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Doctors: Call ambulance during heart attack

Health officials say people are not calling ambulances when they truly need to

By MaryJane Slaby
The Journal & Courier

LAFAYETTE, Ind. — The chest pain started before Edward Lucas finished his first cup of coffee.

It was about 5 a.m. on Sept. 17 when early riser Lucas, a retired high school social studies teacher, noticed the pain. He checked his blood pressure, which he thought might be the cause of the pain, then sat down to rest. But the pain didn’t go away.

"It was a different pain," Lucas said.

So at about 5:15 a.m., he woke his wife, Char Lucas, and told her something was not right and he needed to go to the hospital.

The Monticello couple lives only about 4 miles from IU Health White Memorial Hospital, so Lucas told his wife she could drive him there. But as Lucas was lying on their bed in pain, they decided to call 911 instead.

The reasons for not calling 911 for a potential heart attack are seemingly endless: People are in denial; they don’t want to bother anyone; it’s too expensive; they can drive to the hospital faster; or they believe it’s just indigestion.

But to those who work in emergency care, it’s better safe than sorry. In a heart attack, the saying goes, "time is muscle."

The more time the heart is without blood, the more damage could happen.

Ambulances are like mini, moving emergency rooms to speed things up and treat patients faster, said Dr. Chris Brandenburg, an emergency room physician and medical director for ambulance service at Franciscan St. Elizabeth Health.

That faster treatment is measured by door-to-balloon time, or the time from when a patient reaches emergency room doors to the time he or she is in a catheterization lab receiving treatment. Hospitals are working to reduce this window, because time is critical when a coronary artery is completely blocked by a blood clot, known as a STEMI heart attack.

If a patient calls 911, treatment begins as soon as the ambulance arrives. Treatment and transportation are simultaneous. Plus, the team at the hospital is alerted and can prepare during transportation.

But if a patient goes to the hospital themselves, the transportation is followed by treatment beginning at the hospital, adding more time.

The treatment is the same, but it’s a matter of where that treatment starts, said Mike Fights, STEMI coordinator in the cardiovascular department at IU Health Arnett.

A person may be able to drive to the hospital faster, but cannot activate the catheterization lab team, said Karen Bullard, director of cardiovascular services at Franciscan St. Elizabeth Health.

At St. Elizabeth, the most recent median door-to-balloon time for someone who calls 911 and comes by ambulance is 51 minutes. It’s 69 minutes if the person just walked in to the emergency room, Bullard said.

And at IU Health Arnett, the hospital has an average door-to-balloon time of 54 minutes regardless of how the patient got there, said Mike Wagoner, administrative director of cardiovascular services at IU Health Arnett.

Bullard said the most important thing is to streamline care for a heart attack patient and get them to the closest hospital.

By time the ambulance arrived, Lucas’ chest pain had progressed to numbness in his left arm and jaw.

The heart is supplied with blood by very small coronary arteries, and those arteries can be injured, said Dr. Jay Schlaifer, medical director for the cardiac catheterization lab for Franciscan St. Elizabeth Health.

Schlaifer said plaque repairs the arteries, but when the plaque breaks off it can create a blood clot to block the artery, causing a heart attack.

When EMS first sees someone who might be having a heart attack, they ask the patient questions about the pain and his or her activity, eating habits and medications, said Darrell Clase, director of EMS education at Franciscan St. Elizabeth Health.

They attach a heart monitor and do an EKG as soon as possible. If EMS sees it’s a STEMI heart attack, they call the emergency room ahead to prepare, he said. Clase said the goal is to spend less than 10 minutes on scene.

"A lot of the time the doctor is standing in the garage waiting for us, looking at the EKG," Clase said.

As Lucas was loaded into the ambulance, EMS decided to take him straight to Franciscan St. Elizabeth East in Lafayette. He asked EMS to call his wife once they reached the hospital to tell her they got there safe.

On the ride to the hospital, Lucas said EMS checked his blood pressure, watched his heart on a heart monitor, gave him medication and hooked him up to IVs, explaining along the way.

"I was pleased at getting the attention I needed," Lucas said.

During transfer, Clase said EMS tries to reduce pain and provide treatment if the heart is beating too fast or too slow. He said EMS also starts as many as three IVs so that the patient can receive medication in the hospital right away.

When Lucas reached the hospital, the staff was ready to go. Char Lucas was on I-65 when she got a call: The ambulance had arrived at the hospital, and they were taking care of him.

Clase said he still hears EMS called "ambulance drivers." But calling 911 gives patients an advantage over trying to drive to the hospital or have a family member drive them.

"This is a risk that with today’s technology the public doesn’t need to take," he said.

Char and Edward Lucas said they now know if they had driven to the closest hospital, once Lucas was diagnosed, he would have been driven to a hospital with a catheterization lab. Calling 911 only saved them time.

"This heart attack completely blindsided us," Char Lucas said. The couple, both avid golfers, were supposed to play that day.

Lucas said he had two stints put in two places in the same artery. One spot was completely blocked and the other was 85 percent blocked, he said.

Since his heart attack, Lucas has adjusted his medication and goes to cardiac rehab. He and Char have changed their diet to limit fat and sodium.

Both said they are glad and grateful for the care Lucas received by calling 911.

"We are fortunate that this happened this way," Char Lucas said.

Republished with permission from the Journal & Courier

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