Evaluating State Flex Program Projects Targeting Implementation of EMS Standards and Time-Critical Diagnoses Best Practices

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The purpose of this project was to analyze the efforts of State Flex Program initiatives to support the development of time-critical diagnoses (TCD) systems of care and provide models that can be used by other State Flex Programs to support TCD systems of care in CAH communities. The project resulted in a policy brief summarizing the results of the study. 


The state Flex grant guidance for the FY 2015-2017 competitive funding cycle retained a strong emphasis on the integration and engagement of rural EMS into systems of care for time critical diagnoses (TCDs). As a result, twelve State Flex Programs have undertaken initiatives focused on TCDs, which include ST elevation myocardial infarction (STEMI), stroke, and trauma. TCD systems of care focus on the coordination and integration of local EMS units, CAHs, hospitals with enhanced specialty capacity to serve as referral hubs, and air ambulance services. They also involve the use of transport and clinical guidelines to meet established targets for system performance (e.g., the 90 minute door to balloon standard for STEMI). This project reviewed and categorized state Flex activity related to TCDs and focus on the role of Flex in supporting these TCD systems of care.