EMS Systems Division

EMS Systems Division — Specialty Care

Specialty Care includes Poison Control, Stroke, STEMI, and Trauma care. Trauma care is addressed here.

For Questions Contact:
Sandy Salaber
EMSA Systems Analyst
sandy.salaber@emsa.ca.gov
(916) 322-4336, Extension 423

Strokes can be broken down into two categories ischemic or hemorrhagic in nature. Ischemic strokes are caused by the blockage of a blood vessel and hemorrhagic strokes are caused by bleeding. The AHA/ASA describes the ischemic stroke as “the most common type and accounts for about 87 percent of all strokes”. The AHA/ASA and the Joint Commission describe studies that show better outcomes when strokes are approached as a systematic plan; however, emergency physicians, neurologists, and neurosurgeons have not reached a clear consensus on systematic treatment approaches.

Some local EMS agencies (LEMSA), which may include one or more counties, have developed STEMI and/or Stroke Care Systems. The systems vary from LEMSA to LEMSA. The AHA/ASA is conducting a detailed survey on STEMI and Stroke system approaches. To date the EMS Authority has identified the following LEMSAs as developing/implementing an approach to STEMI and/or Stroke Care: Alameda, Central California, Coastal Valleys, Contra Costa, Inland Counties, Los Angeles, Marin, Merced, NorCal, Orange, Riverside, Sacramento, San Diego, San Francisco, San Mateo, Santa Barbara, Santa Clara, and Ventura EMS.

EMSA staff are members of the Stroke Work Group co-convened by the ASA and California Department of Public Health Stroke Prevention Program. The work group is discussing ways in which to improve stroke outcomes statewide.

For Questions Contact:
Johnathan Jones, RN, BSN
Trauma and Specialty Care Coordinator
Johnathan.Jones@emsa.ca.gov
(916) 322-4336, Extension 415

An electrical cardiogram (EKG) graphically represents the electrical activity of the heart through electrical impulses forming P, Q, R, S, and T waves. When the wave forms are joined the combined forms are referred to as segments. One of the segments on the EKG is the ST segment which corresponds to the heart repolarizing (electrical recharging). When ST segments fail to repolarize the EKG shows an elevation in the ST segment. One type of heart attack or acute Myocardial Infarction (MI) is recognized when two of twelve ST segments on the 12-lead EKG elevate. Upon recognition of a ST elevation MI (aka STEMI), EMS providers, hospitals, and EMS systems may develop processes to achieve optimal care. Optimal care involves the America Heart Association/American Stroke Association (AHA/ASA) guidelines outlined in Advanced Cardiac Life Support (ACLS) 2007 which includes an algorithmic process leading to thrombolytic administration (clot buster), percutaneous intervention (stent placement) with a cardiac catheterization laboratory (cath lab), or coronary artery bypass surgery (open heart surgery).

Some local EMS agencies (LEMSA), which may include one or more counties, have developed STEMI and/or Stroke Care Systems. The systems vary from LEMSA to LEMSA. The AHA/ASA is conducting a detailed survey on STEMI and Stroke system approaches. To date the EMS Authority has identified the following LEMSAs as developing/implementing an approach to STEMI and/or Stroke Care: Alameda, Central California, Coastal Valleys, Contra Costa, Inland Counties, Los Angeles, Marin, Merced, NorCal, Orange, Riverside, Sacramento, San Diego, San Francisco, San Mateo, Santa Barbara, Santa Clara, and Ventura EMS.

EMSA staff are members of the STEMI Work Group co-convened by the AHA and California Department of Public Health Stroke Prevention Program. The work group is developing guidelines for the Early Management of Adults with ST-segment Elevation Myocardial Infarction: A Statewide Plan for California.

For Questions Contact:
Johnathan Jones, RN, BSN
Trauma and Specialty Care Coordinator
Johnathan.Jones@emsa.ca.gov
(916) 322-4336, Extension 415