By Nicole Foy
San Antonio Express-News
Copyright 2007 San Antonio Express-News
SAN ANTONIO, Texas — Larry Scott can’t help but compare. When his 49-year-old brother suffered the heart attack that killed him a decade ago, he was alone at home in a remote Illinois farming community, 30 minutes from the hospital that could have helped him.
But when Scott, 58, had a heart attack at work in October, the medical response was so quick that a San Antonio hospital system now holds him up as a model case of the way to provide emergency care to such patients.
Only 27 minutes — well under the medical guideline of 90 — elapsed between the time Scott arrived by ambulance at Northeast Baptist Hospital and when a cardiologist performed an angioplasty to reopen three clogged places in the arteries supplying his heart with blood.
“There was no one around to help my brother — he didn’t have a chance,” Scott said. “But I had everything going for me.”
The stars aligned for Scott for a variety of reasons, most having nothing to do with luck.
Rather, they are factors that San Antonio hospitals, as well as those across the country, have been meticulously studying and trying to control as part of a large-scale effort to improve survival rates in the most severe heart attack cases.
Officials from San Antonio’s busiest hospitals for emergency heart attack patients said that since January, their systems have been averaging times under the 90-minute standard. But they spent the better part of last year streamlining processes to try to shave precious minutes off each case.
Research shows that if a severe heart attack patient’s blocked arteries can be reopened within 90 minutes of arriving at the hospital, the risk of dying is cut 40 percent. According to a recent national study, only about one-third of U.S. hospitals provide emergency care quick enough to meet that life-saving standard.
It takes nothing short of a culture change for medical systems to reduce the time it takes to treat acute heart attack patients, said Elizabeth Bradley, a professor at the Yale School of Public Health who helped conduct the study, released in November. Bradley and Dr. Harlan Krumholz, a Yale professor of medicine and public health, found that if every hospital met the 90-minute guideline, it would save about 1,000 lives each year.
“It all comes down to how hospital teams work together, and it really requires incredible coordination,” Bradley said.
The study surveyed 365 hospitals between April and October 2005 on what procedures they have in place to get patients to angioplasty quickly. Hospitals agreed to participate if they weren’t individually identified.
Northeast Baptist began its so-called “door-to-balloon” program last spring and has been fine-tuning it since. It’s taken intense commitment from administrators, medical staff and paramedics, but the hospital has consistently been getting severe heart attack patients in to angioplasties within 70 minutes for the past six months, said Danny White, director of the hospital’s cardiac catheterization lab, or cath lab.
Like other hospitals, Northeast Baptist follows a checklist of scientifically proven ways to better beat the clock. The new approach hinges on triggering the mobilization of the hospital’s cardiac team from the field, to be ready before or just as the patient arrives.
Coordination with area paramedics has been key. They now have specialized electrocardiograms in ambulances and can perform sophisticated tests while en route to the hospital to determine if a patient is suffering an acute heart attack.
Paramedics relay the results to an emergency physician over the phone or via wireless fax transmission. The physician, with a single call to a page operator, can activate the cath lab and medical staff instead of awaiting approval from a cardiologist, as had been done in the past.
White said his team has 30 minutes to get in after receiving such a page. A few staff members have even moved closer to the hospital recently in order to better respond to such emergencies, he said.
Dr. Donald Gordon, director of San Antonio’s Emergency Medical Services, said the city’s 35 ambulances were equipped in May with what are known as 12-lead EKGs, which produce 12 detailed looks at the heart. Each testing unit costs about $24,000, he said.
Paramedics were trained to use the machines and can now diagnose a serious heart attack from the field, he said.
But some local cardiologists and hospital officials have complained that although private ambulance companies around the area have the technical capability to transmit EKG results into hospitals via wireless fax, San Antonio EMS does not.
Gordon said it was a nonissue because his paramedics simply place a phone call while en route to relay the results.
“That’s not important — that’s just touted by the instrument makers to sell more gear. It would just add time to the transport,” he said.
Dr. Max Garoutte, a local cardiologist, said seeing the transmitted reports can help reduce false positives. In confusing cases, the emergency physician who receives the results can provide another set of eyes to help diagnose an acute heart attack, he said.
Scott was taken to Northeast Baptist by San Antonio EMS, and the oral report helped trigger the hospital’s door-to-balloon team. Once he arrived, Scott was rushed almost immediately from the emergency room into the cath lab, where Garoutte used three balloon stents, a type of wire scaffolding, to prop open his blocked heart vessels.
“I saw the swarm and I thought, ‘Boy, am I glad these people were ready,’” he recalled. “Then the crowd seemed to follow me around like I was some kind of star or something. ... Thanks to them, I’m here today and I feel better than before it happened.”