter this information in a monthly format, you could go right into this monthly results tab. Achievement measure one, if you already know the denominator. Which, as Dave explained, EMS patients 35 years or older with non-traumatic chest pain. You plug in your number for the denominator and then the numerator is how many of those received that 12-lead. Net calculate your results in the percentage format. When Tami goes through the application walkthrough, you'll basically be able to transfer this data right over to your application fields.

The other feature that we put into this years' spreadsheet is, basically, we're able to collect the information that you put into the patient's entry tab and put it into these charts. Then, you'll be able to select down; I've got a sample list showing up here in a second. You'll be able to select the quarters that you're looking for, they will give you the denominator and numerator for each one of these measures. These darker boxes here are the achievements measures including the 'plus' measures. These are the ones that are going to be required for your reporting and for EMS Recognition. Our reporting measures are these lighter grey-ed out boxes that will obviously collect the information that you pull off that patient entry tab.

Just to give you an example, of the way that this sheet is set up. I have just some sample data entered into this patient entry tab and you can see that there are some transfers, like here, we have a patient that was transferred out from a referral facility. We have different ACS, stroke patients. But you go though and just enter each one of these boxes accordingly and it should populate those charts and give you the numbers as well. If you want to do any kind of presenting quarterly at your staff meetings, these translate over nicely to slides.

Just a little bit of a review of this. If you look at this box here, where it has our different quarters, you can select quarter one, the sheet will work; these are the patients that were entered in for quarter one and you'll be able to, like I said, pull these numbers directly from these charts and enter it into the application. Achievement measure one, 12-lead percentage acquisition, we're at two over two. He had two in our denominator and two in our numerator. That's the way that these are set up. The exclusion criteria or the patients that exceed our time window, we count those as outliers, which once again I'll be able to track those. Of those outliers, how many meet the exclusion criteria? It's all spelled out with these charts.

It's very, very busy but once you look and read the labels to them, you can track and see where things are going. If you go through and say we have patients and we're looking at at all of your totals of the entire year but if you have a quarter that does not have patient information or like if you see measure three door to needle time, we don't have any patients that have [inaudible 00:30:05] in this

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report, when this sheet refreshes, what it does is it pulls all the information from that patient entry tab and tries to run its functions. If there is no data from this measure, it's going to give you a little window error box saying that the field is not valid; just hit 'OK'. What it means is that it's looking really hard for data, it doesn't have it, and so it's going to give you that little warning. That's all that is.

When you go through and you utilize this, I would also recommend you try not to delete any of the functions or the cells themselves, if you're going to restart I would just pick the whole row and delete the whole row. Basically, starting on row nine. We're always improving this tool, from our first call we had some great feedback on separating out the STEMI, the stroke, the cardiac arrest patients and be able to put that into different data entry tabs; and that's definitely on our list to look at for improvement. Once again, our efforts are trying to provide the tools that can lessen the burden on getting this information collected and reported.

With that, I will pass it back over to [inaudible 00:31:37]. If there is questions, as Dave mentioned, reach out to us. Talk with us. There is one I see, we'll address all the questions, I believe, at the end of the call. Tami I'm going to hand it over to you now.

Tami Swart: Great! Thanks Ben. All right, I think I'm presenting now. I'm Tami and now I'll walk you through the application itself. Today I'll be reviewing the individual application, but please do note, you can also apply as an individual with a team recognition option or also the joint application is available. Detailed information is available on the Mission: Lifeline website to help you decide which application would be the best fit for you.

Now comes the exciting part! You've gathered all the data, you've used the spreadsheet, you've done all the great work in the field, and now it's time to apply for your award! The opening questions you'll see when you open the application, take you through the application selection process, and collects specific information about your agency. Please note that when you see an asterisk, this means that it is a required field and we do need you to enter that information. Something new that you're going to see this year, we're asking you for your population served and your annual call volume.

For the population served field, you'll need to know the estimated population in your service area rounded to the nearest thousand. The example they give here is 45,000. You'll also need to enter the total call volume for your agency. Then, you're going to select which type of service you provide next, whether that be private ambulance, county or municipal fire, volunteer fire, county or municipal EMS, hospital based EMS, air, or the other selection; with a free text field for a description. You'll also indicate whether or not your agency provides transports and then select your pre-hospital type; whether either EMS ground, non-fire departments, air ambulance, fire department EMS, or medical first responder with 12-lead capabilities.

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This next portion is really important because this is where you give us permission to publish the awards status of your agency, and it'll also tell us how to publish your agency name when you check the agree selection and then type in your agency name. This is a required field and if you happen to select do not agree, your agency will not be publicly recognized for your award. Please be really careful and check your spelling here, the capitalization, et cetera, for you agency's name.

Now we'll be getting to the awards data. I believe I skipped ahead one slide, let me go back here. There we go!

Please note that agencies that do not meet the volume requirements using 2016 data alone, as Dave mentioned, you can also use 2015 data for some measures in order to qualify for a bronze level award. I'm going to highlight those areas as we go through where you can use that 2015 data as soon as we get to those sections. The first question in this portion of the application asks about the transport destination for STEMI patients, either as STEMI receiving or PCI capable hospitals, or a STEMI referring or a non-PCI hospital.

Next, we get to the achievement measures. Where, as we mentioned, we need 75% overall compliance for awards. Measure one will ask you for the percent of 12-lead ECGs acquired in patients who are 35 years or older, who present with non-traumatic chest pain and are transported. The first part on top, asks for the denominator for each quarter in 2016 and should include the total number of non-traumatic chest pain patients, 35 years of age or older who were transported to a hospital. The bottom portion relates to the numerator; which would be the non-traumatic chest pain patients, 35 years and older, transported to a hospital who received a pre-hospital 12-lead ECG. One note, if you don't have any patients to enter for any particular quarter, enter a zero.

One other note that I did want to mention, is that, before you do click on 'next' in each section, be sure that all of the information is correct; because it won't let you go back and change the information; once the percentages are calculated.

Measure two is going to ask you for the percentage of patients with a first medical contact and device activation or primary PCI, in 90 minutes or less. The inclusion criteria looks for patients who are 18 years or older with a STEMI noted on the pre-hospital ECG and who are transported to a STEMI receiving center or primary PCI was preformed. For the top portion, you'll list the denominator for each quarter comprised of patients 18 or older with a STEMI noted on the pre-hospital ECG, who were transported to a STEMI receiving center where primary PCI was preformed.

Please note here that, if you find that you have less than four patients total, and/or less than two successful cases in any quarter of 2016 data, you can use additional quarters of the 2015 data to meet this measure. You'll need to start by

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using the quarter four numbers from 2015 if you choose to go this route. You'll then enter the numerator information which will include the number of patients who had an SMC to device activation primary PCI time of 90 minutes or less. The option to use 2015 data for this still applies and you'd again use the quarter four 2015 data first if needed.

The next portion is going to look at patients who are outliers or who had a time greater than 90 minutes. You'll need to enter this information if you want to list reasons to exclude these patients. Again, 2015 data can be used here. Here are the exclusions you can select for these outlier patients. If any of them apply, the patient can be counted as excluded for that quarter of data.

Measure three looks at the percent of patients, 18 years and older, with a STEMI noted on the pre-hospital ECG who were transported to a STEMI referring center and received lytic therapy. Note that, 2015 data can be used here if needed. You'll then have the opportunity to address any patients who may have times greater than 30 minutes and who also meet the exclusion criteria. Here, you'll see the exclusion criteria for this measure.

Next portion is optional and can be used to qualify for an additional 'plus' award. If you choose to enter this measure, you'll need to reach 75% compliance and enter the number of 12-lead ECGs performed on patients 35 years or older in the field with an initial complaint of non-traumatic chest pain within 10 minutes of EMS arrival.

This year, as David mentioned, we're also asking you to consider providing these other reporting measures. While they are optional, they'll help us to potentially expand EMS Recognition in other areas of care. You'll choose whether or not you'd like to provide this information and if so, the application will guide you through the screen for each measure.

At the end of the application, you'll be asked if you'd like to apply for the team recognition option. You'll need to provide this additional information as well, if you're applying for team recognition. The last step is completing the application submission authorization. This application must be authorized by either the EMS Director, the Chief, or the Training Officer from the agencies being recognized. You'll enter the applicant's information and authorizing party information here. Finally, you'll provide your e-signature and click on 'next' to submit the application. From there, you'll be able to save a PDF version of the application which we recommend that you review for any errors. If you happen to notice any errors or mistakes, please do contact us at the e-mail address listed. Which is: missionlifeline@heart.org and leave 72 hours before the application deadline, which is March 31, 2017.

One other highlight I'd like to point out is that, this year we've included links to the AHA's Employee Health Program and our new target blood pressure program. We'd invite you to take a look and let us know if you're interested in

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hearing more about either of these programs, and how they can benefit your agency. With that, we've completed the application walkthrough and I will turn it back over to James.

James Lugtu: Thank you Tami. David or any of our presenters, do you have any additional comments?

David Travis: Just one quick comment, this is Dave. Thank you so much for going through that Tami and Ben, that was awesome.

With the applications, if you do submit the application and you realize that you made a mistake, you can e-mail us and let us know. There is a mechanism for us to get you back into the application, again, that's why we suggest that you consider applying as early as you can in the application cycle. Certainly not waiting until March 28th or 29th to submit data because people do realize that mistakes have been made and do need to go back into the application. We had quite a few agencies who were jumping through hoops to assist at the 11th hour last year.

One other point I wanted to make was with the data collection worksheet that Ben went through, is optional. It's a great tool, especially for larger agencies with a volume of patients, to collect the data using that data collection worksheet. That is not part of the actual application and you don't have to use that. It's just that he and others have made great strides this year in improving it and making it easier to use. It's certainly very worthwhile to consider, particularly if you're a larger volume agency. It's not necessary. I just wanted to make those two quick points. Thank you James.

James Lugtu: Thank you David.

We've been trying to work vigorously. The panel has had to answer some of the questions that have been on the queue for the Q&A portion of it. Operator if you have any questions from the audience, we'll be glad to accept it now.

Operator: Thank you. We will now begin the question and answer session. If you would like to ask a question, please press star followed by the number one on your phone. Make sure your phone is not on mute and record your name clearly when prompted. Your name will be required to introduce your question. To cancel your question, you may press star followed by the number two.

One moment, to see if we have questions.

Ben Leonard: This is Ben and I had a question pop up about the Excel spreadsheet. When you're utilizing it, and I'm going to actually share my screen again. Dave can you make me presenter quickly? For a quick second?

All right, thanks.

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If you go through the spreadsheet and you enter in all of your patients into the patients tab and you go onto the achievement 'plus' measure, if you've got a bunch of information that's entered in and it's showing up as it's blank, what you need to do is come up here to the data tab; that's on this top row and then hit 'refresh all'. What that will do is that will run the Pivot tables and everything involved with the reporting. This is that little error window that I was telling you about, just hit 'OK'. If you hit that data table and then 'refresh all', that'll pull all that information from the patient entry tab into your charts.

Operator: Speakers, we show no questions on queue at this time. Again, if you would like to ask a question, please press star followed by the number one. Thank you.

We have a question on queue, one moment for the name please.

Our first question comes from Blake. Blake, your line is now open.

Blake: Can you hear me?

James Lugtu: Yes we can.

Blake: My name is Blake Ables and I'm a lieutenant and paramedic with [inaudible 00:45:15] fire rescue. Just to give you a brief background on us, we got involved with this last year with a private ambulance service that provides a transport service for us. We are a non-transporting advanced life service fire department, so we provide on-scene medical treatment and then we pass that patient off to a private ambulance service, that transports the patient to whichever facility that they deem necessary. Last year, we were recognized as part of a team with MedStar EMS as an ambulance company, so our question to start out: is that probably how we should go about it again this year? Or, are we eligible to submit this information apart from MedStar being that, that's the type of service that we provide?

James Lugtu: Yeah. Actually, if you're an advanced life support service and you all are capturing this 12-leads on patients, then you should really be applying as doing a joint application with MedStar versus them doing an application as an individual agency with a team option and recognizing you. The individual application with the team option is really designed for those agencies that perform the 12-lead themselves and transport themselves, and then seek to acknowledge medical first responders who may also be on the scene. If you're the ALS agency in your area and you're using them for transport, that's the ideal situation for a joint application for those patients that both agencies touched.

Blake: That being said, we should touch base with MedStar EMS and go jointly with them, correct?

James Lugtu: That's correct. That would be my suggestion.

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Blake: If we do touch base with them and this is nothing something they're pursuing this year, are we still eligible to pursue it apart from them? Or is that something that we would have to do jointly with them?

James Lugtu: If you don't transport, we do need the agency that does the 12-lead and the transportation; so that, ideally, would be a joint application with them.

Blake: Okay. Well we'll touch base with them and that'll tell us if we're going to be able to pursue this any further from this point; even, what they're going to be doing on this.

James Lugtu: Yes sir. Thank you.

Blake: Thank you.

Operator: Thank you. Our next question comes from Anthony. Anthony your line is now open.

Anthony: I see the 'plus' criteria is set at 10 minutes for this previous year. Are we going to be looking to decrease that time as the years go on, so that we can track that measure a little more closely this time and make sure that we're trying to hit that benchmark? Or, are we going to be consistently keep it at 10 minutes?

James Lugtu: That's a great question, and I'll let you know that it was a lot of discussion about where we set that. Do we set that at five minutes? Eight minutes? What is the time? While we have a guideline for hospitals, we don't have a clear guideline from the AHA on this measure. We set it at 10 minutes which is consistent with the hospital measure. We would like to see how agencies are performing, that's why we're really hoping that a lot of agencies do apply for the 'plus' measure. Even if they aren't able to achieve it, so we can see how agencies are doing for that measure. It certainly could be reduced but I would think it would be highly plausible that that as it is now could become an achievement measure for 2018. That just remains to be seen.

Anthony: As the year progresses on and we're looking at data, I'm looking at a 10 minute benchmark and then when we come out for the awards, we have this webinar again in December 2017. Now we say, "Well the performance measure was 10, but we're going to do eight"; and we haven't hit that benchmark because we're not really prepared for it. I just want to make sure that's communicated out during the year, if we're looking to reduce that, so we can strive to hit that new measure.

James Lugtu: Right. We are going to try to have that 2018 criteria available sooner in the year, this coming year. Hopefully you would know by February or March, if that had happened. I do not anticipate that that number will change but it is certainly possible; I would say remote but possible.

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Anthony: Thank you.

James Lugtu: Thank you.

Operator: Our next question comes from Timothy. Timothy your line is now open.

Timothy: Thank you very much. Can you all hear me?

James Lugtu: Yes we can.

Timothy: Thank you for your time and the presentation, it's been extremely helpful.

I'm kind of, picking up on this from the person who did it last year, as the person is no longer with us; I'm playing catch up here. If you could touch on the re-profusion strategy and the date and time re-profusion strategy cells on the spreadsheet. I'm a little unclear on those as far as, the re-profusion strategy itself, the primary PCI and the transfer; is that based on the pre-hospital provider deciding to go to a primary PCI? Or, the local hospital for potential transfer? Or, is that the hospital's decision? The date and the time of the re-profusion strategy, would that be the pre-hospital? Or, would that be the actual facility itself? How do we acquire that time?

Ben Leonard: That's a great question.

The re-profusion strategy column there really is looking at the hospital's decision. Obviously our role as EMS providers is to help influence those folks the best we can with us knowing what our goals are and whatnot. That's one of the great things about this program is understanding that if you're going to transfer the patient, we need to have them on the table and re-profuse within 120 minutes. If not, we want to make sure we're going down that path of thrombolytic administration. Ultimately, when you're looking at this transferring, basically, the best thing to do is just get a relationship established with your hospital counterpart.

Timothy: Mm-hmm (affirmative).

Ben Leonard: Whether it be an ER Manager or if it's the [CAT lab 00:51:45], touch base with your [CAT lab 00:51:47] Director. Just check to see when the patient is going to be done and just get a report back from them; whether or not they received primary PCI or transfer from PCI or if they received thrombolytics. Whichever intervention they had, time stamp it, so you can track that. If that makes sense.

Timothy: Okay. Yeah. The same individual who I took over was entering our [CARES 00:52:17] data in the [CARES 00:52:18] system-

Ben Leonard: Mm-hmm (affirmative).

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Timothy: Some of this goes hand in hand with that, so is there a way to pull that data from the [CARES 00:52:24] system that we can look into from there as well? If you're familiar with that.

Ben Leonard: Sadly, I'm not super familiar with [CARES 00:52:33]. So I'll give that over to Dave.

Timothy: Okay. Sure.

David Travis: That's a great question, as well. Actually right now, there is not; however there is a separate effort that the AHA is working on to try to improve the data flow FROM hospitals back to EMS and vice versa. It's not ready for prime time yet. There is actually a pilot study going on right now looking at that with stroke and they're looking at that with resuscitation; and there may be some commonality with [CARES 00:53:08]. That's all up in the air at this point.

Timothy: Okay, great. Thanks Dave, I appreciate it.

David Travis: Thank you.

Operator: We share no further questions at this time. Again, please press star one if you would like to ask a question.

James Lugtu: While we're waiting, I just want to let everyone know that in the next couple of weeks this presentation and recording will be made available. For those who are interested in doing that, it will be made available in a couple of weekS.

David Travis: That will be with the other resources on the Mission: Lifeline website. As I mentioned, we do have our first webinar up there loaded now, if you would like to take a look.

Operator: Speakers, we show no further questions on queue at this time.

David Travis: All right. Well, on behalf of the American Mission: Lifeline, we'd like to thank everyone for joining us today and we look forward to your participation in the EMS Recognition Program.

If you do have any questions and you would like to e-mail me, you can do so at: david.travis@heart.org. There are other resources on the website and you can also contact your local affiliate personnel to help, particularly with getting data from hospitals. The AHA affiliate staff is very good at working that out and assisting you with that.

With that, we'll close at this time. Again, thank you very much for joining us and thanks very much to all of our panelists. Great job.

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