Are You Up for the E2B Challenge?

     For some time, cardiologists and ED personnel have known that time is critical when you're dealing with a heart attack patient. STEMI (ST elevation myocardial infarction) episodes kill thousands of people every year when one of the three major arteries in the heart is suddenly blocked, and to save the patient, blood flow must be restored within the artery as soon as possible. Recently, prehospital care has been added to the equation, and paramedics are taking on a crucial role in the initial care of STEMI victims.

     "There are some very good drugs out there and some amazing devices, but the key variable is time," says Los Angeles emergency physician Ivan Rokos, MD, FACEP. "The faster you can deliver these devices and drugs to the patient, the faster you can restore blood supply to the heart and minimize heart muscle damage. Given the importance of time, paramedics are now in a novel role, where they are able to diagnose STEMI faster and earlier than ever before using a prehospital EKG machine. This is important for two reasons: One is that hospital ED overcrowding has become a big issue and it's sometimes challenging for a walk-in STEMI patient to have an EKG in a timely manner in an ED where staff and beds are pushed to the limit. In contrast, paramedics provide one-on-one care, so they can do a prehospital EKG very quickly. The second thing is that it's increasingly recognized that a prehospital EKG done in isolation means nothing unless it's acted upon by the receiving hospital, which can get its ED, cardiac cath lab and ICU ready to receive the patient when he arrives."

     To create awareness of the importance of prehospital care in STEMI patients, EMS EXPO is inviting attendees to take the E2B (EMS-to-Balloon) Challenge while attending the conference in Las Vegas, October 13–17.

     "It's very exciting in 2008 that paramedics are in a unique position to trigger a whole cascade of events that can make a big difference in a STEMI patient's life," says Rokos. "Basically, the clock has always started at the hospital door. The current cardiology guidelines recommend that the blocked artery should be open within 90 minutes from the hospital door to balloon inflation, but we want to push it up another notch, raise the bar on perfusion speed and set the clock not at the hospital door, but in the patient's living room or office, or wherever the prehospital EKG shows a STEMI. That is the idea of the E2B Challenge."

     It's really an awareness campaign, says Rokos, and a chance for paramedics to ask themselves whether they can diagnose a STEMI in the field, get the patient to the ED and on to the cath lab within 90 minutes.

     "That leads to the 30-30-30 goal, where each of the three sprint units has 30 minutes to do their task and hand off to the next care provider unit," he says. "To accomplish the challenge, you have to use the tools and resources available from the American College of Cardiology's Door to Balloon Time Alliance program and the AHA's Mission: Lifeline initiative, as well as some of the large quality improvement registries like the ACTION/Get with the Guidelines Quality Improvement Database from the National Cardiovascular Data Registry, or the National EMS Information System (NEMSIS) registry.

     "There are some interesting online communities already formed, such as STEMISystems.org, which is open to diverse care providers, and the E2B Yahoo group, which is run by paramedics," Rokos adds. "Lastly, the whole E2B Challenge is supported by the E2B Coalition, which has physician representation, as well as support from EMSResponder.com, EMS EXPO leadership and EMS Magazine, and senior leadership from the three major prehospital EKG vendors: Philips, Physio Control/Medtronic and ZOLL."

     In addition to print information and a lecture by Dr. Rokos on October 16 at EMS EXPO, titled EMS and STEMI: The Evolution of Major Paradigm Shift, free E2B lapel pins will be available after Dr. Rokos' lecture and at the EKG vendors' booths.

     "We just hope to generate some enthusiasm, interest and awareness about E2B," says Rokos. "Many of us believe this is as exciting to the world of EMS as defibrillation was almost four decades ago."

     For more information, visit www.E2Bchallenge.com and www.emsexpo2008.com.