Texas County Memorial Hospital recently received Level III STEMI designation from the Missouri Department of Health and Senior Services (DHSS).
TCMH has been providing lifesaving care for patients experiencing heart attacks since opening its doors in 1958. This new designation represents an upgrade from Level IV, which the hospital has held since 2018. The Level III STEMI designation reflects TCMH’s enhanced ability to respond to patients experiencing ST-elevation myocardial infarction or STEMI, commonly referred to as a heart attack.
As a Level III STEMI center, TCMH provides initial emergency cardiac care and maintains transfer agreements with Level I and II centers for patients who require advanced interventional treatment.
Lauren Toman, MA, RRT, TCMH respiratory, pulmonary rehab, and sleep laboratory director and STEMI program manager, led the application process for the upgraded designation. She worked closely with emergency department and cardiopulmonary teams to reduce critical response times for heart attack patients.
“The heart is a big muscle, and during a heart attack, blood flow to the heart stops, causing the muscle to die,” Toman said. “Every minute we can save when treating a heart attack patient gives us a better chance of preserving more of that patient’s heart.”
The Time Critical Diagnosis System, created in 2013 through DHSS, is a statewide emergency medical response system designed to improve outcomes for time-sensitive emergencies. The system establishes consistent rules and protocols to ensure patients are transported to the most appropriate facility for their condition.
Missouri’s benchmark for STEMI response is 30 minutes from the time a patient arrives at the hospital with heart attack symptoms to transfer to a higher level of cardiac care.
However, many rural hospitals face challenges meeting that benchmark. Facilities must rapidly recognize and treat heart attacks while navigating geographic and logistical obstacles to get patients to interventional care as quickly as possible.
Rural hospitals like TCMH face unique challenges because air ambulances are not stationed on-site. TCMH is approximately 24 minutes by air from the nearest helicopter base. While multiple ground ambulances are available on site, ground transport for heart attack patients is typically used only during severe weather.
Once a STEMI is identified, there is an unavoidable wait for air ambulance arrival, followed by additional time to prepare and load the patient.
“To hot-load a patient onto a helicopter takes about five minutes,” Toman said. “And that’s a really intense five minutes — moving a critical patient while the helicopter is still running.”
Despite these challenges, Toman said the hospital’s teams have made measurable improvements.
During the 2023–2025 cycle, TCMH treated 45 STEMI patients, with 23 patients receiving lifesaving Tenecteplase, including 10 patients this year alone. Tenecteplase is a clot-busting medication that helps restore blood flow to the heart, preserving heart muscle until surgical intervention can occur.
“In October and November of this year, we had two patients who required CPR after their hearts stopped,” Toman said. “Both regained a heartbeat, were emergently transferred to higher-level centers, received stents to open blocked arteries and were discharged home within days.”
Toman noted that the upgraded designation also emphasizes recovery.
“When a patient suffers a heart attack, we know they achieve better outcomes when recovering closer to home,” she said. “STEMI protocols allow our staff to make knowledgeable, streamlined decisions consistently with every patient encounter.”
TCMH treats a high volume of cardiac patients, and cardiac-related conditions remain the hospital’s leading reason for patient transfers.
“We are extremely pleased to receive this designation,” Toman said. “The protocols our staff follows with each STEMI patient are working — and we are saving lives.”
“We are thrilled to enhance the level of care we provide patients experiencing cardiac emergencies,” Bill Bridges, TCMH chief executive officer, said. “This Level III STEMI designation reflects the dedication, teamwork and commitment of our staff. Their hard work allows us to deliver lifesaving care to our community when they need it most.”
According to the American Heart Association, heart attack symptoms may include chest discomfort; pain in one or both arms, the back, neck, jaw, or stomach; shortness of breath; sweating; nausea; or lightheadedness. Anyone experiencing these symptoms should call 911 or go to the nearest emergency department immediately.