Identifying Heart Attacks in the Field Means Faster Care – “Time is Muscle”


time saves muscleTHUNDER BAY – HEALTHBEAT – November 6, 2011. 2 am. Superior North EMS receives an emergency 911 call about a man who is in extreme physical distress – so much so that the first paramedics on the scene request assistance from a new specialized team.

“He was in critical condition when we arrived to assist the first team,” said Rob Plummer, a paramedic from Superior North EMS. “When we applied the 12-lead electrocardiogram (ECG), it was clear from the snapshots of his heart that there were sections that were completely deprived of blood and oxygen.”

As it turned out, it was Thunder Bay’s first positive identification of a “ST-Elevated Myocardial Infarction” or STEMI in the field. Paramedics were able to call ahead to the Emergency Department at the Thunder Bay Regional Health Sciences Centre so staff could prepare for the patient’s arrival.

Often when EMS arrives, patients will have symptoms similar to heart attack like chest pain and shortness of breath. In fact, when the program first started, the ECG showed negative results 15-20 times before they first positively identified a heart attack.

Now that EMS can get a confirmed STEMI in the field, they can call ahead to the Emergency Department so that they can prepare for the patient’s arrival.

“We have the results come up on a print out immediately… so now we can be very helpful in getting patients in to [the Emergency Department] faster,” Plummer said.

That’s important because time is muscle.

“The program is critical due to its positive effect it can have on patient outcome,” said Wayne Gates Deputy Chief of Superior North EMS.

Studies have shown that getting the artery reopened with angioplasty in 90 minutes or less can greatly increase positive outcomes including saving heart muscle, reducing recovery time, and reducing hospitalization.
“In the past, it might take an hour, an hour and a half. Now we suspect we’ll be having times of about 30 minutes from first patient contact until they are into [the Emergency Department] and being prepped for the Cath Lab,” Gates said.

The program developed in partnership between Superior North EMS, the Base Hospital Program – NW Region, and the Health Sciences Centre.

“Our biggest role was being able to give paramedics the tool to do 12-lead in the field. That’s key because that speeds up the process so much,” he said.

Now all 80 or so paramedics in Thunder Bay have been trained in STEMI identification, and all ambulances are equipped with a 12-lead ECG machine. The program will be rolled out to other Superior North EMS bases in the region in the future.

A large part of the success of the program is the fact that the region has highly skilled paramedics.
“We’re very lucky that we have some extremely good medics in this region,” said Karen Coulson, Clinical Educator with the Base Hospital Program, NW Region.

To date, four heart attacks have been positively identified in the field, and Gates said he expects they will see up to about 30 STEMIs per year. In one case, the EMS team caught a heart attack earlier than might have been done previously.

“We had one lady that was just feeling generally unwell – no chest pain or anything. They did a 12-lead on her, and found she had a STEMI. Normally that wouldn’t have been picked up and she might have been brought in as a [lower-priority patient],” Gates said.

For paramedics like Rob Plummer, that in itself is rewarding.

“The first time we had findings, [I thought] this is definitely someone who will benefit from rapid transport – it was very exciting,” he said.

In the photograph: Don Lemieux, a paramedic with Superior North EMS, holds up an example of an ECG graph showing a STEMI heart attack. Training paramedics to positively identify heart attacks in the field will mean faster care for patients – and that’s important when time is muscle.

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