Ambulance, hospital teams give best response

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New processes are available for early diagnoses, swift treatment, for heart attack patients

A major six-year international study released May 2 in the Journal of the American Medical Association – the Global Registry of Acute Coronary Events study – involving some 44,000 heart attack patients, has revealed a dramatic parallel between better treatment methods and a sharp drop in deaths from heart failure and stroke.

Practicing healthy lifestyles (good nutrition and regular exercise), taking cholesterol lowering drugs and blood thinners when indicated, and rapid access to emergency cardiac angioplasty have all contributed to this lower figure.

In America, some of our 335,000 annual coronary deaths would be preventable if the public recognized warning signs of heart attack and took quick action by calling 911 for emergency medical assessment and swift treatment.

Not all heart attacks are alike. One particular type of heart attack, the ST Elevation Myocardial Infarction (STEMI), occurs about 500,000 times every year. In STEMI, permanent damage occurs if coronary blood flow is not quickly restored. Long durations between diagnosis of STEMI and opening the coronary arteries with insertion of a balloon (angioplasty) increases the risk of permanent damage or death.

Rapid response by trained medical professionals is crucial for survival; reducing “door-to-balloon time” for these heart attack victims is a major goal of cardiac programs. Door-to-balloon time are the minutes between when a heart attack victim enters the emergency room and when the coronary arteries are opened by the angioplasty procedure.

At Central Maine Medical Center and the Central Maine Heart and Vascular Institute, an innovative program has shortened door-to-balloon times well below the national average.

Hospital physicians have reviewed interpretations of 2-lead EKGs, measures of heart electrical activity (also known as electrocardiograms), that were performed in the field by more than 80 paramedics from 10 local emergency medical services. Following this review, physicians have proven, and are confident, that these EMS professionals can accurately identify patients with STEMI heart attacks.

For once this cardiac event is diagnosed, the EMS team is authorized to call from the field so institute physicians and nurses are prepared for the incoming patient. Processes are in place so the hospital emergency department staff can quickly assess the patient and then rush them directly into the cardiac catheterization suite.

National guidelines developed by the American College of Cardiology and the American Heart Association state hospitals treating STEMI patients with emergency cardiac angioplasty should reliably achieve a door-to-balloon time of 90 minutes or less. Every minute wasted increases the risk of death.

In Central and Western Maine, EMS personnel trained to diagnose patients with STEMI in the field have already achieved a mean door-to-balloon time of 35 minutes. In contrast, mean door-to-balloon time for STEMI patients who walk into an emergency room is 77 minutes; those who go first to a community hospital that does not perform angioplasties and who then must be transferred average 140 minutes.

Despite the success of our EMS responders in diagnosing STEMI, only one-third or so of patients with chest pain ever call an ambulance. Some drive themselves or are driven by family or friends to the emergency room, some remain stoic and suffer the pain, and some simply don’t want to bother the ambulance crew.

But when a heart attack strikes, time is muscle, and across the region EMS is the first line of defense. Participating EMS providers include: United Ambulance; LifeFlight of Maine; Turner Rescue; Poland Rescue; Monmouth Rescue; Lisbon Rescue; Topsham Rescue; Winthrop Rescue; Oxford Rescue; and NorthStar Ambulance.

The model is so successful it is being replicated statewide, in the service areas of Eastern Maine Medical Center in Bangor and Maine Medical Center in Portland, which is a testament to this simple logic:

Calling 911 at the first sign of trouble increases a patient’s chances of surviving a heart attack.

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Dr. Kevin M. Kendall is director of emergency medical services at Central Maine Medical Center, and medical director for LifeFlight of Maine. He lives in Falmouth.

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