EMS Key in Heart Attack Care

Paramedics speed heart attack treatment improving patient care

(RxWiki News) "Door to balloon" time, or the amount of time from when a patient arrives at the hospital until they receive angioplasty to open a clogged artery, has long been considered critical in improving outcomes.

University of Cincinnati researchers have determined that the amount of time between first medical contact, often by emergency medical services, and balloon time also play a significant role in minimizing permanent heart muscle damage.

"Call 9-1-1 immediately for heart attack symptoms."

Dr. Jason McMullan, an assistant professor at the University of Cincinnati, referenced a common saying among doctors, that "time is muscle." He said that is because the sooner they can open a clogged artery to the heart, the smaller the chance of permanent heart muscle damage and the more muscle they can save.

Both the American Heart Association and American College of Cardiologists suggest that clogged arteries should be opened with angioplasty within 90 minutes.

During the multi-center study investigators examined cases of patients with ST-elevation myocardial infarction (STEMI), who were transferred by air from local hospitals to larger medical facilities with the capabilities for percutaneous coronary intervention (PCI), including angioplasty and stent placement. STEMI is a type of heart attack caused by a sudden and total blockage of a coronary artery.

They then studied two scenarios for patient care: cases where EMS requested helicopter emergency medical services (HEMS) transport from a scene to a hospital with PCI capabilities, and cases where the helicopter met EMS at a smaller, local hospital without PCI capabilities to transfer a patient to a facility to perform PCI. Among the cases reviewed, the medical contact to balloon time for 36 hospital-initiated transfers was 160 minutes.

They found there was a median time of 112 minutes for patients transported from a scene compared to 112 minutes for patients transferred from a smaller hospital.

Researchers found that EMS could play a significant role in improving medical contact to balloon time by activating helicopter emergency medical services (HEMS) sooner. However, this did not guarantee treatment within the 90-minute goal.

Investigators found that in cases where paramedics called for air transportation to meet them at a smaller hospital or in the field, a patient received PCI about 48 minutes sooner.

"Both of the modeled strategies with EMS crews could result in meaningful time savings for patient care,” said Dr. McMullan, "But neither strategy was superior, meaning individual communities can determine which method is best based on their unique needs and capabilities.”

The study was recently published in the journal Academic Emergency Medicine.

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Review Date: 
March 23, 2012