2013-02-05 / Front Page

Owen County EMS Staying Ahead Of The Curve With Cath Lab Preparations

Vital Steps In Protocol Help In Preventing Cell Loss In Heart Muscle
by Michael Stanley
Staff Writer

Owen County Emergency Medical Services Director Cris Lunsford compares 12-lead EKG readings of patients, one with chest pain and high blood pressure, the other experiencing a STEMI heart attack. (Staff Photo) Owen County Emergency Medical Services Director Cris Lunsford compares 12-lead EKG readings of patients, one with chest pain and high blood pressure, the other experiencing a STEMI heart attack. (Staff Photo) In the business of saving lives, the Owen County Emergency Medical Service is taking strides to help prevent heart tissue damage through tasks in the field that streamline a patient’s inevitable trip to a cardiac catheterization lab.

An estimated 30 percent of heart attacks in the United States are deemed as STEMIs, or ST segment elevation myocardial infarction, which occur when a coronary artery is at least partially blocked by a blood clot.

“I wish we had one million dollars’ worth of equipment and it never had to leave the building... we want to be prepared, but we hope we never have to use it,” EMS Director Cris Lunsford said. “We’re pretty active with the cath lab at Bloomington Hospital, we try to work with them as much as we can. You hear that time is muscle and without us having a hospital here, we are very conscious about conserving time. Prior to our push to work aggressively on STEMIs we would always have to wait until we got to the hospital for the doctor to diagnose. Now we’re identifying STEMIs and doing more things from the field.”

Lunsford noted that the area’s primary hospital joined a nationwide initiative sponsored by the American Heart Association entitled, Mission Lifeline.

According to Lunsford, the initiative mandates that if a patient is identified as having a STEMI, “from the time the patient comes in contact with a medical professional, in this case, us, they want that patient to have an intervention of a heart catheterization within 90 minutes. It’s saving muscle, saving the heart, but that is challenging when you’re out this far.”

Through the initiative, the Owen County EMS received grant funding from IU Health-Bloomington Hospital to install modems into the department’s 12 lead heart monitors or Lifepak defibrillators.

“Our training allowed us to identify STEMIs and the modems allowed us to send a copy of the EKG to the hospital,” Lunsford said. “The hospital’s computer evaluates it and if it’s a STEMI, it will forward on to the doctor who’s oncall in the cath lab and to the emergency room. Right now, we’re very accurate on our diagnosis, about 95 to 98 percent.”

Once EMS personnel establish that a heart attack is a STEMI, the department’s new protocol mirrors procedures taken by outlying general hospitals without cath labs.

“In this instance we are bringing the hospital to the patient,” Lunsford said. “Following a treatment pathway used by critical access hospitals we should be getting these patients prepared to go right to the cath lab. We can get the patient out of their clothes and into a gown. We already give them aspirin and nitroglycerin. We normally just start one IV and draw lab work, but they want two IVs so now we start two. Further down the line it’s suggested outer lying hospitals give Heparin before they transport them to Bloomington, so now we are doing that. Heparin blocks the clotting factor or clotting cascade and can start breaking down clots; there is a checklist we perform before we give Heparin to ensure the patient does not have any contradictions to the medication.”

As the only ambulance service in the surrounding area providing Heparin to STEMI patients, Lunsford had the foresight to use specific wrist bands similar to those from the hospital to identify that a patient had received a specific dose of Heparin to prevent over medicating once in the catheterization lab.

Luckily, the EMS has yet to have the need to provide Heparin to an Owen County resident.

“What it’s about is time, it’s muscle. Every second your heart is going without oxygen to a certain part of it, you’re having cell death, which leads to heart failure and decreases the ejection fraction of your heart, the amount of blood it takes in one beat and then expels,” Lunsford explained. “Our goal is to do our part to beat the 90-minute time, and to do it as quick as we can. We are especially challenged at nighttime because the Cath lab is not staffed, so we try to get the cath lab called in early so they’re in there when we arrive. What our new protocol does is cut time off of their time in the cath lab – if we didn’t give Heparin, or put them in a gown or start the second IV, that’s what they would do when they got to the cath lab, which is time that they’re waiting before making the incision in the thigh and starting to run the catheter to the heart. Every second we cut off of the time is heart cells we’re saving.”

Since starting these steps (minus the dose of Heparin) the EMS has seen patients sustain zero heart damage due to a heart attack.

“It was because we were treating them aggressively with medications we we’re allowed to give, so we were warding off damage to the heart,” Lunsford said. “Luckily the patient was able to get right into the cath lab and be opened up before any cells were lost.”

The average ambulance drive from Spencer to IU Health-Bloomington Hospital is 20 minutes, meaning many trips from outlying areas in Owen County happen during vital moments in a patient’s treatment phase.

“By the time we identify the heart attack, transmit the EKG and getting going, we can be 45 minutes out sometimes,” Lunsford said. “So it can take about an hour or so to get to the hospital if we’re in Coal City or up north somewhere. If they’re having a STEMI, we take them to a hospital with a cath lab, because if we take them to a critical access hospital without a cath lab all they’re going to do is call another ambulance to transport them to a hospital with a cath lab. We can also transport to Union Hospital and Regional Hospital, because there are residents out west who go to Terre Haute. Our protocol says that we can only give Heparin to patients going to Bloomington Hospital because it fits in with their treatment process. After this initial trial period we hope to add Terre Haute Hospitals, but the Terre Haute hospitals are looking to use a different anticoagulant than Heparin so rather than create problems we don’t give Heparin to those patients. That has nothing to do with getting people to go to Bloomington, it’s just a pharmacological therapy issue.”

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