Developing Regional STEMI Systems of Care: A Review of the Evidence and the Role of the Flex Program (Policy Brief #23)

Document Type

Policy Brief

Publication Date



MRHRC, rural, EMS, emergency medical services, Flex, USM Aging Initiative, Health and Wellness


This policy brief summarizes the evidence for regional systems of care for patients presenting with ST-segment elevation myocardial infarction (STEMI). These systems of care have both a quality improvement and a systems development focus and provide a valuable opportunity for State Flex Programs to engage CAHs and EMS in rationalizing and improving STEMI care for rural residents, particularly with respect to MBQIP Phase 2 Measures.

Key Findings:

  • CAHs and rural EMS agencies play an important role in STEMI systems of care.
  • EMS providers use pre-hospital ECGs and transport protocols to ensure timely reperfusion.
  • CAHs provide fibrinolytic therapy and post-reperfusion followup care including cardiac rehabilitation.
  • State Flex Programs can facilitate involvement of CAHs and EMS agencies in STEMI systems of care.