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Update on Stroke & STEMI, Time Critical Diagnosis PDF Print E-mail
A recent interview with Dr. Samar Muzaffar, State EMS Medical Director for the Missouri Department of Health and Human Services, gave us an update on the Time Critical Diagnosis (TCD) task force initiative which is setting the stage for the statewide emergency response system for victims of stroke and ST-Segment Elevation Myocardial Infarction (STEMI).

Since the larger task force meeting in May 2009, smaller work groups have been meeting regularly to discuss and revise regulations and protocols for stroke and STEMI.  

The full task force will come together for a statewide meeting in November.  Before then, six regional meetings will take place in September and October, the purpose of which is to introduce plans for the system as it relates to regulations and protocols.  The format of these meetings will be presentation style covering the work that has been done, with a break for direct one-on-one input, feedback, comments and questions from attendees with Department and local/regional representatives.   The schedule and location for the regional meetings are available at:

When the regulations are drafted, they will be submitted to the state for review.  Likely this will be in early 2010.  From there the next target will be education and the quality improvement process.  Specifically, EMS agencies, state wide, will receive education and new guidance for triaging and determining a patient’s destination based on the type of incident and the centers in the system.  This will include proper identification of patient diagnosis, processes for appropriate patient transport, decisions for correct hospital destinations as well as creating guidelines for hospital-to-hospital transfers.
Of course, at the moment, the system and centers have yet to be determined.  The law and statute exist, establishing the system, and Dr. Muzaffar estimates another two years before functionality.

Once the regulations become final, hospitals will submit applications to be designated as stroke or STEMI centers following evidenced-based guidelines.

Compliance under the law determines where patients will be transported based on their diagnosis, but will not be so rigid that an agency cannot stop elsewhere if warranted.  A presumption is that not every patient will wish to be directed to a center by the system.  A process for managing such scenarios will be developed for the patient and EMS crew alike.  

Overall, Dr. Muzaffar says the TCD process has remained an energetic and exciting one, with significant participation state wide.  Dedication and commitment to the process of developing regulations and protocols continue to be very evident with ample input from many stakeholders.

Missouri is the first state in the nation to enact legislation governing a STEMI and stroke statewide system of care.  The goal is simple – do what’s best for the patient and the population in Missouri by giving them the right care and getting them to the right place in the right amount of time.

Now other states are taking great interest in the TCD effort, some moving forward with their own approaches to stroke and STEMI, using trauma as the model.

As always, EMS professionals and participants are encouraged to share TCD information and knowledge with each other and to visit  for more information.  


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