Emergency medical service system evaluation and planning strategies for prehospital chest pain in Howard County, Maryland.

Patients experiencing ischemic chest pain represent one of the most common emergencies in prehospital emergency medical service (EMS) systems. Recent national guidelines for emergency department and EMS care of chest pain and acute myocardial infarction (AMI) patients have quantified standards for time to evaluation and treatment. Prehospital EMS systems and hospitals will need to change their processes of care for chest pain patients to meet or exceed these national guidelines. In addition, the EMS system and the hospital will need to work more closely and seamlessly to integrate chest pain care for the maximum benefit of the patient. The Howard County Department of Fire and Rescue Services (DFRS) recognized the need for change in its EMS system. Its unique approach involved chartering a multidisciplinary task force to assess the current EMS system. The task force analyzed the literature to decide evidence-based standards for EMS system performance, and evaluated public and private EMS systems that possessed state-of-the-art processes for providing patient care. Based upon the information gathered and considering qualities essential to future performance, the task force made recommendations for changes to Howard County's EMS system. This study reports the task force recommendations and describes those implemented thus far. Changes to the EMS system are quantified, descriptive data from the system are reported, and future goals are presented.