Chief's Blog

Tuesday, January 17, 2012

New Technology Makes Diagnosis Possible During Ambulance Transport


Those with Heart Attack Symptoms Should Always Call 911

Rockville - An updated EKG (electrocardiogram) system that transmits heart rhythm data and vital signs is now available in Montgomery County advanced life support ambulances making it possible to notify Emergency Department physicians within moments of a paramedic diagnosis,  saving valuable time during transport to the hospital.

Background

The window of time from when a patient starts experiencing heart attack symptoms to the moment the patient receives treatment is a critically important period. This newly acquired equipment allows paramedics to send critical data directly and securely from remote locations to awaiting area hospitals and accelerates the diagnosis process while shaving off critical time that can ultimately make a difference in patient outcome and survival. While hospitals and first responders have many protocols in place to ensure that cardiac patients are diagnosed and treated quickly, providing this early diagnosis “en route” ensures that the hospital team will be mobilized and standing by to intervene with angioplasty, as needed, so that blocked heart vessels can be opened, blood flow to the heart restored and heart muscle (and lives) saved.  This time period from diagnosis to the opening of the vessels is known as “door to balloon” or D2B time. According to guidelines by the American Heart Association, optimal D2B time is 90 minutes or less.

“This technology is the perfect example of collaboration at work to save lives,” said Fire Chief Richard Bowers. “The technology enhances our ability to network with the hospitals, speed up care for heart attack victims and provide critical patient care and it’s already made a difference in the lives of several patients since the system was implemented.”

Problem

The signs and symptoms of a heart attack can be subtle and hard to identify. “One of the biggest challenges is that too often victims of heart attacks will ignore symptoms or choose to drive themselves to the hospital when they suspect a possible heart attack,” said EMS Chief Diane Zuspan. “The best course of action is to call 911 immediately for help. Our paramedics have the training, and now the technology, to diagnose a heart attack on the scene while working with our hospitals to provide the best chance of survival.” 

Patient Story

Mr. Kenneth Courage, age 61, experienced chest pain on July 29, 2011 and called an ambulance.  When EMS arrived at his home they performed an EKG at 10:38 am.  The EKG was transmitted electronically via the LIFENET system to the Suburban Hospital Emergency Department, where Dr. Matthew Leonard confirmed the diagnosis of STEMI (ST- segment elevation myocardial infarction) also known as a heart attack.  A heart attack is caused by a sudden, prolonged blockage of an artery that supplies blood to a large area of the heart. To ensure the best outcome, the blocked artery must be opened quickly with balloon angioplasty performed in a cardiac catheterization laboratory.

Once the diagnosis was confirmed, Suburban Hospital’s “Code Heart” team was activated. On that day the team included interventional cardiologist Dr. Yuri Deychak. Mr. Courage was transported directly to the hospital’s cardiac catheterization lab, bypassing the emergency department. He arrived in the catheterization lab at 11:07 am and his vessels were opened by the Code Heart Team 28 minutes later. The home/diagnosis to balloon catheter intervention time was 57 minutes.

LIFENET, a Web-based system, allows EMS teams in the field to send EKG readings to hospital staff digitally, with the results immediately accessible on desktop computers as well as smart phones. At the hospital, teams of cardiologists, nurses and technologists provide 24/7 coverage in the cardiac catheterization labs. 

All County hospitals which have the Cardiac Intervention Center (CIC) designation from the State of Maryland, including Suburban Hospital, Shady Grove Adventist Hospital, Washington Hospital and Holy Cross Hospital, collaborated with MCFRS to implement the LifeNet System. Each of the hospitals contributed toward the initial equipment purchase and has agreed to support ongoing expenses.   

Since July, many patients have benefited from this new technology and this new process, which applied together with state and local protocols, bypass the Emergency Department and saves valuable time. The difference in minutes can be the difference between life and death.

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