New technology, cooperation increases heart attack victims' chances of survival

September 5, 2009 

Using firefighter paramedic Alfonso Lee as a mock heart attack victim, Hilton Head Island Fire and Rescue Division lieutenant paramedic Tom Bouthillet activates a mobile cardiac monitor that can transmit an electrocardiogram from an ambulance at the scene to doctors at Hilton Head Hospital. Use of this technology can help speed the time it takes to treat a heart attack patients once they arrive at the hospital.

JAY KARR/THE ISLAND PACKET-

  • A statewide group of medical officials is attempting to put together a set of protocols to expedite care for patients suffering the deadliest kind of heart attack -- protocols that may particularly affect where Beaufort County EMS responders take patients they pick up in northern Beaufort County. "S.C. Mission: Lifeline" is a partnership among groups that include the S.C. Hospital Association and the state chapters of the American College of Cardiology and the American Heart Association. Among other things, the group wants to create a statewide protocol directing where EMS responders take patients suffering ST Elevation Myocardial Infarction, or STEMI, the most serious type of heart attack, according to Dr. Rick Foster, senior vice president for quality and patient safety for the S.C. Hospital Association. Similar to the statewide trauma protocols directing EMS responders to take trauma patients to the hospital best-equipped to treat them -- not necessarily the closest one -- the STEMI protocols may tell emergency responders to take patients suffering the deadliest type of heart attack to the hospital where life-saving surgery can be performed, Foster said. Again, this is not necessarily the nearest hospital, he said. Foster said the protocol likely would instruct emergency responders to take STEMI patients to the nearest facility only if they're unstable -- for example, if they're experiencing cardiac arrest and may die en route. Hilton Head Hospital is the only facility in Beaufort County equipped to perform the life-saving operation necessary to treat STEMI patients, officials there said. Hilton Head Fire & Rescue Division responders take all STEMI patients on Hilton Head Island there, officials said. Beaufort County EMS responders also take patients they pick up south of the Broad River to Hilton Head Hospital, a county EMS official said. Currently, however, Beaufort County EMS takes most heart attack patients in northern Beaufort County, including STEMI patients, to Beaufort Memorial Hospital -- a facility where clot-busting drugs may be administered as an interim treatment, but that is not equipped to perform the invasive surgical procedure to re-open coronary arteries, according to Julie Williams, a training officer for the county EMS system. Less severe types of heart attacks may be treated at Beaufort Memorial, but patients who receive interim clot-busting treatment for STEMIs there still must be flown or taken by ambulance to Hilton Head Hospital or hospitals in other counties where the surgery may be performed -- a transfer that costs valuable time, she said. The new protocols, which Foster hopes will be in place by January 2010, "will help us," Williams said. But she said she hopes to begin discussions -- possibly this week -- with Beaufort Memorial well before those protocols take effect. "Our intention is to recommend bypassing the facility (Beaufort Memorial) and taking them (STEMI patients) directly to Hilton Head" or if they're on Fripp Island or near Sheldon, flying them from the scene, Williams said. Williams said the county also is trying to implement another change in the way it respond to STEMI patients. Currently, county EMS responders transmit northern Beaufort County patients' EKGs to Beaufort Memorial only. Williams said technology is becoming available that would allow responders to transmit the EKG to Beaufort and Hilton Head simultaneously -- a change that could expedite care for those patients at Hilton Head Hospital, she said. - Renee Dudley You may be suffering a heart attack if you experience chest pain, especially if the pain radiates into your neck or left arm; shortness of breath; and profuse sweating, medical officials said. "Do not wait to call 911," Dr. Rick Foster of the S.C. Hospital Association said. The longer you wait to seek treatment, the more damage you may do to your heart, he said.

Improved technology and advanced cooperation between Hilton Head Hospital and two local EMS systems over the past two years has led to a drop in the amount of time it takes to get patients suffering the deadliest kind of heart attack into surgery, local hospital and EMS officials said in recent interviews.

The process improves patients' chances of survival and diminishes the threat of long-term damage to the heart, officials said.

When patients suffer serious heart attacks, every minute that passes before life-saving treatment begins at the hospital diminishes their chances of returning to a normal lifestyle, medical officials say.

That's why, starting about two years ago, Hilton Head Hospital and local EMS officials began coordinating their responses to patients suffering ST Elevation Myocardial Infarction, or STEMI, the most serious type of heart attack. In that type, a blood clot in the coronary arteries severely blocks the flow of oxygen to the heart.

STEMIs are detected by an abnormality on the patient's electrocardiogram, or EKG, and are different from less severe types of heart attacks because blood and oxygen supply is blocked for a prolonged period and a large amount of heart muscle is affected, emergency responders said.

Hilton Head Hospital is the only one in the county -- and one of 17 in the state -- to have a cardiac catheterization laboratory, or cath lab, where the life-saving surgery to re-open blood flow to the heart may be performed, according to Tom Neal, director of cardiovascular services at the hospital.

Guidelines set by the American College of Cardiology and the American Heart Association recommend "door-to-balloon" time -- the amount of time it takes to get the patient into surgery after arriving at the hospital --of less than 90 minutes. The balloon is the device used to reestablish blood flow to the heart.

Two years ago, the hospital was able to meet this goal, Neal said.

Now, after two years of implementing the national recommendations, including one in which paramedics initiate the diagnosis in the field, that time has dropped to an average of 72 minutes, he said.

"Getting EMS involved was one of the biggest opportunities we had to improve patient outcomes," Neal said. Waiting too long for a procedure called emergency percutaneous coronary intervention, or PCI, "can be the difference between returning to your normal lifestyle or being what I call a 'cardiac cripple' for the rest of your life," he said.

Emergency medical technicians and paramedics in the Hilton Head Fire & Rescue Division and in the Beaufort County EMS system have trained to be able to recognize signs a patient may be suffering a STEMI, officials from those departments have said.

When they respond to patients who are possibly suffering heart attacks, EMTs take an EKG at the scene.

When the hospital began implementing nationally-recommended guidelines for STEMI patients two years ago, the EMS systems used technology that allows them to wirelessly transmit the EKG to the hospital from the patient's home or from inside the ambulance, EMS officials said. Previously, emergency room doctors would see the EKG only after the ambulance arrived at the hospital.

Hilton Head Fire Chief Lavarn Lucas said the technology allows the patient to bypass the emergency room and go directly to the cath lab for final diagnosis and surgery.

"Before, the paramedic may have recognized it on the EKG, but still had to take the strip in the ER, then the doctors would decide there," Lucas said.

Emergency room doctors are alerted to the from-the-field transmission and then may call a "Code STEMI" if they see an abnormality on the EKG. When that happens, the team of doctors and nurses who perform the emergency surgery are paged simultaneously -- they have 30 minutes to get to the hospital -- and the coronary cath lab is prepared for the incoming patient.

Hilton Head Hospital spokeswoman Kelly Presnell said the hospital receives a total of about 30 transmissions a month from the two EMS systems. Emergency room doctors call a Code STEMI for an average of four of them each month, she said.

In the two years the hospital has used Code STEMI to expedite care, there have been only one or two false alarms in which the patient wasn't actually suffering the deadliest kind of heart attack, Neal said. The determination is made by taking a coronary angiography, or x-ray picture of the heart, he said.

Neal said he'd rather the emergency room doctors err on the side of caution and call a Code STEMI if they suspect the patient may be suffering one.

"Even if it's not a STEMI, they still may need to go to the cath lab," he said.

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