By Emily Groves
The Baltimore Sun
Copyright 2008 The Baltimore Sun Company
HOWARD COUNTY, Md. — Gene Poligardo awoke in the middle of a November night sweating profusely and feeling pressure in his chest.
His condition quickly deteriorated as an ambulance arrived to take him from his home in Elkridge to Howard County General Hospital.
“If we didn’t get him to the hospital quickly, he was going to go into cardiac arrest,” said Ashley Tartufo, a paramedic with the Elkridge Volunteer Fire Department.
Because of an unusual protocol in Howard County, Tartufo called ahead to alert the emergency room to bring in a cardiac catheterization team. Poligardo went into cardiac arrest minutes after arriving at the hospital. He was revived and immediately taken to the catheterization lab, where the team was waiting.
Howard County is the only jurisdiction in the Baltimore region with a countywide policy enabling a local hospital to assemble a catheterization team based solely on a paramedic’s en route determination.
“It’s hard to tell if someone would have lived or died, but there are cases where we can say someone would have died,” said John Jerome, battalion chief of the emergency medical service training branch of the Howard County fire department.
As much as 30 minutes can be saved, Jerome said, which is significant in the case of a heart attack victim.
“There isn’t a doubt in my mind that it’s saving lives every day,” Tartufo said.
In Baltimore City and Baltimore County, EMS paramedics can call for catheterization teams when transporting to some hospitals. But not all hospitals participate, and there is no jurisdiction-wide policy.
In Carroll County, ambulance staff can call ahead and alert the emergency room that a patient with a serious condition is on the way. In Anne Arundel County, a digital electrocardiogram can be sent from the ambulance to the emergency room. But an emergency room physician must read it before summoning the team.
Many medical and EMS professionals expect the Howard approach to spread. On Tuesday, Howard officials gave a presentation to representatives of other area hospitals at a meeting held by the Maryland Health Care Commission in Baltimore.
Howard County can rely on the EMS provider because, unlike in other counties, a paramedic-level emergency medical technician rides in every ambulance. State guidelines require at least an intermediate-level EMT on all ambulances.
Howard’s paramedics perform a more advanced electrocardiogram in the ambulance, which enables them to make a determination of the severity of the case.
The policy went into effect in August, and through December, 22 requests had been made by EMS providers, Jerome said.
The idea for the policy originated with Howard County General Hospital officials. Under state requirements, hospitals are allowed 120 minutes between when a patient with an ST-elevation myocardial infarction - a type of heart attack - arrives at the hospital and when he is treated in the catheterization lab.
Howard County General is aiming to meet the 90-minute standard of the American College of Cardiology, said Pat Miller, coordinator of the catheterization lab.
The new policy has produced encouraging initial results. From Jan. 1 to June 30, 2007, the hospital had an average arrival-to-treatment time of 101 minutes, according to a Maryland Health Care Commission’s quarterly report. From July 1 to Sept. 30, the most recent quarter for which data are available, that number dropped to 90 minutes.
For Tartufo, the result is more tangible. Poligardo, who is the treasurer for the Elkridge Fire Department and a popular figure there, first met the 23-year-old paramedic at a firehouse function the night he fell ill.
The 60-year-old, who had five artery blockages, including one 90 percent obstruction, made a full recovery.
“If it didn’t totally save my life, I think it made it so I can live a normal life,” Poligardo said.
Two days after Poligardo came home from the hospital, his entire family, including grandchildren, visited the fire department to thank Tartufo and the others who worked that night. They gave her two dozen roses and an “angel poem,” which she keeps in her locker.
But Tartufo shrugs off the praise.
“I just did my job,” the Worcester County resident said. “I did what I was trained to do, and luckily it saved his life.”