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Every Minute Matters. Every Connection Counts.
Highlights from the 2026 Virginia Heart Attack Coalition Statewide Meeting
Richmond, Virginia | October 22, 2026
When cardiac emergencies strike, outcomes often depend on decisions made long before a patient reaches the catheterization laboratory. From the first 911 call to definitive treatment, every minute, every communication, and every member of the cardiovascular care team matters.
That message resonated throughout the Virginia Heart Attack Coalition (VHAC) 2026 Statewide Meeting, which brought together cardiologists, emergency physicians, EMS professionals, nurses, data specialists, healthcare leaders, and regional partners at Lewis Ginter Botanical Garden.
The gathering was more than an opportunity to review clinical research and performance measures. It was a statewide conversation about how to build stronger systems, remove barriers to timely treatment, and translate evidence into practical improvements for patients throughout the Commonwealth.
Across regional presentations, statewide data reviews, expert discussions, a forward-looking keynote, and clinical workgroup updates, one theme emerged: The next chapter of cardiovascular care will depend as much on how teams work together as on the technologies and treatments available to them.
SPECIAL EVENING HIGHLIGHT
E. Reed Smith, MD, FACEP (Arlington County Fire and Police Departments) Challenges Virginia to Rethink Heart Attack Care
October 21, 2026 | VHAC Statewide Meeting
The evening before the statewide meeting, Dr. Smith delivered a thought-provoking presentation that helped set the tone for the following day's discussions on improving STEMI systems of care.
His message, referenced repeatedly throughout the October 22 meeting, centered on reducing unnecessary treatment delays, strengthening trust in EMS professionals, and removing operational barriers that stand between patients and lifesaving care.
A particularly important theme was the value of direct-to-catheterization-laboratory pathways. Dr. Smith challenged traditional practices that can delay reperfusion, encouraging healthcare teams to reconsider unnecessary emergency department stops and better recognize the clinical capabilities of EMS providers.
His presentation also sparked discussion about appropriate STEMI activations, shared clinical decision-making, and the importance of building a collaborative culture across emergency departments, EM
S agencies, and cardiac teams.
The highlight: Improving heart attack care is not simply about moving faster—it is about building a coordinated system where every professional, every decision, and every minute works toward better patient outcomes.
STATE OF THE STATE
Eighteen Years of Progress — and a Renewed Call to Action
Featuring Peter K. O'Brien, MD, CPPS, FACC | VHAC Co-founder
The meeting opened with a reminder of the fundamental principle that has guided heart attack care for decades: time is muscle.
Dr. Peter O'Brien (Centra Lynchburg) reflected on the progress achieved through nearly two decades of coordinated cardiovascular improvement in Virginia while challenging attendees to confront the persistent differences in how quickly patients receive treatment.
VHAC's accomplishments tell a powerful story. According to the statewide presentation, the proportion of ambulances equipped with 12-lead ECG capability has increased from approximately 60% to 99%. Statewide first-medical-contact-to-balloon times have declined from roughly 95 minutes to less than 70 minutes over the coalition's history. VHAC also developed its own STEMI registry, recruited 28 PCI centers, and established statewide clinical workgroups.
Yet, as O'Brien emphasized, success cannot be measured solely by statewide averages. Differences among hospitals, delays in emergency departments, and disparities affecting older adults, women, and Black patients remain significant concerns.
His presentation also drew an unexpected comparison to professional hockey, illustrating how teams can improve when they combine data, shared goals, and a culture that prioritizes collective performance over individual achievement.
The message was clear: successful cardiovascular systems require more than expertise. They require relationships, accountability, continuous measurement, and a willingness to change established practices.
With expanded regional leadership, growing EMS engagement, and new clinical resources under development, VHAC enters 2027 focused on sustaining progress while broadening participation across Virginia.
The highlight: Eighteen years of collaboration have produced measurable improvements, but equitable access to timely, high-quality heart attack care remains unfinished work.
REGIONAL SPOTLIGHT
Six Regions. One Statewide Mission.
Regional updates from Central, Eastern, Northwestern, Southern, Western, and Northern Virginia
One of the meeting's most important sessions brought the coalition's regional leaders together to describe local accomplishments, persistent challenges, and priorities for the coming year.
Although each region faces different geographic, operational, and organizational realities, their presentations revealed a strikingly similar set of priorities: stronger EMS engagement, improved information sharing, faster reperfusion, and meaningful use of performance data.
Central Virginia | Rebuilding Momentum Through Collaboration
Presented by Megan Vaughan, MSN, RN (Bon Secours Richmond Heart & Vascular Institute)
Central Virginia reported a renewed focus on strengthening its regional STEMI network, including the relaunch of the ODEMSA Region 6 collaborative structure in January 2026.
The region highlighted improved communication between EMS and hospitals, increased prehospital ECG transmission, direct-to-catheterization-laboratory processes, and efforts to reduce unnecessary STEMI team activations.
Education has been a central component of that work, with training offered through EMS conferences, hospital programs, and local fire and rescue agencies.
Looking ahead, Central Virginia intends to strengthen regional cardiovascular protocols, improve hospital and EMS data sharing, and make transfer processes more efficient.
Regional takeaway: Better communication is becoming the foundation for faster activation, more coordinated care, and stronger regional accountability.
Eastern Virginia | Building Connections Across a Complex Geography
Presented by Anand Krishnan, MD (Sentara Healthcare)
From Hampton Roads to the Eastern Shore, the Eastern Region faces the challenge of coordinating care across urban, rural, and geographically separated communities.
Its regional presentation identified nine PCI-capable hospitals, additional transfer and referral sites, and more than 90 EMS agencies within its broad network.
Education emerged as one of the region's strongest engagement tools. Four ECG education sessions held in 2026 reached approximately 50 participants, strengthening relationships between physicians, hospitals, and EMS professionals.
Eastern Virginia's next priorities include expanding education, improving quarterly data submissions, and incorporating case-based learning into regional meetings. The region also established an ambitious performance goal tied to seven national STEMI measures.
Regional takeaway: Education can open the door to collaboration, but sustained participation and reliable data will determine how far regional improvement efforts can go.
Northwestern Virginia | Renewing Leadership and Strengthening Participation
Presented by Patrick Stafford, MD (University of Virginia)
The Northwestern Region highlighted efforts to restore regular meetings, strengthen relationships among hospitals, and improve engagement with EMS partners following changes in regional organization.
Serving communities that include Charlottesville, Harrisonburg, Winchester, and surrounding rural areas, the region is working to identify local hospital champions and encourage a stronger multidisciplinary presence at meetings.
Regional performance data demonstrated both encouraging results and opportunities for further improvement.
The goal moving forward is to turn data sharing into practical action by identifying performance differences, learning from successful facilities, and developing stronger connections with EMS.
Regional takeaway: Sustainable improvement begins with consistent participation and local leaders willing to champion change.
Southern Virginia | Technology Streamlines the STEMI Response
Presented by Maegan Sholes (Centra Lynchburg)
The Southern Region shared a practical example of how communication technology can improve cardiovascular systems of care.
Centra's implementation of a new communication platform in May 2026 created a more coordinated approach to STEMI activation among EMS, hospital personnel, physicians, and transferring facilities.
Before implementation, a single activation could require 10 to 15 separate calls, messages, pages, and callbacks. The new approach is intended to simplify communications, reduce delays, and improve the reliability of team notifications.
The region also reviewed reperfusion performance, cardiogenic shock data collection, and efforts to expand ECG transmission and EMS education.
Looking ahead, Southern Virginia plans to strengthen consistent platform use and explore artificial intelligence-supported recognition of coronary occlusion.
Regional takeaway: Better technology creates opportunity when it is paired with consistent use, coordinated workflows, and measurable improvement.
Western Virginia | Reducing Delays for Transferred Patients
Presented by Melanie Johnson, MSN, RN-BC (Carilion Clinic)
The Western Region focused attention on one of the most challenging areas of STEMI care: transferring patients from facilities without immediate PCI capability to hospitals equipped to provide definitive treatment.
Reducing door-in-door-out times, encouraging early STEMI identification, improving transportation availability, and expanding appropriate thrombolytic education were identified as priorities.
Western Virginia also reported ongoing efforts to strengthen EMS involvement through flexible meeting formats, educational presentations, and closer collaboration with regional partners.
The presentation celebrated Chest Pain–MI Registry performance achievement recognition for several participating hospitals, including Carilion Roanoke Memorial Hospital and multiple LewisGale and regional facilities.
Regional takeaway: Improving transfer coordination is an essential part of reducing total ischemic time, particularly in communities where definitive treatment requires travel.
Northern Virginia | Transparency as a Tool for Improvement
Presented by Laura Atwell (NVERS Northern Virginia Emergency Response System)
Northern Virginia highlighted a growing regional approach to collaborative performance measurement.
Five hospitals participated in an initial de-identified data-sharing effort, providing a starting point for comparisons of first-medical-contact-to-device intervals, transfer performance, emergency department ECG times, and direct-to-cath-lab processes.
The region also emphasized EMS quality measures, including aspirin administration in suspected cardiac chest pain and oxygen administration for hypoxic patients.
By sharing data across institutional boundaries, Northern Virginia aims to identify practical opportunities for improvement while promoting stronger relationships among participating organizations.
Regional takeaway: Regional transparency can help healthcare teams identify variation, learn from one another, and establish shared improvement priorities.
BY THE NUMBERS
Statewide Data Turns Performance into Purpose
Featuring Eddie Fonner, VCSQI Executive Director, Laura Atwell and Karen Owens, NVERS Northern Virginia Emergency Response System
Numbers took center stage as the meeting shifted from regional experiences to statewide cardiovascular performance.
The VCSQI/VHAC STEMI database provides participating hospitals with a foundation for tracking care processes, comparing performance, and identifying opportunities for improvement.
The meeting materials reported 26 programs in the database, including 22 sharing Chest Pain–MI information quarterly, with additional participation and uploads in development.
Among the statewide indicators reviewed were first-medical-contact-to-device time, transfer intervals, and door-in-door-out performance.
For the reviewed reporting period, statewide summary measures included a median door-in-door-out time of 61 minutes, a median interfacility transportation time of 29 minutes, and 86.7% of patients meeting the 90-minute first-medical-contact-to-device measure.
These figures demonstrated meaningful progress while revealing where delays can accumulate, especially when patients must navigate multiple facilities before receiving reperfusion treatment.
Connecting Hospital and EMS Data
The statewide EMS discussion extended the conversation beyond hospital performance.
Virginia's EMS data infrastructure receives approximately 1.7 million to 1.8 million patient care reports annually from more than 500 agencies. These records offer substantial opportunities to evaluate care provided before hospital arrival.
Two statewide performance improvement priorities received particular attention: increasing documented aspirin administration among eligible patients with suspected cardiac chest pain and improving documented oxygen administration for hypoxic patients.
The 2026 statewide goals target 60% performance for each measure, compared with reported 2025 baselines of 50% for aspirin and 35% for oxygen.
Presenters stressed that documentation remains a critical challenge. When medications or procedures are recorded only in free-text narratives rather than structured reporting fields, the care provided may not appear in performance metrics.
That distinction matters. Quality improvement cannot depend on incomplete or inconsistent data.
The highlight: Better data does more than describe performance. It makes improvement measurable, directs education, and helps EMS and hospitals operate as one cardiovascular system.
EVIDENCE TO ACTION
When New Research Challenges Familiar Practices
Evidence review by Michael Kontos, MD (University Medical Center) | Moderated by Lt. Yasmin Ahmady (Prince William County Department of Fire and Rescue [PWCDFR]), with panelists Aman A. Shah, MD, FAEMS, FAAEM (Prince William County Fire & Rescue System and Public Safety Communications [911], Cooper University Hospital, Cooper Medical School of Rowan University); Kayla Long, DO (Centra Lynchburg); Patrick Stafford, MD (University of Virginia); and Kim Pumphrey (NVERS Northern Virginia Emergency Response System)
Scientific evidence came under close examination during an interactive panel exploring research with implications for emergency cardiovascular care.
Rather than treating each new study as an automatic reason to change practice, the discussion encouraged participants to consider patient selection, operational realities, clinical outcomes, and how evidence should be translated into systems of care.
Mechanical CPR | Technology Does Not Automatically Equal Better Outcomes
The panel reviewed research examining whether the introduction of mechanical CPR devices at EMS agencies was associated with improved cardiac arrest survival.
The study included more than 83,000 out-of-hospital cardiac arrests across 122 EMS agencies. Findings did not demonstrate improved survival to hospital discharge or favorable neurological outcomes associated with introducing mechanical CPR devices.
The discussion reinforced the distinction between a technology's potential operational advantages and demonstrated patient benefit.
Prehospital Heparin | Can Earlier Treatment Improve Coronary Flow?
Another study examined unfractionated heparin administered before arrival at the catheterization laboratory in selected STEMI patients.
Findings suggested improved coronary artery patency at initial angiography without a significant increase in major bleeding. However, the reported results did not establish improvements in mortality or other major clinical outcomes.
The panel explored how earlier anticoagulation might fit into existing prehospital treatment strategies and what additional evidence would be needed to support broader practice changes.
Targeted Temperature Management | Reconsidering the Duration of Cooling
The ICECAP trial prompted discussion about temperature management after out-of-hospital cardiac arrest.
The research evaluated different durations of therapeutic hypothermia and did not find improved outcomes simply by extending cooling duration.
The conversation highlighted the challenge of applying broad trial findings to diverse patient populations, particularly when neurological injury, initial arrest rhythms, and clinical circumstances vary.
The highlight: Innovation must be guided by clinical evidence, meaningful outcomes, and careful evaluation—not by technology adoption alone.
THE KEYNOTE
Moving the Decision Upstream: Recognizing the Crashing Patient Before Collapse
Presented by Aman A. Shah, MD, FAEMS, FAAEM (Prince William County Fire & Rescue System and Public Safety Communications [911], Cooper University Hospital, Cooper Medical School of Rowan University)
One of the day's most compelling presentations challenged attendees to rethink when cardiovascular decision-making should begin.
Dr. Aman Shah's keynote, Moving the Decision Upstream: The Crashing Patient and the Future of Prehospital Cardiovascular Care, focused on recognizing physiological deterioration before a patient reaches obvious cardiovascular collapse.
Through a case-based scenario, Shah demonstrated how a patient who initially appears relatively stable can rapidly progress toward shock.
The central lesson was that a single blood pressure reading or ECG cannot tell the whole story. Changes over time—the patient's trajectory—may reveal the seriousness of their condition before conventional thresholds are reached.
Seeing What Vital Signs Cannot
Shah explored the potential role of focused prehospital ultrasound in identifying abnormal cardiac function, right ventricular enlargement, and other findings that can inform early decisions.
The objective is not to perform a comprehensive echocardiogram in an ambulance. Rather, it is to answer focused clinical questions that help EMS providers and receiving teams identify the physiology driving deterioration.
Artificial Intelligence as a Second Reader
The keynote also examined the emerging role of AI-assisted ECG interpretation, including technology designed to recognize patterns associated with acute coronary occlusion that traditional STEMI criteria may miss.
Shah emphasized that artificial intelligence should support—not replace—clinical judgment.
Serial assessments, ECG findings, bedside observations, focused ultrasound, and AI-assisted interpretation may together create a clearer understanding of a patient's condition.
But earlier recognition has value only when it changes the response.
That may mean activating a catheterization laboratory sooner, alerting a cardiogenic shock team, contacting a pulmonary embolism response team, or selecting a more appropriate destination.
Build the System Before Buying the Technology
Perhaps the keynote's most important message was operational rather than technological.
Training, clear communication pathways, defined clinical responses, quality review, and ongoing feedback must exist before new diagnostic tools can consistently improve care.
A promising device without an actionable pathway simply generates more information.
The highlight: The hospital door should not be the starting point for cardiovascular decision-making. The future lies in recognizing deterioration earlier and preparing the right team to respond.
WORKGROUP SPOTLIGHTS
Turning Shared Ideas into Practical Tools
The afternoon rapid-fire updates showcased how VHAC's multidisciplinary workgroups are translating statewide collaboration into educational resources, clinical pathways, and improvement initiatives.
EMS Education | Teaching for Real-World Decisions
Lt. Yasmin Ahmady (PWCDFR) highlighted the workgroup's broadened mission that extending beyond ECG interpretation to cardiovascular assessment, patient deterioration, communications, and interfacility transport.
Two major educational efforts are advancing: a case-based cardiogenic shock course targeted for early 2027 and a standardized ECG teaching library focused on clinically reviewed cases, STEMI mimics, and challenging interpretations.
The approach emphasizes realistic scenarios, clinical context, and shared learning rather than memorization alone.
The highlight: Education is becoming more practical, interactive, and closely connected to the decisions EMS professionals face in the field.
Direct to Cath Lab | Eliminating Unnecessary Stops
Dr. O'Brien (Centa Lynchburg) reviewed the progress of initiatives intended to help appropriately selected STEMI patients reach definitive treatment without unnecessary emergency department delays.
The workgroup has developed shared terminology, statewide guidance, and performance measures while supporting facility-level pilots.
The presentation also highlighted considerable variation in existing practices and proposed improvement benchmarks tailored to baseline facility performance.
Expanding consistent protocols, improving prearrival ECG communication, and monitoring inappropriate activations remain important components of the effort.
The highlight: Every unnecessary stop can delay reperfusion; standardized pathways can make timely treatment more reliable.
Thrombolytics | Addressing the Transfer-Time Challenge
The Thrombolytics Workgroup concentrated on patients whose access to primary PCI is delayed by transportation or transfer limitations.
Dr. Michael Kontos (VCU), highlighted the group's work which includes a decision-support algorithm, evaluation of variation in thrombolytic use, and education focused on selecting appropriate reperfusion strategies.
The group also discussed a potential prehospital thrombolytic pilot for carefully selected patients facing prolonged transport times. The proposed model would require standardized screening, physician oversight, training, and safety protocols.
Statewide data revealed substantial variation in transfer performance and thrombolytic utilization, reinforcing the importance of studying barriers rather than assuming all patients have rapid access to PCI.
The highlight: A statewide reperfusion strategy must account for patients whose geography and transportation circumstances make rapid PCI difficult.
Cardiogenic Shock | Creating a Common Language for Critical Care
The Cardiogenic Shock Workgroup, represented by Chalak Berzingi, MD, described efforts to strengthen early recognition and coordinated treatment of patients with severe cardiovascular instability.
Its ongoing work emphasizes practical shock pathways, multidisciplinary activation, hemodynamic assessment, and shared case review.
Regular case presentations have helped connect clinicians across institutions and create opportunities to discuss escalation decisions, mechanical circulatory support, and patient outcomes.
The workgroup is encouraging participating hospitals to identify local champions, adapt protocols to their capabilities, and contribute to a practical statewide measurement framework.
The highlight: Early recognition, multidisciplinary teamwork, and structured reassessment are central to improving shock care.
Pulmonary Embolism Response Team | Coordinating Complex Decisions
The Pulmonary Embolism Response Team (PERT) discussion, led by Michael Kelley, MD, highlighted evolving approaches to patients with serious pulmonary embolism.
A clinical case involving a patient with a large saddle pulmonary embolism and significant right ventricular strain illustrated the complexity of risk assessment and treatment selection.
The presentation also considered recent trials evaluating catheter-based treatment options and the importance of multidisciplinary decision-making.
The discussion reinforced the need for appropriate patient selection, timely consultation, clear escalation pathways, and continued evaluation of emerging evidence.
The highlight: Complex pulmonary embolism care benefits from coordinated teams capable of connecting diagnosis, risk assessment, and advanced treatment.
CLOSING PERSPECTIVE
Celebrating Progress. Strengthening the Coalition. Preparing for 2027.
As the statewide meeting drew toward its conclusion, attention returned to the people and partnerships that make VHAC's work possible.
The coalition's continued development depends on participation across hospitals, EMS agencies, professional disciplines, and geographic regions. Discussions throughout the day repeatedly called for greater EMS representation, stronger communication, improved data sharing, and wider dissemination of educational resources.
The meeting also celebrated the inaugural VHAC Champions Cup, a perpetual award
recognizing the region with the highest number of registered participants. Congratulations to the Southern Region for taking home the 2026 Champions Cup! This friendly competition celebrates regional engagement, encourages participation, and recognizes the dedication of VHAC members working together to strengthen cardiovascular care across Virginia.
Across every session, it became clear that the coalition's greatest strength lies in its ability to bring professionals from different organizations together around the needs of patients.
Looking toward 2027, the priorities are both ambitious and practical: expand participation, improve transfer STEMI care, support regional education, grow registry contributions, implement appropriate emerging technologies, and continue strengthening multidisciplinary systems.
The meeting left participants with a challenge that extends beyond any one presentation or institution.
Progress must reach every community. Successful practices must be shared. And every new technology, protocol, and quality measure must ultimately serve the patient.
Because the most important measure of a cardiovascular system is not simply how fast it can move—but how reliably it delivers the right care to the right patient, wherever that patient happens to be.
EDUCATIONAL SESSION SPOTLIGHT
Critical Care Drips: An Engaging Finish to the VHAC Statewide Meeting
Featuring Cary Strosnider, BSA, FPC ( LifeEvac)
The 2026 VHAC Statewide Meeting concluded with an engaging educational session led by Cary Strosnider, who brought his critical care experience and interactive teaching approach to Critical Care Drips.
The session challenged participants to test their knowledge of medications commonly encountered in emergency and critical care settings. Topics included vasoactive medications, cardiovascular infusions, medication side effects, trauma management, and treatment considerations for complex medical emergencies.
Through practical questions and real-world clinical scenarios, Cary reinforced the importance of understanding medication selection, dosing, monitoring, and potential complications when caring for critically ill patients.
The highlight: A special thank you to Cary for bringing an interactive and educational conclusion to our statewide meeting. His dedication to EMS education and critical care training helped make this final session a valuable opportunity for continued learning and professional development.
THE BIGGER PICTURE
One Coalition. One Commonwealth. One Commitment.
The 2026 VHAC Statewide Meeting illustrated the value of a learning cardiovascular system—one that measures its performance, questions existing practices, shares clinical experience, invests in education, and continually adapts.
From the first ECG in the field to the most advanced hospital-based interventions, the future of heart attack care depends on connecting every part of the patient journey.
Every minute matters. Every connection counts. And every Virginia patient deserves a system prepared to respond.
Virginia Heart Attack Coalition
Improving cardiovascular systems of care through education, data-driven collaboration, and a shared commitment to high-quality, patient-centered, equitable treatment.
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