STEMI protocol saves time and lives

By Dave Rogers | Published Wednesday, February 1, 2012

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CATH LAB - Lacretia Miles, a nurse in the cardiac catheterization lab at Wise Regional Health System, pulls a gurney carrying a patient into the cath lab at the Decatur hospital as cardiovascular technologist Damien Morales CVT awaits their arrival. Messenger photo by Joe Duty

The ambulance crews for Wise County EMS play “beat the clock” every day when it comes to saving lives.

But they are time bandits when it comes to assisting people having heart attacks. Working with the heart specialists at Wise Regional Health System, they have found a way to steal back precious minutes that can make the difference between life and death.

It’s called the “STEMI protocol,” and it’s a valuable shortcut.

“If our medics are on a call and determine the patient is having a heart attack, we can notify the hospital it’s a STEMI, and they have their people ready when we get there,” explained Charles Dillard, Wise County EMS administrator.

A STEMI is a heart attack in which an artery to the heart is completely blocked, and it is considered much more life-threatening than a non-STEMI heart attack, where blockage is only partial.

“We can’t tell how much blockage there is until we get them up there (to the hospital) and get an MRI,” Dillard explained. “But we can definitely tell if a person is needing intervention. If we see there’s a blockage, we’re going to proceed like it is a STEMI until it’s proven otherwise.”

A STEMI call from Wise County EMS activates the “LifeNet” machine in the cardiac catheterization lab, which is essentially an operating room just for heart patients. The machine calls all the needed personnel, including the on-call cardiologist.

The EMS ambulances, each staffed by a paramedic and an emergency medical technician (EMT), are certified as mobile intensive care units. They can transmit electrocardiograms (EKGs) to the cath lab at Wise Regional.

“As soon as they see that (EKG), they know we’re transporting a STEMI patient, and they can start getting ready, start getting people down there that they need,” Dillard said. “We pull up to the emergency room doors and usually two people from the cath lab will meet us and escort us straight to the cath lab.”

Calling 911 is the most important thing, Dillard said.

“We can get an ambulance to you and as soon as we start treating you, we’re going to give you the same meds as the hospital,” he said. “We give medication to start dissolving the clots prior to getting (to the hospital).

“If you drive yourself to the hospital, you’re going to go to the ER (emergency room) and get checked out. However, if you say you’re having chest pains, they’ll start doing triage.”

The STEMI protocol is an exception rather than a rule for most ambulance operations.

“There are some others in the Metroplex who have a similar program,” Dillard acknowledged. “But most places, you have to see a doctor first (before being admitted to the cath lab).”

In order to earn the privilege, Wise County EMS employees have taken part in specialized training offered by the hospital’s cardiology staff and outside trainers.

“It’s a pride deal with us,” Dillard said, “that you have cardiologists and doctors that have that much trust in our paramedics.”

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