Survey of EMS Practices for Heart Disease and Stroke Massachusetts Summary of Results

Massachusetts

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Background

Heart and stroke-related deaths are, respectively, the first and fourth leading causes of mortality in the United States and major causes of disability. The most current comprehensive statistics on cardiovascular disease from the American Heart Association, published in February 2011, show that an estimated 82,600,000 American adults (1 in 3) have one or more types of cardiovascular disease. It is estimated that approximately 1,255,000 heart attacks and 795,000 strokes will occur in 2011. Also, statistics show that approximately 1 in 6 deaths are due to coronary heart disease (the most common type of heart disease) and 1 in 18 deaths are due to stroke.1

Approximately half of heart- and stroke-related deaths2 occur before a patient arrives at a hospital, underscoring the important role of pre-hospital emergency medical care in the “chain of survival” for heart attack and stroke. The statistics for cardiac arrest are difficult to pinpoint, but the best estimates are a survival rate of just 7.6%.3 Time to treatment is critical for these patients, and rapid emergency medical services (EMS) response, intervention, and transport to specialized medical facilities is essential for positive patient outcomes. The Institute of Medicine has noted, however, that across the United States, the delivery of emergency care across the health care system is fragmented, which could influence timeliness and quality of care provided for cardiovascular-related emergencies.4

Survey Objectives

In light of the important role of pre-hospital care in the treatment of heart and stroke events, the Division for Heart Disease and Stroke Prevention (DHDSP) at the Centers for Disease Control and Prevention (CDC) conducted a survey of state and local EMS managers to better understand EMS capacity for emergency care of acute cardiovascular events. DHDSP developed this survey as part of its mission to increase early detection and treatment of heart disease and stroke, promote coordinated systems of care policies, enhance collaboration between CDC and state and local agencies, and identify at-risk populations to help eliminate disparities. The survey also serves to inform CDC programs in their designated role to support EMS through the Federal Interagency Committee on EMS (FICEMS).

Survey Response Rates for the 9 Participating States

State Percent Responded
Florida 76.7
Massachusetts 74.8
Kansas 71.1
Montana 69.8
New Mexico 50.2
Wisconsin 67.6
Oregon 71.7
South Carolina 57.4
Arkansas 60.9

EMS Agency Personnel*

Massachusetts All 9 States
Volunteer Staff Total Min† Max‡ Total Min† Max‡
EMT-Basic 951 0 60 8,514 0 100
EMT-Intermediate 75 0 12 2,520 0 60
EMT-Paramedic 113 0 22 934 0 50
Paid Staff
EMT-Basic 3,461.5 0 100 14,769.6 0 100
EMT-Intermediate 448 0 50 3,139.3 0 75
EMT-Paramedic 2,252 0 100 16,159.9 0 100

* Source: Survey of EMS Practices for Heart Disease and Stroke, 2008.
† The smallest number of staff reported from a single agency.
‡ The largest number of staff reported from a single agency.

EMS Agency Call Volume*

Massachusetts All 9 States
Total Min† Max‡ Total Min† Max‡
Total non-fire 676,638 15 60,000 4,749,605 1 130,000
Chest pain 58,416 0 4,800 453,831 0 25,200
Cardiac arrest 4,648 0 300 58,703 0 2,400
Stroke 20,910 0 1,800 143,711 0 9,600

* Source: Survey of EMS Practices for Heart Disease and Stroke, 2008. Results reported are approximate numbers. When respondents reported a range for the number of received calls, an average of the two numbers was reported.
† The smallest number of calls reported from a single agency.
‡ The largest number of calls reported from a single agency.

Survey Description

The survey consisted of 46 questions covering location and characteristics of the service area; basic descriptive information, such as EMS capacity, service levels, and types of care provided; medical direction; heart attack and stroke patient encounters; and transportation protocols. Also included was a list of 18 medical interventions (i.e., medications, devices, and procedures) relevant to emergency medical care for out-of-hospital cardiovascular crises.

The computer-assisted standardized telephone survey was administered by trained interviewers to 1,292 ground-based emergency care agency supervisors in nine states (Florida, Massachusetts, Kansas, Montana, New Mexico, Wisconsin, Oregon, South Carolina, and Arkansas). The response rate for each state ranged from 50.2% to 76.7%. The survey was designed by a team of researchers based on literature reviews and recommendations of a panel of emergency care experts to devise a set of questions relevant to assessing cardiovascular emergency care capabilities.

Results

There are nine separate state summaries—one for each of the states that participated in the survey. Each state summary report provides an overview of the state-specific results and comparison data for all nine states combined. The tables and maps in this summary are survey results from participating EMS agencies in Massachusetts.

These data will be useful for state and local EMS agencies and policymakers to provide a snapshot of heart- and stroke-related emergency response policies and personnel capabilities as well as highlight the importance of these policies for providing care to residents. These data also will provide a useful planning resource for state and local EMS providers and serve as the basis for continued dialogue with CDC to help the agency better understand the critical care challenges that face EMS and identify ways that CDC can support emergency response for cardiovascular disease.

  1. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics—2011 update. A report from the Ameri-can Heart Association. Circulation. 2011;123:e18–e209.
  2. Centers for Disease Control and Prevention. State specific mortality from sudden cardiac death: United States, 1999. MMWR2002;51(6):123–126.
  3. Sasson C, Rogers MA, Dahl J, Kellerman AL. Predictors of survival from out-of-hospital cardiac arrest: A systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010;3:63–81.
  4. Institute of Medicine, Committee on the Future of Emergency Care in the United States Health System. Emergency Medical Services: At the Crossroads. Washington, DC: National Academies Press; 2007.

Characteristics of EMS Agencies in Massachusetts*

EMS Agency Personnel Types

This map shows the distribution of EMS personnel by agency. Each agency is represented by a pie chart which reflects the total number of personnel and the slices represent the proportion of all personnel that are EMT-Basic (range: 0-146), EMT-Intermediate (range: 0-50) or EMT-Paramedic (range: 0-120). In general, both the proportion of personnel type and the total number of agency personnel appear to vary by location and county population size. Note: EMS agency is represented at the centroid of the zip code in which it is located. In zip codes where multiple agencies responded to the survey, agencies are slightly offset from the centroid. All EMS agencies in the state are not represented in this map. Only EMS agencies that responded to the survey and answered the questions relevant to each map are included here.

EMS Agency Medical Director Oversight

This map shows the distribution of type of medical director involvement by EMS agency. Each agency is represented by a point that reflects type of medical director involvement: full-time (n=90), part-time (n=49), volunteer (n=46) or absence of a medical director (n=6). Points are overlaid on county-level population size. In general, the spatial distribution of agencies by type of medical director oversight shows a random pattern. Note: EMS agency is represented at the centroid of the zip code in which it is located. In zip codes where multiple agencies responded to the survey, agencies are slightly offset from the centroid. All EMS agencies in the state are not represented in this map. Only EMS agencies that responded to the survey and answered the questions relevant to each map are included here.

EMS Scope of Practice for Cardiovascular Events: Percentage of EMS Agencies That Authorize EMTs to Perform Each Intervention*

Massachusetts All 9 States
Interventions EMT-Basic
(%)
EMT-Intermediate
(%)
EMT-Paramedic
(%)
EMT-Basic
(%)
EMT-Intermediate
(%)
EMT-Paramedic
(%)
Thrombolytic agent 0.0 0.0 15.1 0.6 1.6 25.1
Morphine or equivalent 0.0 0.0 91.5 0.5 27.7 91.6
Surgical airway 0.5 3.5 64.1 0.6 2.2 78.8
Beta blocker 0.5 0.9 84.9 0.6 5.6 78.2
Anti-arrhythmic medication 0.5 0.0 87.6 0.7 24.0 93.2
Pressor agent 0.5 1.7 83.0 0.8 9.9 86.3
Central IV 0.5 11.3 19.1 1.0 15.2 35.0
Endotracheal intubation 1.1 87.0 92.8 8.7 41.0 95.4
Peripheral IV 2.7 88.7 92.8 9.2 93.3 97.1
Nitroglycerin from EMT supply 3.8 7.0 87.6 15.5 56.4 95.0
12-lead ECG 7.0 9.6 88.9 22.8 36.7 88.2
Monitor end-tidal CO2 8.1 34.8 88.2 26.4 45.0 90.2
Aspirin (ASA) from EMT supply 89.7 88.7 99.4 63.7 80.8 98.1
Alternate mechanical airway 4.8 75.4 92.8 66.7 91.9 97.0
Glucometry 77.4 86.1 95.4 83.9 95.3 98.2
Assistance with patient’s nitroglycerin 91.4 93.0 98.0 86.7 91.6 93.1
Assistance with patient’s aspirin 95.1 96.5 96.1 87.6 91.6 94.0
Pulse oximetry 94.1 97.4 100.0 93.8 98.0 99.1

* Source: Survey of EMS Practices for Heart Disease and Stroke, 2008. In Massachusetts, 196 EMS agencies participated in the survey. In the total 9 states, 1,292 EMS agencies participated in the survey. However, not all of the respondents answered all questions in the survey. Therefore, the proportions reported may have slightly different denominators. Results displayed are not comprehensive and do not reflect all important characteristics for cardiovascular emergency response.

EMS Agency Organization Type

This map shows the distribution of organizational type by EMS agency. Each agency is represented by a point that reflects type of EMS agency organization: fire department-based (n=144), hospital-based (n=5), stand-alone (n=46) or other type (n=1). Points are overlaid on county-level population size. In general, the spatial distribution of agencies by organization type shows a random pattern. Note: EMS agency is represented at the centroid of the zip code in which it is located. In zip codes where multiple agencies responded to the survey, agencies are slightly offset from the centroid. All EMS agencies in the state are not represented in this map. Only EMS agencies that responded to the survey and answered the questions relevant to each map are included here.

EMS Agency Volunteer Status

This map shows the distribution of volunteer status by EMS agency. Each agency is represented by a point that reflects whether the agency is classified as a volunteer agency (n=44) or non-volunteer agency (n=151). The points are overlaid on county-level population size. In general, the spatial distribution of agencies by volunteer status shows a random pattern, but there is some variation in volunteer status by geographic location. Note: EMS agency is represented at the centroid of the zip code in which it is located. In zip codes where multiple agencies responded to the survey, agencies are slightly offset from the centroid. All EMS agencies in the state are not represented in this map. Only EMS agencies that responded to the survey and answered the questions relevant to each map are included here.

EMS Agency Characteristics That Are Important for Cardiovascular Emergency Resonse*

Massachusetts All 9 States
Number of Agencies that Responded to Survey 196 1,292
Count (%) Count (%)
Location Rural 14 71 665 51.5
Urban 182 92.9 627 48.5
Organization Type Fire based 144 73.5 756 58.5
Non-fire based 52 26.5 536 41.5
Volunteer Status Volunteer 44 22.6 545 42.4
Non-volunteer 151 77.4 672 55.2
Medical Director Involvement Full-time 90 47.1 520 40.9
Part-time 49 25.7 354 27.8
Volunteer 46 24.1 383 30.1
No medical director 6 3.1 15 1.2
Involvement in past 4 weeks 86 46.7 633 50.4
Communication Center Prioritizes dispatching 118 61.1 678 54.2
Provides caller with CPR instructions 112 59.6 861 69.5
Uses automatic vehicle location technology 22 11.4 210 16.6
Highest EMS Level of Life Support Basic life support 30 15.6 187 15.6
Intermediate life support 28 14.6 187 15.6
Advanced life support 134 69.8 828 68.9
Online Immediate Access to Medical Consultation Always, 24 hours a day, 7 days a week 184 94.4 1,155 90.3
Sometimes, less than 24 hours a day 5 2.6 88 6.9
Never 6 3.1 36 2.8
Provides On-Scene Time Benchmark Chest pain or suspected heart attack 173 88.7 1,045 82.0
< 15 min 146 84.9 914 87.7
> 15 min 26 15.1 128 12.3
Cardiac arrest 163 84.0 969 76.1
> 15 min 131 80.4 806 83.4
> 15 min 32 19.6 160 16.6
Stroke 173 89.2 1,037 81.4
> 15 min 148 85.6 921 89.1
> 15 min 25 14.4 113 10.9
Uses Stroke Scale for Diagnosing Stroke 188 96.4 1,018 80.3
Patient Information to Receiving Hospital in Advance of Arrival Yes 191 99.5 1,158 96.3
No 1 0.5 45 3.7
New Therapy or Technology Adopted for Stroke in the Past Year
Most common therapies/technologies reported (if specified):
Medications for stroke patients
New/updated stroke protocol
Updated pre-hospital transport policies
15 23.1 399 31.4
Funding Basis Private for-profit 17 8.7 102 8.0
Private not-for-profit 20 10.3 184 14.4
Public/government 153 78.5 933 72.8
Public-private partnership 191 98.0 62 4.8
System Capabilities Basic 9-1-1 system 12 6.2 160 12.6
Enhanced 9-1-1 system 175 90.2 1,073 84.2
Other 7 3.6 41 3.2

* Source: Survey of EMS Practices for Heart Disease and Stroke, 2008. In Massachusetts, 196 EMS agencies participated in the survey. In the total 9 states, 1,292 EMS agencies participated in the survey. However, not all of the respondents answered all questions in the survey. Therefore, the proportions reported may have slightly different denominators. Results displayed are not comprehensive and do not reflect all important characteristics for cardiovascular emergency response.