Since changing the protocol for handling the transfer of ST-Elevation Myocardial Infarction (STEMI) patients in 2005, first responders with the Hialeah Fire Department have decreased door-to-balloon time to 51 minutes.
Working closely with Hialeah, FL-based Palmetto General Hospital, EMS providers can activate the cath lab while a patient who is experiencing a STEMI – the most serious form of heart attack – is en route to the hospital.
As a result, the time that patient is seen at the hospital and intracoronary balloon inflation occurs has decreased from an average of 2 hours and 27 minutes to 51 minutes. By American Heart Association standards, a STEMI must be treated within 90 minutes, before the heart muscle is irreversibly damaged. This decreased door-to-balloon time has led to better patient outcomes.
If a patient is experiencing a STEMI, first responders will immediately call in a STEMI alert, notes Fire Chief Patrick Flynn. Since Palmetto General Hospital is the only hospital in the region that is a recognized STEMI center, a majority of cardiac patients are routed there. Thanks to improved protocols and radio communications, first responders can communicate directly with emergency department physicians who can help make a prehospital diagnosis and begin preparation to treat the incoming patient more efficiently.The Hialeah Fire Department has a similar telemedicine program in place with Palmetto’s Comprehensive Stroke Center. The American Stroke Association recommends that qualified ischemic stroke patients receive the clot busting drug, tPA, within 60 minutes of their arrival to a stroke center. Over the past four years, Palmetto’s stroke program has worked with interdisciplinary specialties to optimize the stroke patient pathway and provide timely care. Palmetto’s average door-to-needle time is 30 minutes, while the national average is 66 minutes, says Flynn.
Through the use of an iPad, first responders will call in a stroke alert. A neurologist on call will then communicate with that first responder on the scene and go over the signs and symptoms, while making preparations to treat the incoming patient.
Flynn points out that his first responders undergo training at the University of Miami to learn about EKGs and troponin levels so they can better evaluate a patient with an active myocardial infarction (MI). This prevents any unwarranted calls to the hospital.
“We’re not perfect, but we’ve become so good over the years that we’re about 92% effective,” says Flynn. “This program has been essential in improving a patient’s outcome. It truly has made a big difference.”
Dr. Mike Diaz, a cardiologist at Palmetto, agrees and adds that implementing any technology with the ability to streamline safe and beneficial care is something all hospitals should consider.“In the realm of STEMI and acute MI care, time to treatment is extremely important,” he says. “Anytime you can institute a program where you can reduce door-to-balloon times safely, it’s certainly something that the hospital and the physicians who are taking care of the patients should be enthusiastic about.”
Dr. Diaz notes that they are fortunate to have a strong program where the door-to-balloon times are well below the county and national average.
“A program like this helps improve patient outcome and leads to shorter hospital stays,” he says. “Any time that you can get physician knowledge out to the field through different technologies, you can help with the triage process. Our goal is to help EMS and first responders provide better care initially in the field so that the patient outcomes improve once they arrive at the hospital.”
One of the keys to success, according to both Flynn and Dr. Diaz, is the working relationship be-tween the two entities.
“Amazing things can happen when you can get two different organizations, such as our fire ser-vice and the hospital, working together for the betterment of the patient. I think that’s the key for a successful implementation,” says Flynn.
A willingness to work together is critical, says Dr. Diaz, because there are always hurdles to overcome. “Anytime you try to put together a good working relationship between an entity outside the hospital, such as EMS providers, and anything inside the hospital, such as the physicians, both parties have to want to work together.”
Dr. Diaz adds that communication is also important in any partnership such as this.
“Some of our STEMI doctors have given EKG courses or EKG tutorials to the EMS providers,” he says. “Through this we have a better understanding of what each of us is seeing because we’re not always seeing the same thing. Our physicians learn what they’re seeing in the field and the challenges they’re having, and the EMS providers learn what we’re seeing and the challenges we face in the hospital. If everyone can have the same knowledge base when it comes to that, I think it streamlines things tremendously.”
