Articles / 2007
New program in county aids heart attack victims
Ventura County Star
By Michelle L. Klampe
If you're having a heart attack, time equals heart muscle. The longer you go without treatment, the more likely your heart will suffer significant and irreversible damage.
In an effort to reduce the time it takes to get treatment for the most severe heart attacks, the Ventura County Emergency Medical Services Department has launched a new program to help emergency workers identify heart attacks and get patients treatment quicker.
The 12-lead STEMI program is named for the 12 electrodes used in the electrocardiogram that diagnoses a ST-segment elevation myocardial infarction, or STEMI. In a STEMI, heart muscle is either dying or dead as a result of the blood supply to the heart muscle being cut off, said Dr. Angelo Salvucci, medical director for the county EMS department.
"Heart muscle has a certain amount of time that it will survive if that blood supply is restored," he said. "Minutes count."
So far, the 12-lead STEMI program has significantly cut (by about 25 minutes) the time it takes for the patient to reach a hospital and begin angioplasty to treat the blockage causing the heart attack, Salvucci said.
"It has really been successful," he said.
The effort began in December after a pilot study in 2005, making Ventura County second in the state behind Orange County to implement the 12-lead STEMI system. Now, all ambulance companies that serve the county (American Medical Response, Gold Coast and Lifeline) are equipped with ECG machines.
Some ambulances already had the machines, and others had to purchase the equipment. For AMR, that meant 25 machines at $17,000 each, said John Wilson, clinical director for AMR in Ventura County. AMR needed to replace some outdated ECGs anyway, so the timing of the new program was good, although it was hard on the budget, Wilson said.
"It was the right thing to do," he said. The paramedics in the field "feel like it's making a big difference in the care of the patients. It's probably one of the best programs we've put in in this county."
If a person reports heart attack symptoms, paramedics will perform the ECG on the scene. The machine, not the paramedic, determines whether the heart attack is a STEMI, Salvucci said. Few patients are actually having STEMIs in Ventura County, he said.
"It's about 8 to 10 per month countywide," he said. "We're truly targeting the high-risk patient who will benefit from this procedure (angioplasty)."
Patients having STEMIs are taken to one of three county hospitals considered "STEMI-receiving centers" because they have cardiac catheterization labs and can quickly mobilize and begin angioplasty to unblock the clogged artery causing the heart attack. The three are Community Memorial Hospital in Ventura, Los Robles Hospital & Medical Center in Thousand Oaks and St. John's Regional Medical Center in Oxnard.
The goal is to reduce the time to 90 minutes or less between the paramedic doing the ECG and the balloon reinflating the artery in a catheterization lab, Salvucci said. The county is already reaching that goal with the new program.
Performing the ECG adds a minute or so to the time paramedics spend on the scene. The saved time comes in being able to take the patient directly to a hospital that offers angioplasty and calling ahead so it can get ready.
"When we know in the field that somebody is coming to the ER with a definite heart attack, we mobilize in advance," said Dr. Tom Kong Jr., an interventional cardiologist and director of the cardiac catheterization lab at Community Memorial Hospital. "It gives us a 15- to 20-minute window to get going" before the patient arrives.
If a patient is treated within 60 to 90 minutes of the first symptoms, the damage to the heart can be almost nothing, Kong said.
Medical advances aside, the most significant way to begin treating heart attacks quickly is to get patients to act more quickly when they have symptoms by calling 911 and taking an ambulance to the hospital, rather than driving themselves, Kong and Salvucci said.
"People tend to minimize it. Sometimes they'll think it's nothing," Salvucci said. "The additional time we're going to gain is going to be by getting people to call (911) sooner."