For three years, the Missouri Department of Health and Senior Services has been working on a plan to establish a Time Critical Diagnosis (TCD) System in the state of Missouri to improve health outcomes for Missourians who have a stroke or ST-elevation myocardial infarction (STEMI).  The program will use knowledge gained from Missouri’s trauma care system and will improve the timely diagnosis and care of those who have one of these two conditions.

 

While Missouri’s heart disease and stroke death rates are declining, the leading cause of death in this state remains heart disease and stroke ranks third.  Acute ischemic stroke and STEMI contribute to this high death rate.

DHSS says it believes that medical advances require this move to an improved system and has invited individuals from several medical disciplines including pre-hospital to join a task force to make formal recommendations for the design of the TCD System to coordinate with the current trauma system.  The task force will serve from January through June of 2008 to finalize the guiding principles and advise DHSS on a consensus plan to create a functional system.  The first task force meeting will take place in January of 2008.

As EMS professionals, we know that the timely treatment of STEMI and stroke patients treated can reduce deaths and disability.  Delay in treating patients who experience STEMI have increased risk for death and increased damage to heart muscle while delays in treating stroke victims pose major barriers to improving outcomes.

The DHSS goal of creating the TCD System has already reached several milestones since 2004, including a broad public and private partnership to improve statewide coordination and establish a mechanism for standardizing EMS care and treatment of trauma, forming the DHSS Heart Disease and Stroke Prevention Program (HDSP) Statewide Stroke Committee, achieving a Missouri Foundation for Health three-year funding commitment to improve emergency medical care in Missouri, and more.

Another important milestone was the 2005 DHSS appointment of William (Bill) Jermyn, DO, FACEP, as the state Medical Director of Emergency Medical Services.   Jermyn’s vision for Missouri is “a system that supports the right patient to the right place in the right amount of time with the right care along the way.”  The time critical diagnosis is this label for this vision.

June 2008 outcomes from the TCD task force include a TCD system design for the state that addresses time-critical conditions of trauma, stroke and STEMI - consensus plans to create functional systems for the transport, diagnosis and treatment for stroke and STEMI - measures to evaluate outcomes and improve quality of care for stroke and STEMI.

A Phase 2 plan from July 2008 through June 2009 will set guidelines for centers of care, field triage and timely transport - provide professional development for EMS, ED, hospitals, healthcare providers and physicians - plan for a data management system and implement plans to evaluate progress and improve quality of care.