The Clintonville Area Ambulance Service (CAAS) partnered with ThedaCare and Appleton Medical Center (AMC) to conduct a mock patient heart attack scenario on Thursday, Dec. 6.
The mock patient was former CAAS Director Carol Kersten. Erickson Home Medical Equipment allowed CAAS to use their warehouse on 11th Street for the response location.
The scenario began with a call to 911 and continued all the way through transport to AMC. CAAS crew members Andrew Werth and Darlene Peterson responded to the scene.
“The purpose of this drill is to identify time parameters to define areas where savings can be had by every person involved,” explained CAAS Director Don Kimlicka. “Time parameters help determine whether we should use an ambulance for transport, or call in a helicopter.
“On Dec.19, the CAAS will become part of a ‘Code STEMI’ process in cooperation with AMC,” he explained. “Certain calls relating to a possible heart attack may potentially be defined as ST-segment elevated myocardial infarction (STEMI).
“This type of heart attack is one where an artery that supplies blood to the heart muscle is severally occluded, or most commonly blocked,” said Kimlicka. “Often times it comes on suddenly, even when a person is at rest. It may give the classic signs of chest pain, breathing problems, nausea and possible vomiting. It may also be subtle and without pain, but the patient begins feeling sick or weak, with flu like symptoms. The symptoms truly depend on each individual and their medical history.”
Kimlicka said the STEMI heart attack is identified through a procedure called a 12 lead EKG – similar to what hospitals and doctors’ offices provide during routine exams.
“Ten small electrodes and wires are placed on the patient’s body to get a reading of 12 different angles of the heart muscle,” explained Kimlicka. “This procedure is now provided by the ambulance service at anytime there is indication that a heart attack may be taking place. If a STEMI is identified, the crew will immediately notify AMC and activate a ‘Code STEMI’. Depending on the location within our service area, either the crew will begin immediate transport to AMC or contact a helicopter.”
Kimlicka said that in heart attack cases, the main goal is to re-establish blood flow to the affected part(s) of the heart within 90 minutes from the onset of symptoms. This is done by procedures performed within a cardiac catheterization (cath) lab.
A STEMI patient requires quick intervention such as cardiac catheterization and balloon angioplasty to open the blocked vessel and get blood flowing fully to the heart again.
“Before this can been done, there are numerous procedures and several medications administered that need to be completed. Current literature suggests that if these are performed by an ambulance service it can save up to 30 minutes of time,” said Kimlicka.
Clintonville EMS personnel will start the STEMI process in the field, saving valuable time. They are already trained to administer IV lines and oxygen, track the patient’s condition with a cardiac monitor, and provide pain management drugs such as Nitroglycerine, Morphine and Fentanyl. Other drugs, such as aspirin and Plavix, may be administered to prevent blood platelets from sticking together and increasing the clot.
Currently, the STEMI protocol begins once a suspected heart attack patient arrives at a hospital emergency department. Under the new “Code STEMI” protocol, when the patient arrives at AMC or Theda Clark, cath lab staff, along with an interventional cardiologist, will be waiting for the patient. Previously, emergency department physicians would examine the patient and EKG results before initiating the Code STEMI process.
“We are taking the ER out of the picture and putting the assessment back onto the paramedics in the field, including Clintonville,” said registered nurse Julie Thompson, ThedaCare’s STEMI and EMS coordinator. “Time is heart muscle, so we will eliminate all unnecessary pit stops.”
ThedaCare already ranks among the top two percent of health facilities across the country for its fast “door-to-balloon” time – the time it takes to get heart attacks patient from their arrival in the emergency department to surgery in the cath lab.
More than 98 percent of ThedaCare patients experience a door-to-balloon time of less than 90 minutes, which is the standard set by the American College of Cardiologists. ThedaCare’s average time is roughly 37 minutes.
The implementation of field STEMI aims to improve the time even more for suburban and outlying areas that are further away from ThedaCare’s catheterization labs, which are located at Appleton Medical Center and Theda Clark Medical Center in Neenah.
“We are trying to speed up the triage process and this was the next logical step in cutting down time,” said Peter Ackell, MD, an interventional cardiologist and president of Appleton Cardiology Associates. “This will help better serve the suburban and rural communities that we don’t reach with our helicopter service. They are close but not next door.”
“Prior to initiating this process, it is important to practice all the steps – that’s why we conducted the mock patient scenario on Dec. 6,” said Kimlicka. “Although this type of call only occurs 12-20 times per year for the CAAS, outcomes are greatly enhanced by following these procedures, as outlined.”
Kimlicka says the most crucial step in the whole process is early recognition by the person affected.
“People will often shrug off symptoms and deny that they are having a heart attack,” commented Kimlicka. “The best advice that can be given is if someone has symptoms that they can’t easily explain, they should call 911 immediately. Be sure to give the dispatcher all information they ask, especially your current location. With the advent of cell phones, the call can be placed at a different location than the location of the person. Stay on the phone with dispatch until they tell you to hang up.”
Kimlicka said future drills will take place with other facilities that provide cardiac catheterization, so regardless of which hospital the service transports to, residents with STEMI will receive the same initial care to facilitate reduced time to cath lab intervention.
Any citizens with questions regarding this new process are encouraged to contact the CAAS at 715-823-5967.