As the Cardiovascular Service Line Director I am involved in reviewing and evaluating all the STEMI cases that we receive in our ED.  I am also a member of the ODEMSA Regional STEMI Committee and a guest to VHAC.  It is imperative that we include STEMI to the language of of 12VAC5-31-390 to include STEMI.

The American College of Cardiology has changed the time frame of door to balloon time based on extensive research stating that the quicker the culprit vessell is opened, the decrease in mortality rate for the patient.  The time of coronary flow establishment is now calculated from the first medical encounter to balloon time which raises the standards in meeting 90 minutes from the time EMS encounters the patient.  The change in language would emphasize this goal and allow for standardized care for the patient. 

Please consider and allow this change in verbage so that we can have the consistent care for our patients and reduce the effects of an MI according to evidence base practice.

Thank you.