An ST-elevation myocardial infarction (STEMI), named after the changes seen on electrocardiograms, is a type of heart attack primarily impacting the lower chambers of the heart. These types of heart attacks can be severe but are amendable to reperfusion treatment if given within 90 minutes. STEMI care is complex with multiple steps and frequently begins only when the patient arrives at the emergency department. Due to long transportation distances for emergency medical services (EMS) with delays in the start of STEMI care, rural areas are eight times less likely to receive definitive treatment compared to those living in urban areas. The use of a clinical decision support tool would allow for STEMI care to begin during transportation, reducing first medical contact (FMC) to reperfusion therapy times. Such an app has the potential to bring consistent and evidence-based STEMI care to rural areas.

Building on their previous research that identified critical gaps in STEMI emergency care, the study team will develop, implement, refine, and evaluate an open-source mobile application, Rural STEMI App, which will support paramedics in prehospital STEMI care, so that steps required in that care are not forgotten or delayed.

The specific aims of the research are as follows:

• Translate evidenced-based rural EMS STEMI best practices into a digital clinical decision support tool.
• Evaluate the feasibility and effectiveness of the Rural STEMI App.
• Determine implementation barriers and facilitators of the Rural STEMI App.

Researchers will develop and assess the usability of the app in a rural North Carolina County EMS agency to improve providers’ ability to reduce FMC to reperfusion therapy times. The app will assist the EMS team by providing a scene time countdown, hospital activation metric countdowns, and EMS-specific route navigation assistance. A second implementation phase will evaluate the feasibility and effectiveness of the app in seven additional rural EMS agencies. The app will also address the need for improved STEMI encounter communication by electronically sending an automatically generated feedback report to all key stakeholders, as determined by customizable regional standards. Researchers will then identify the key barriers and facilitators to using the tool by conducting key informant interviews with app users and by evaluating app program data, encounter data, and EMS staff encounter surveys for quality improvement information.

This research will address a critical gap in how to improve rural prehospital FMC to reperfusion times, which in turn will reduce cardiovascular disease morbidity and mortality. Results from this study will inform a large multisystem hybrid effectiveness-implementation trial to assess the effectiveness of the highly scalable Rural STEMI App within diverse rural sites across the United States.