Stop Missouri's Time Critical Diagnosis Budgetary change proposal

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March 15, 2018


Office of Governor Eric Greitens

P.O. Box 720

Jefferson, City, MO 65102


Dear Governor Greitens;

The members of the East Central Region of Emergency Medical Services need to be heard regarding the proposed budgetary changes to the Department of Health & Senior Services Time Critical Diagnosis (TCD) program’s financial support structure. This program has been established to designate hospitals to manage complex life-threatening diagnoses of heart attack, stroke and trauma.  While the budgetary changes proposed may appear to be minimal, these cuts will have devastating results should they be put into practice.

Time Critical Diagnosis legislation provides for emergency medical personnel to transport victims of stroke, heart attacks or trauma to immediate appropriate healthcare.  While the American Heart Association, The Joint Commission and other regulatory bodies oversee the appropriate facility certification, and EMS regulation and transport algorithms for heart attack and stroke diagnosis, trauma lacks enough nationally recognized centers to sustain a similar oversight.   Thus, EMS would lose critical legal protections to take patients to the appropriately accredited and staffed centers.  Ultimately, this will put patients at risk of delays in care; potentially losing the “golden hour” of treatment in which research proves provides the best outcomes.

Additionally, loss of a state system for time critical diagnosis care will put charges for these services at risk for hospitals.  This will further tax healthcare resources within this already strapped and heavily regulated environment.

We recognize the need to improve the time critical diagnosis system and are willing and eager to work with our legislators and regulators from this point forward.  At this time, this program is poorly funded as compared to sister states, and data collection for the continued improvement of the systems and the development of meaningful research has been unsuccessful.  However, the system itself is serviceable and must be maintained for the health and well-being of the citizens of the state of Missouri.

We appreciate your support for the people of Missouri.



Douglas J. E. Schuerer, MD

Chairman, East Central Regional EMS Committee


Cc:  East Central Region Legislators

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