BY: RHODA WEISS
Ms. Weiss is a Santa Monica, CA-based health care consultant and speaker.
When a person suffers a heart attack, the best clinical outcomes are achieved
when he or she is treated within two hours of the onset of acute symptoms. Treatment
benefits decline as further time elapses.
Health care providers have instituted various communications and medical strategies
to reduce the time between onset and treatment. Among these strategies are patient
education initiatives, specific clinical protocol development for emergency
departments (EDs), and the transmission of preadmission electrocardiogram (ECG)
tracings from emergency medical services (EMS) vehicles to EDs.
Several states (and communities within them) are working together to speed
the identification and treatment of myocardial infarctions—heart attacks—which
are today the number one cause of death in the United States.
A North Carolina Program
One example of such a program is the North Carolina Acute Coronary Response
ECG Study (NC CARES), which was begun in the early 1990s. A comprehensive community-based
program, NC CARES is dedicated to finding ways of ensuring earlier ECG use among
EMS teams in the field, thereby improving the recording and interpretation of
ECG data. The territory covered by NC CARES includes rural, regional, and tertiary
medical centers in eastern and central North Carolina. The program has made
great strides in encouraging community hospitals to partner with EMS teams and
save lives.
One of the hospitals participating in NC CARES is NorthEast Medical Center
in Concord, NC, a suburb just outside Charlotte. "For more than 15 years, cellular
transmissions of ECGs to receiving stations in hospitals have been commonplace,"
says Mark Rado, RN, clinical director of the ED at NorthEast. "This initiative
has been shown to reduce the time from the EMS's arrival at the scene to successful
transmission of the ECG to the ED."
To speed treatment, a more advanced program was recently developed by NorthEast
and the Cabarrus County EMS. With it, ECG data taken from a suspected heart-attack
victim can be directly transmitted not just to the hospital ED but—via a hand-held
computer device that employs a wireless modem—to a cardiologist as well.
The great thing about this advanced communications method—called the "digitized
heart imaging information system"—is that it can provide life-saving treatment
for thousands suffering from heart attacks, according to Dari Caldwell, PhD,
chief operating officer at NorthEast.
Initiated earlier this year at NorthEast, the new digitized system links paramedics
throughout the county to cardiologists and emergency medicine teams at the hospital.
It has enabled NorthEast to establish a national record for what is known as
"door-to-dilation" response time.
"Door-to-dilation" response time, according to Rado, is the time elapsed between
the patient's arrival at a cardiac catheterization laboratory and the successful
completion of an angioplasty procedure to alleviate the effects of a blocked
coronary artery. The national average of such times is 104 minutes. The shortest
previous time recorded by the American College of Cardiology was 39 minutes.
Recently NorthEast Medical Center recorded a response time of 33 minutes.
The process involves preparing the catheterization lab to receive the patient;
assembling the team that will perform the angioplasty; prepping the patient;
locating the artery blockage; and inserting into the blocked artery a balloon
device that, by removing the blockage, will reduce the patient's pain and other
symptoms. All this must be done quickly, before lack of blood flow damages the
heart muscle.
A Case History
One of the first Cabarrus County residents to benefit from this new technology
was a 41-year-old Concord resident who experienced chest pains while exercising
at a gym. Returning to his home, he complained about the pains to his daughter.
She called the EMS. When the paramedics arrived, they immediately taped ECG
leads to the man's chest.
The ECG data went straight via cellular transmission to Paul Campbell, MD,
a cardiologist on call at NorthEast. Dr. Campbell read the ECG tracings transmitted
from the patient's home and quickly determined that he needed an immediate cardiac
catheterization because of blockage of a coronary artery. Dr. Campbell knew
that if proper blood flow were not quickly restored to the patient's heart muscle,
he could sustain severe heart damage and perhaps even die.
Dr. Campbell told the paramedic team, "Take the patient directly to the catheterization
lab." He also notified the catheterization team that it must hurry to the lab
and prepare it for the patient's arrival. When the ambulance pulled into the
ED 19 minutes later, the lab was ready for the patient, who was taken straight
to the catheterization lab, where Dr. Campbell and the team awaited him.
The door-to-dilation clock started the moment the patient was wheeled through
the lab door, and, 33 minutes later, Dr. Campbell successfully established good
blood flow through the affected coronary artery to the heart muscle. "Under
normal circumstances, it takes 30 minutes just to get the team assembled, but
this experience proved that new technology and training can really pay off,"
Dr. Campbell says.
Good News for Infarction Victims
In NorthEast's case, the new technology and training was funded by the Duke
Endowment and William T. Morris Foundation, which together gave more than $175,000
to provide EMS personnel and cardiologists in Cabarrus County with field-transmission
ECG devices and receiving equipment. In addition, the grant provides English
and Spanish language materials to help people become more aware of warning signs
and symptoms.
As part of the project, NorthEast and Cabarrus County EMS is conducting clinical
research in collaboration with Duke University. "A team of doctors at Duke will
review analysis and reporting of data collected during the year-long study,"
says Dianne Snyder, RN, executive director of NorthEast's department of Health,
Wellness, and Community Outreach. Bringing the project to fruition required
more than two years of research, grant application work, and training.
The hospital's public relations department is also part of the team, according
to Lee Brower, director of public relations and marketing at NorthEast.
Copyright © 2003 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.