City paramedics get technology for faster heart attack treatment

Hospitals donate broadband units to transmit electrocardiograms

May 13, 2010|By Meredith Cohn and Kelly Brewington, The Baltimore Sun

In a broad effort to speed treatment of heart attack victims in Baltimore, five area hospitals are distributing hand-held devices to every paramedic unit in the city that can transmit patients' heart rhythms, or EKGs, to the hospital before they arrive.

Doctors have 90 minutes to open an artery after someone shows symptoms of a serious heart attack before survival becomes far less assured. The hand-held units, which can send information straight to a cardiologist's smart phone, could speed up that treatment by as much as 15 minutes, research shows.

"Ninety minutes, that's the magic number that the emergency room has until a [catheter] needs to be placed," said Dr. Dov Frankel, assistant chief of Sinai Hospital's Department of Emergency Medicine. "Time is muscle."

The technology isn't new — paramedics in 14 counties and a handful of cities in the state use it, as do many other jurisdictions nationally from Iowa City, Iowa, to Dallas. But the hospitals believe the latest effort will have a significant impact because so many hospitals and city units will be equipped.

James Scheulen, the chief administrative officer for the Johns Hopkins Department of Emergency Medicine, initiated the effort to bring the $270,000 worth of hardware and software to the city. Joining Johns Hopkins Hospital were Johns Hopkins Bayview Medical Center, Saint Agnes Hospital, Sinai Hospital and Union Memorial Hospital.

Scheulen and others said there aren't widespread studies that show how many more patients would survive if the technology were employed. But one study published in the New England Journal of Medicine in 2006 showed an EKG done in the field and communicated to emergency room doctors could shave up to 15 minutes off the front end of treatment.

That can help doctors achieve a "door to balloon time," which means an angioplasty or some other artery-opening treatment, in under 90 minutes, said Dr. Jeff Trost, assistant professor of medicine and director of the Cardiac Catheterization Laboratory at Johns Hopkins Bayview Medical Center.

He said Johns Hopkins Hospital and Hopkins Bayview annually treat about 100 to 120 of the severe type of heart attacks that result from complete blockage of an artery called a STEMI, or ST segment elevation myocardial infarction. They account for about 15 percent of heart attacks nationwide.

Nationally, he said, 1 in 20 heart attack patients dies within 30 days if they receive angioplasty or other appropriate treatment within the 90-minute window. For those who miss that treatment window, the rate climbs to 1 in 6.

At St. Joseph Medical Center in Towson, where the mobile technology was first used in Maryland in 2007, doctors have been able to intervene an average of 15 to 30 minutes faster on STEMI patients, said Dr. Gail Cunningham, the hospital's chief of emergency medicine.

Upon receiving the EKG, an emergency physician can notify a cardiac catheterization team, which includes interventional cardiologists and specialized nurses who work to clear the blockage in a blood vessel that is causing the heart attack. Such specialists aren't on staff at a hospital during nonpeak hours and often need to be called in from home. Doing so before a patient arrives saves vital minutes, Cunningham said.

"It's helped us tremendously," she said. "Each time we get one of these calls we're able to mobilize the people we need to mobilize. We can get a room cleared, get the drugs lined up. Everything about the patient's care is improved if we have advanced notice they are coming."

While these kinds of severe heart attacks are not the norm — St. Joseph's emergency room gets about 8-10 such patients a month — they can be devastating, Cunningham said.

The technology is particularly helpful for a hospital like St. Joseph, which treats patients from the immediate Towson area as well as rural parts of Baltimore County that can be up to a 25-minute ambulance ride away, she said.

Dickson Henry, the Baltimore City Fire Department's deputy chief for emergency medical services, said getting the 36 mobile devices has been in the works for about a year. The cost was high for the city or one facility, and he was pleased the hospitals donated technology he believes will save many patients.

In Baltimore, paramedics would not necessarily be transported to one of the five hospitals that donated the equipment and already have corresponding technology to receive the information on their own smart phones or computers. The information, however, can be communicated other ways to the emergency rooms, and other hospitals can acquire the mobile technology, said Hopkins' Scheulen.

Ambulances in Maryland go to the closest appropriate hospital, said Jim Brown, spokesman for the Maryland Institute for Emergency Medical Services System, which oversees the state's emergency system. Most paramedics would now deem a hospital with a cardiac catheterization lab the appropriate place to take a STEMI patient, and by fall that will be official policy, he said.

Brown said most Baltimore-area counties already use the technology and Baltimore residents will surely benefit from its use. He said agency officials would like to see the remaining jurisdictions in Maryland acquire it.

"It's not mandated," he said. "But it's really good to have. It really helps the hospitals to have what information the emergency officials in the field have."

meredith.cohn@baltsun.com

kelly.brewington@baltsun.com

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