Health & Medicine - Posted by Debbe Geiger-Duke on Tuesday, June 5, 2012 12:38 - 2 Comments 
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(No Ratings Yet) Loading ...Ambulance-to-ER care critical for heart attacks
"Every second counts when it comes to salvaging the heart muscle and saving lives," says Christopher Granger, a Duke cardiologist and co-author of the study. "This statewide effort was designed to treat patients faster regardless of the challenges posted by geography or healthcare settings." (Credit: Kevin Spencer/Flickr)
DUKE (US) — A coordinated effort between hospitals and emergency services in North Carolina improved survival rates for heart attack patients, a new study shows.
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The text of this article by Futurity is licensed under a Creative Commons Attribution-No Derivatives License.
“When treating heart attacks, the most important care decisions need to take place before the patient is brought to the hospital,” says James Jollis, a Duke University cardiologist and first author of the findings published in the journal Circulation. “These procedures should be in place in every hospital and every emergency service system in the country.”
RACE-ER (Reperfusion of Acute Myocardial Infarction in Carolina Emergency Departments – Emergency Response) is the largest voluntary statewide heart attack care intervention ever undertaken in the United States. Thousands of health care professionals from North Carolina’s 119 hospitals collaborated with more than 500 emergency service agencies across 53,000 square miles.
From July 2008 through December 2009, RACE-ER decreased the time from first contact to medical treatment from 103 minutes to 91 minutes when patients were brought directly to hospitals that performed angioplasty, now known as percutaneous coronary intervention (PCI). Of those patients, 52 percent were treated within 60 minutes.
Treatment times for patients transferred from non-PCI hospitals to PCI centers improved from 117 minutes to 103 minutes. Thirty-nine percent of transferred patients were treated within 90 minutes by December 2009.
“Our intervention demonstrates how competing healthcare entities can work together to overcome the systematic barriers that prevent timely heart attack treatment,” says Jollis. “We were able to embed a standard of care that was independent of what hospital the patient was brought to or where the heart attack occurred.
“By the end of our intervention, our protocols were adopted by state regulation for all EMS agencies, and all hospitals agreed to continue supporting regional care.”
RACE-ER focused on treatment of the most deadly form of heart attack known as STEMI (ST Segment Elevation Myocardial Infarction), which occurs when a sudden blockage in a coronary artery damages the heart muscle. Each year, about 300,000 people have a STEMI, according to the American Heart Association.
National guidelines call for blocked arteries to be opened medically or surgically within 90 minutes of a patient’s first contact with the emergency medical system, either paramedic arrival, or arrival of self-transported patients at the hospital door.
“Every second counts when it comes to salvaging the heart muscle and saving lives,” says Christopher Granger, a Duke cardiologist and co-author of the study. “This statewide effort was designed to treat patients faster regardless of the challenges posted by geography or healthcare settings.
“We coordinated a system of care that starts when the 911 call comes in, includes the care patients receive in the ambulance, and the treatment they undergo at hospitals to restore blood flow in blocked heart arteries. As a result, when patients were treated within the 90-minute door-to-device goal, we were able to reduce mortality rates to 2.2 percent.”
By comparison, the mortality rates stands at 5.7 percent when door-to-device treatment exceeds the 90-minute goal.
RACE-ER also emphasizes the need for paramedics to diagnose heart attacks in the field using ECGs, which can provide necessary information to mobilize interventional cardiology teams. The North Carolina researchers showed that pre-hospital ECG rates for patients transported to PCI hospitals by emergency medical services (EMS) increased from 67 percent to 88 percent.
Using this approach, patients are transported directly to waiting catheterization laboratories. Prior evidence shows paramedics can reliably diagnose heart attacks, and more than half of patients are treated within 60 minutes of hospital arrival.
Duke is now working with the American Heart Association to implement programs similar to RACE-ER in 20 regions across the country including New York City, Philadelphia, Detroit, San Antonio, and Phoenix.
More news from Duke University: http://today.duke.edu/
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2 Comments
The joint venture of hospitals and emergency service provider offers multipurpose facilities to the victims; therefore especially during emergency hour we get proper and beneficial support from emergency service provider. Ambulance are especially hired during emergency hours to carry patient from the homes to hospitals, here we can found how emergency care service helps patient during their emergency needs.
The issue in North Carolina is the sheer distances of things. A family member lives in Columbia, NC and the nearest hospital is 35 miles away.
Where I live the nearest hospital capable of the procedure is 2 miles away. Plus the city is starting to roll out Advanced Life Support vehicles which in essence is just equipping the vehicles with 18 lead portable EKG.
Even more interesting, I note in almost EVERY large retail outlet in the city there are automatic defibrillators in each.
So I’d say the chances of dying from a heart attack are greatly reduced in my city of Providence than they are in say Columbia, NC.
The window here is < 45 minutes and in many cases less than 30 minutes.