Table 5.

Domains and key strategies used by higher performing hospitals to engage EMS in the care of patients with AMI

Domain	Key strategy(s)
Respect for EMS as valued professionals and colleagues	Value EMS clinical skills and judgment; treat EMS providers as health care professionals, rather than technicians solely responsible for rapid transport Tolerate false activations of the cardiac catheterization laboratory by EMS providers Invest in relationships with EMS by building tight connections with EMS and making EMS part of the care team
Strong communication and coordination with EMS	Ensure timely, bi-directional communication between the hospital and EMS (e.g., hospitals employ EMS liaisons and meet regularly with EMS agencies) Ensure EMS providers have up-to-date, evidence-based clinical knowledge base (e.g., hospital staff teach EMS continuing education classes and integrate EMS staff into hospital-based educational forums) Cultivate shared, patient-focused mission with EMS providers to improve AMI care and outcomes (e.g., review findings on current patients’ electrocardiogram, allow the EMS providers to observe the angiogram for patients they transported, and share information on previously transported patients’ clinical course in the hospital)
Active engagement of EMS in quality improvement	Include EMS representation on hospital AMI quality improvement committees Share AMI performance data with EMS regularly through EMS liaisons and AMI quality improvement committees Encourage EMS participation in creative problem solving and consider piloting EMS process improvement proposals (e.g., pilot EMS activation of the cardiac catheterization laboratory without ED confirmation)