Eliminating permanent heart damage is goal of medical community

The Stoddard County Ambulance District (SCAD) recently upgraded equipment to respond to cardiac emergencies which will allow patients to bypass the emergency room and go straight to the Cardiac Catheterization Lab.

Chuck Kasting, assistant manger at SCAD, said the goal of all emergency services is to prevent heart attacks, or in medical terms an ST Elevated Myocardial Infarction (STEMI). Kasting explains that a heart attack actually means part of the cardiac tissue is killed, and it will never rejuvenate. The goal of emergency responders and doctors is to treat the condition before it kills cardiac tissue.

Kasting notes it starts with the patient. Anyone with a history of cardiac problems or disposition to heart problems should know the symptoms of a heart attack, and take immediate action when a symptom occurs.

The ambulance district has worked to keep up with the latest technology and decrease the time it takes for the patient to receive treatment.

The district started sending EKGs electronically from the ambulance to a chest pain center in 2010. At that time, only SoutheastHEALTH in Cape Girardeau was able to receive those transmissions. Currently SoutheastHEALTH and St. Francis Medical Center in Cape Girardeau and the Poplar Bluff Regional Medical Center are able to receive the EKG transmissions. Those are the only three certified chest pain centers in the area.

SCAD purchased two Lifepak 15s recently, manufactured by Physio Control. They already had five Lifepak 12s. They are cardiac monitors which are capable of recording a 12-lead EKG in the field. This allows the paramedic to look at the patient's heart rhythm and send that information to a chest pain center. The equipment also provides an arterial line which accurately gauges blood pressure and provides cranial monitoring to check for a possible stroke. The Lifepak 15 is also a defibrillator. It can monitor infra-red rays through a finger probe and monitors carbon dioxide and carbon monoxide levels.

Kasting says the monitoring is important for field treatment, and becomes even more valuable in getting quick treatment for the patient. The chest pain center receives the necessary information to call the needed staff to the cath lab and have the lab set up for immediate treatment. Often the doctors already know what part of the heart is not functioning properly before the patient arrives. The ambulance personnel have the patient shaved, robed and prepped for the cath lab upon arrival.

"The cath lab team is waiting on us when we get there," Kasting said.

The goal of cardiac professionals is to get the patient from the door of the center to the cath lab for the medical procedure in 90 minutes or less (door to balloon time). Most often stints are used by doctors to open blocked arteries, although sometimes surgery is required.

Medicine is advancing. Stints traditionally have been administered through the groin. The procedure usually takes a few days for the patient to return to activity. A new procedure feeds the stints through the radial artery in the wrist, which allows much quicker recovery time.

The ideal situation would be that stints, or even by-pass heart surgery, are administered prior to a myocardial infarction, or heart attack. This means there is no dead cardiac tissue and the heart is not permanently damaged.

One aspect the ambulance district cannot control is the transport time. Both Cape Girardeau and Poplar Bluff are miles away, and transport time is a factor. It is less of a factor if the paramedic in the field can stabilize the patient and get an IV inserted. No medication can be administered without an IV, Kasting said.

SCAD is working with SoutheastHEALTH of Stoddard County to provide services to help stabilize heart patients when that cannot be achieved in the field or in the ambulance. It would be an intermediate stop where the "door in to door out" time would be the main factor in getting the patient to a chest pain center.

The Lifepak 15 costs between $35,000 and $36,000, depending on the features required.

SCAD pays for personnel to attend a Critical Care Paramedic Class, a 16-week course which provides CCEMPT certification. The course is only offered in St. Louis.

Since SCAD started EKG transmissions in 2010, the door to balloon time has continued to improve for patients, Kasting said.

Preventing permanent heart damage is the goal of ambulance district personnel and the chest pain centers.

It starts with the patient becoming familiar with symptoms and seeking immediate help.