Pennsylvania Medevac, ER Staff use ‘Hot Load’ to Save Time

New procedures are the result of a comprehensive review of how the hospital stabilizes patients experiencing a cardiac event.


CRAIG K. PASKOSKI, The Evening Sun | | Tuesday, November 8, 2011

The sleek blue and white Penn State Hershey Life Lion helicopter gently touches down on the Hanover Hospital helipad and the crew hops out with its equipment and gurney.

The medical technicians, clad in their glistening helmets and matching flight suits, scramble the short distance over to the waiting area inside the helipad tower and within minutes have assumed care of a heart attack victim from hospital staff and prepared her for transport.

All the while, the helicopter's two jet turbine engines are roaring and the rotors spinning.

The process is part of the hospital's new "hot load" procedure in which the Life Lion crew keeps the helicopter idling while the patient is secured and loaded into the helicopter. It's a measure that saves another few precious minutes in a race against time, hospital officials say.

Hospital and Life Lion staff demonstrated Monday a mock "hot load" and other new timesaving steps now used to stabilize and transport certain cardiac-arrest patients to Hershey Medical Center. From the time a patient arrives at the hospital until they receive angioplasty treatment at Hershey is a process hospital officials call "door to device."

The new procedures are the result of a comprehensive review of how the hospital stabilizes patients experiencing a cardiac event called a STEMi and are able to get that person to Hershey. They found the process was typically taking anywhere from 90 to 180 minutes, longer than the national standard of 90 minutes.

"Hanover Hospital really looked at each step to see where time could be saved," said Gloria Sanders, nurse manager for the hospital's emergency department.

"We were realizing our benchmark times were way over what they should be," said Janet Cutsail, supervisor of cardiovascular disease management and cardiac rehabilitation at the hospital.

Along with the "hot load," hospital emergency department personnel now transport the patient to the helipad waiting area instead of having the helicopter crew come down to the emergency room to secure the patient.

"It only takes a few minutes to go down there and back up, but all that time adds up," said Scott Christensen, transportation supervisor and chief flight nurse for Life Lion. "It's that golden hour. Anything we can do to speed things up."

And the Life Lion helicopter does its part, making what would be an hour drive to Hershey in less than 15 minutes, Christensen said.

Improved communication has also shortened the process. Emergency medical personnel in the field can often perform an EKG on a patient and send that information ahead to the hospital. If the EKG reveals the patient is experiencing a STEMi cardiac incident, hospital staff can in turn notify the Heart Alert Center at Hershey to prepare for a hot load.

Since implementing the hot load and other procedures, Hanover Hospital and Life Lion have been able to drastically reduce the "door to device" time.

"It's cut down tremendously on any delay," said Dr. Steven M. Ettinger, interventional cardiologist at Hershey Medical Center. "All of the cases have been about 20 minutes less than what we were doing before. It will have a tremendous impact on the treatment of patients in this region."

Ettinger emphasized that time is crucial in treating heart attack victims. He said a medical team waiting at Hershey would generally be able to insert a balloon device to open a patient's blocked artery within minutes after arrival.

Hanover Hospital has only had to use the "hot load" procedures a half-dozen times since initiating the measures in June, but it has had great results. Sanders said the last STEMi patient received treatment at Hershey Medical Center 63 minutes after being brought in to Hanover Hospital.

"It's worked out great. The timing has gotten so short," Christensen said.

Next on the agenda for Hanover Hospital will be a GPS system to help Life Lion pilots navigate to the hospital in bad weather. Hospital officials are hoping to have that operational next spring.

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