Ohio Crews Help Streamline Heart Attack Care - News - @ JEMS.com

Ohio Crews Help Streamline Heart Attack Care

Almost every local hospital has a center dedicated to heart services.


SUZANNE HOHOLIK, The Columbus Dispatch | | Monday, January 31, 2011

If you are going to suffer a heart attack, central Ohio is the place to have one. "We have three competing health-care institutions, and no matter where you're taken with an acute (heart attack), you should get top-notch care," said Dr. Paul Zeeb, a board member of the American Heart Association's Columbus chapter. "If you compare Columbus to other parts of the country, the care in Franklin County is quite good." And that care starts before you enter an emergency department or catheterization lab.

EMS workers begin treatment on the way to hospitals and relay electrocardiogram information to medical teams waiting there. It's a process carefully honed to save lives. Just ask Sandy Smeenk. During an early-morning teachers meeting last month at Heritage Middle School in Hilliard, Smeenk felt increasingly warm and weak. The symptoms seemed to pass; but later, when Smeenk walked down two flights of stairs to another meeting, both of her arms felt weak. The language-arts teacher turned to a colleague and said, "I wonder if I'm having a heart attack." A 911 call brought Norwich Township Fire Department paramedics, who hooked her up to an electrocardiogram machine and took her to Ohio State University Medical Center. On the way, her EKG data were transmitted to Ohio State's emergency department, catheterization lab and to on-duty cardiologists' phones.

"When EMS calls us and tells us they have a (heart attack), they bypass our ER and take the patient directly to our (catheterization) lab," said Sharon Hammond, nurse coordinator of Ohio State's STEMI program, which addresses the most-serious heart attacks. "We notify everyone, and they move faster," said Capt. Shawn Koser with the Columbus Division of Fire. "It increases the sense of urgency in the hospitals." Heart attacks and cardiac arrest are time-sensitive medical conditions. Going directly to a catheterization lab can mean less damage to the body.

The national standard of clearing a blocked artery once the patient enters a hospital is 90 minutes. Most central Ohio hospitals with catheterization labs beat that. For example, Grant Medical Center averages 48 minutes; Ohio State and Riverside Methodist Hospital both average 52 minutes. One reason is better communication with EMS.

In recent years, all adult Franklin County hospitals began accepting electronic EKG transmissions from paramedics. All Franklin County hospitals, except Dublin Methodist Hospital and University Hospital East, can accept the transmissions 24 hours a day, according to the Central Ohio Trauma System EMS resource guide. "They're the first link in the chain for cardiac care," Dr. Kanny Grewal, chief of the cardiovascular council at Riverside, said of emergency medical workers.

A couple of years ago, the local adult hospital systems gave EKG transmitters to central Ohio EMS agencies. EMS agencies get reports from hospitals on every heart-attack patient they transport. The information includes a time chart so paramedics know how quickly things occurred and the outcome. "Any time we try to improve a process, you have to look at it from beginning to end," said Dr. Timothy Timko, an interventional cardiologist at Mount Carmel St. Ann's. "It's good to give them feedback on how the patient did when they got there. We also have squads observe the procedure (catheterization) and see what we do."

A few years ago, Columbus paramedics started using a procedure to cool cardiac-arrest patients -- a procedure that can increase survival rates and reduce the risk of brain damage. The division told local hospitals they would take such patients to hospitals that could continue the hypothermia protocol started by paramedics in the field. All of the adult hospitals agreed.

Caring for the heart is a lucrative business. Some of the highest insurance payments come from cardiac procedures. Almost every local hospital has a center dedicated to heart services. The most recent is St. Ann's, which is adding a $100 million heart center expected to open in 2014. It will fill a gap in heart services for northeastern Columbus and Delaware County, Timko said. As for Smeenk, doctors at OSU Medical Center knew that she needed catheterization before she was taken out of the ambulance. "I think any time you can bypass an emergency room and get into treatment is good, but especially with a heart attack," she said.

Smeenk, a married mother of three grown children, had 99 percent blockage in a major artery. The artery was cleared 26 minutes after she got to the hospital. She spent two days in the hospital. She is currently in cardiac rehabilitation. "I ended up with very little heart damage and a strong heart as a result of quick action," she said.

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