By Peggy Kreimer
The Kentucky Post
Copyright 2007 The Cincinnati Post
EDGEWOOD, Kent. — St. Elizabeth Hospital has thrown a new lifeline to people having heart attacks in Northern Kentucky. It’s a small data cable which paramedics can attach to their cellular phones to transmit EKG results directly from the ambulance to the emergency room at the hospital’s south campus in Edgewood.
Most ambulances have been using the new equipment for three weeks. By next spring, every paramedic-equipped ambulance in Northern Kentucky will have the capability.
The hospital is buying the cables for every paramedic ambulance in Northern Kentucky, as well as the computer equipment to receive those transmissions and display the EKG results on a computer screen. The hospital spent more than $25,000 on the transmission cords for life squads and buy receiving equipment that puts the EKG directly onto a computer screen instead of a fax. What it really bought, though, was crucial time.
Without the equipment, paramedics could do an EKG — which records how the heart is functioning from 12 views using sensors attached to the body — on board the ambulance or in a patient’s home. Doctors couldn’t see the results, though, until the patient got to the hospital.
“We had to wait until it physically arrived. Depending on where the ambulance is coming from, this can give us up to a half-hour lead time to get the cath lab started,” said Heather Eckart, EMS coordinator for St. Elizabeth’s emergency department.
With the new system, the results are popping up on a computer screen while the ambulance is rushing the patient through traffic. When the patient arrives at the hospital, care teams can be ready to treat immediately.
When the heart muscle is the issue, every minute is crucial, said Eckart. “Time is muscle,” she said.
If blood flow to the heart is blocked, an angioplasty in the catheterization lab can open the blocked artery and get the oxygenated blood flowing.
“The longer that artery is blocked, the more heart muscle is damaged,” said Dr. Stephen Boyer, director of the Cardiac Catheterization Laboratory at St. Elizabeth Medical Center South in Edgewood. Once damaged, heart muscle doesn’t repair itself.
St. Elizabeth’s in Edgewood has the only catheterization lab in Northern Kentucky that can do the procedure in such emergency situations because St. Elizabeth’s is the only Northern Kentucky hospital with open-heart surgery capabilities. Regulations require an open-heart surgery program as a back-up when performing catheterization in emergency situations.
The technology change allowing ambulances to transmit EKG results directly to the hospital is only the latest development in a three-year effort to cut the time between when a patient comes through the hospital doors and when a tiny “balloon” pushes its way through a clogged artery, restoring blood flow to the heart. It’s called the “door-to-balloon time,” and the national goal is an average of 90 minutes.
Three years ago, St. Elizabeth Medical Center’s average was 117 minutes. The hospital put several time-saving changes in place and brought its door-to-balloon time down to 74 minutes. “That’s before this latest equipment,” said Boyer. “We anticipate this may shave another 30 minutes or more off the time.”
Once a patient is in the catheterization lab, the actual angioplasty process to open the artery takes about 30 minutes. “We can’t eliminate that,” said Boyer. “What this gives us is lead time.”
St. Elizabeth Medical Centers already had been working on ways to save time for two years when the American Heart Association launched a nationwide initiative to cut door-to-balloon time last year, asking hospitals to initiate suggested measures toward meeting the 90-minute goal.
St. Elizabeth’s and several other emergency rooms in Greater Cincinnati already had implemented most of the suggestions. One was to use EKGs done in an ambulance to trigger preparing the catheterization lab.
Cincinnati’s Christ Hospital, which has the region’s premier heart program, equipped 14 life squads with the special transmission equipment last year and saw its door-to-balloon time drop to 34 minutes. Christ used a grant from Carl and Edyth Lindner to equip the ambulances, including those in Covington and Hebron.
Covington ambulances were able to fax EKG information to St. Elizabeth Hospital several times, said Michele Halloran, nurse manager of the St. Elizabeth Emergency Department. By getting the EKG information early, the hospital had the catheterization lab ready and waiting. The best time for any singe patient was 20 minutes door to balloon.
“We said ‘This is really working. We need to get this on all the ambulances,’” said Halloran.
Life squads have had portable EKG machines on board for some time. St. Elizabeth’s bought different types of receiving equipment so the medical center could accommodate any EKG equipment a life squad might have, said Halloran.
Now that ambulances have the transmission capability, the medical center and emergency squads are mounting a public information campaign to tell people to call 911 for an ambulance rather than drive themselves or have a friend or relative drive them to the hospital.
The wait until the ambulance arrives may seem long, but those minutes buy immediate care on board and the EKG report that gets to the hospital before the patient does, said Boyer.
“Occasionally, if you walk in the door and everything happens almost perfectly, some cases have been close to 30 minutes,” said Boyer. “The big problem is, if somebody is at home, after hours, and you have to call in the cath lab physician and staff members.
“How quickly can you get the EKG done and read and get the lab prepped? Every month we review the cases and people who drive themselves to the emergency room consistently have higher time,” Boyer said.
“Even before this new system, the life squad could call and tell us they thought they might have a heart attack, and the hospital could be on alert. If you walk into an emergency room, even if you get rushed to the head of the line it will be a slower process than if you came by ambulance.”
Chris Snyder, EMS Director for the Burlington Fire Department, worked with St. Elizabeth’s to purchase the data cables for Northern Kentucky ambulances.
The technology has become available only in the past five years, and it’s saving heart muscle, Snyder said.
“We’re all working for the same thing,” he said. “We’re all working to get oxygen to that heart muscle as quickly as possible.
“Minutes count. Seconds count.”