6/24/2009 6:00:00 AM Help for hearts: Ludlow, EJFR medics have rare 'clot buster' power for heart attack patients
East Jefferson Fire Rescue paramedic student Tammy Ridgeway and paramedic Jeff Woods review the contents of a STEMI kit now carried by all EJFR and Port Ludlow Fire & Rescue medics. Photo by Keppie Keplinger/EJFR
'The no. 1 symptom of a heart attack is denial'
Paramedics in Jefferson County now have more tools with which to treat a heart attack, but emergency response can begin only when a patient calls for help.
"The no. 1 symptom of a heart attack is denial," said Tim Manly, Port Ludlow Fire & Rescue paramedic/firefighter and medical services officer.
"The average person waits two to three hours before they seek help and that is the no. 1 mistake and the no. 1 killer. If you're at home, and the man is complaining of chest pain and the wife says, 'Let me call an ambulance,' and the man says, 'No, why don't you just take me to the hospital,' that is wrong."
A myocardial infarction (heart attack) may be evidenced by chest pain, toothache and jaw pain, neck pain, shoulder pain, shortness of breath, nausea or vomiting, and being sweaty or feeling anxious. Women may experience fewer symptoms - generally shortness of breath, weakness or fatigue.
"But it can also be just 'not feeling right' without any pain or nausea," Manly noted.
During his 12 years of experience in Jefferson County, Manly has found that people call 911 for all sorts of minor emergencies, but are often slow to ask for help with a suspected heart attack.
"It's pure denial. If I'm having a heart attack, that may mean I'm dying, and I don't want to think about that," Manly surmised. "And if I call for help, I may die, so if I don't call, it won't make it real."
By Patrick J. Sullivan of The Leader
Port Ludlow and East Jefferson paramedics can now do what most other medics in the United States cannot - give heart attack patients "clot buster" treatment.
"This procedure will save lives," said Gordon Pomeroy, Fire District 1 (East Jefferson Fire Rescue) assistant chief of emergency medical services. "It is cutting-edge treatment for medics to be doing in the field."
Only two other paramedic programs in the United States are known to have a similar field protocol. The work was pioneered in Dade County, Fla., and a similar but smaller program is in use in Clallam County District 3.
Pomeroy worked closely with Jefferson Healthcare, Harrison Medical Center, Kitsap Cardiology, the Poulsbo Doctors Clinic and Port Ludlow Fire & Rescue in developing the protocols for paramedics to administer thrombolytic drugs.
"It's going to save lives," said Tim Manly, District 3 (Port Ludlow Fire & Rescue) paramedic/firefighter and medical services officer who contributed to the 500 man-hours spent by the organizations working up these protocols.
A myocardial infarction (heart attack) occurs when the heart's blood supply is interrupted, often by a blood clot. (The pain of a heart attack is caused by the heart muscle going without oxygen). If the problem occurs in a large enough area, it can start full cardiac arrest.
"The clot-busting drug will dissolve the clot to restore blood flow to the heart," Manly said. "Time is muscle. When heart muscle dies, it cannot be replaced. Saving heart muscle improves the patient's quality of life and can save their life."
Fire District 1 (Port Hadlock, Chimacum, Irondale, Cape George Kala Point and Port Townsend) has eight (soon to be nine) paramedics plus two chief paramedics. District 3 (Port Ludlow/Shine) has four paramedics. The medics can use the clot-busting drugs on patients they treat as part of mutual aid responses to adjacent districts, Pomeroy noted.
This program began here June 1 and as of June 22 had not been employed, but local paramedics and doctors are excited about the life-saving option.
"Time is crucial. There is a 90-minute window in which to diagnose a patient and administer the drugs," said Pomeroy. The 90 minutes is defined as 45 minutes for transport/treatment once medics arrive on scene, and 45 minutes for treatment at the hospital.
Quick response
While paramedics and hospitals are prepared to help heart attack victims, it all starts with a 911 call.
"Key to the success of this whole process is how fast the patient calls 911. Patients who have previously experienced similar chest pains frequently just try to 'tough it out' and don't call 911 until it's too late to administer the drugs that could save the heart muscle from permanent damage," Pomeroy added.
If a patient in Jefferson County is diagnosed with a "STEMI" by paramedics and the Jefferson Healthcare ER physician, the clot-busting drugs can be administered in the ambulance while the patient is on his or her way to Harrison Medical Center's Catheterization Lab in Bremerton.
The medical protocol name STEMI comes from the letters that are part of an electrocardiogram (ECG or EKG) reading: ST elevated myocardial infarction.
Patients can be given an EKG in the ambulance with the results being transmitted to the emergency room, explained Keppie Keplinger, District 1 public information officer. Data that shows up on the EKG strip together with the patient's other vital statistics assists the ER physician and paramedics to come to a determination about using the thrombolytic medication.
Chief Pomeroy warns that if a person is experiencing chest pain, nausea, sweating or feelings of indigestion, he or she could still be having a heart attack that may not present with the same EKG results as a STEMI. The aforementioned symptoms could be indicative of a non-STEMI heart attack, which still requires many of the same procedures and treatment.
"Bottom line - don't delay in calling 911," Pomeroy said.
Life-saving option
Patients who get themselves to the Jefferson Healthcare hospital emergency room "will be assessed rapidly and, if appropriate, thrombolytics will be administered to the patient before he/she is transported to Harrison Medical Center," said Jim DiCianne, director of emergency services in Port Townsend.
Paramedics here know the time it takes to transport a patient, for example, from Cape George or Coyle or Marrowstone Island to Harrison's Catheterization Lab in Bremerton. This new clot-busting protocol gives the medics more options.
"Patients need the drug or the cath lab," Manly said. "The cath lab is the best. But if there is a bridge delay or a highway delay, we now have the ability to administer the drugs."
Reader Comments
Posted: Friday, June 26, 2009
Article comment by:
Pat Nicholson
Great article.. But it doesn't mention than this program is also in place for Quilcene, Discovery Bay, and Gardner. Medic 25 which services those areas carries a STEMI kit.
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