Every second is critical when it comes to a heart attack victim’s survival. Fortunately, since January of 2007, 13 area hospitals, including Balboa Park’s Naval Medical Center, have benefited from a field-based heart care plan that has more than halved the wait time between the event and its conclusion ” to 62 minutes from an average 120 to 140. This also significantly beats the national target time of 90 minutes.
The decrease is due to the implementation of a new program called The Cardiac System of Care, under which para­medics carry special equipment that allows them to diagnose heart attacks in the field. The paramedics can then call any of 13 designated hospitals’ heart attack teams to let them know a patient will soon arrive, allowing the teams to prepare.
In the past, paramedics used a three- or four-lead electrocardiogram (EKG) machine to diagnose patients, but things have greatly improved in recent years.
“The system was put together to take advantage of the [new] 12-lead EKG in the field,” said Bruce Haynes, M.D., medical director of the county’s Emergency Medical Services. “But just as importantly, it was done to get the hospitals reorganized and ready to go so that [hospital personnel] could respond to a definite heart attack notification from the field. This way, they can take the patient straight to the cardiac cath lab.”
Many heart attack victims need cardiac catheterization, so the streamlined process saves vital minutes. This program, however, will not help all patients.
“The kind of heart attack that we’re talking about is the most common, called ST-segment elevation myocardial infarction, or STEMI,” Haynes said. Non-STEMI heart attacks are usually caused by clots or blockages that haven’t stopped blood flow entirely and so are considered less urgent.
“There wasn’t much additional training required, because over the years paramedics have learned how to use a 12-lead EKG system versus the old three- or four-lead,” he commented. “There was just minor additional training in terms of reporting a heart attack into the hospital, how to word that report and how to look out for mimics, things that look like heart attacks but really aren’t, so they could report that as well.”
The 12-lead machines were bought, in part, with a grant from heart patient Jack White, of La Jolla. When White was stricken in 2004, paramedics couldn’t diagnose him because they lacked the proper equipment. White donated $536,000, enough to equip 125 ambulances, but future funding for the program is still uncertain.
“We’ll have to look at that in the future as we have to replace equipment,” Haynes commented. “But I would think it would come from the operating budgets of the fire departments and ambulance companies.”
The choice of participating hospitals was relatively easy.
“Hospitals had to have the facilities, a cardiac catheter lab, that could do emergent angioplasty for heart attacks,” Haynes said. “There were 13 in the county, including the Naval Hospital [in Balboa Park]. Eventually, all the ones that had a cath lab went through a designation process. All were designated following a review and agreement to meet certain standards.”
At this point, the program cannot be expanded, as other hospitals do not have the necessary cath lab facilities.
“With the 13 we have now, there is probably enough capacity for a number of years going in to the future,” Haynes noted.
Though in its infancy, the program has had a major impact. Last month, San Diego County officials reported that 330 patients had been helped under the program from January of 2007 to January of this year.
“The median ‘door-to-angioplasty balloon’ time was 60 minutes, and that’s contrasted to before, when it could be more than twice that,” Haynes said.
For him, the bottom line is simple: “With this, we’re going to directly reduce the death rate from heart attacks.”