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MailTribune.com
  • Docs, nurses, EMTs go straight to the heart

    Giving paramedics the tools to diagnose heart attacks shortens treatment time and saves lives
  • Say what you will about Southern Oregon, one thing is certain: If you're going to have a heart attack, this is one of the best places it could happen.
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    • Signs of a heart attack
      Calling 9-1-1 is the fastest way to get help for a heart attack here in Southern Oregon because ambulance services and many fire departments are now equipped with 12-lead ECG machines that can diag...
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      Signs of a heart attack
      Calling 9-1-1 is the fastest way to get help for a heart attack here in Southern Oregon because ambulance services and many fire departments are now equipped with 12-lead ECG machines that can diagnose heart problems before the patient arrives at a hospital.

      Symptoms vary from person to person, but many people who have a heart attack feel tremendous pressure in the chest. The feeling is often described as "an elephant sitting on my chest." The pain may radiate into the left shoulder or arm.

      Some heart attacks are sudden and intense, but others start slowly with mild pain or discomfort that may disappear and then return. Heart attack victims may also experience shortness of breath, nausea, intense sweating or lightheadedness.

      Some people may feel pain in the neck, shoulders or back. Others may even feel pain in the jaw that makes them think they're having a toothache rather than a heart attack.
  • Say what you will about Southern Oregon, one thing is certain: If you're going to have a heart attack, this is one of the best places it could happen.
    Just ask Brian Moore.
    The last thing the Medford man was expecting, at the age of 35, was heart trouble. When paramedics realized he probably had a blocked coronary artery, they alerted a special cardiac care team and drove him straight to Rogue Valley Medical Center.
    Moore's alive today in no small part because cardiologists here make a special effort to treat heart attacks as swiftly as possible. They've developed a complex arrangement that brings together 19 cardiologists in two different practice groups, five hospitals, seven paramedic systems in three counties, and dozens of emergency room physicians, nurses and hospital staff.
    "If it wasn't for them I wouldn't be here," Moore said two weeks after his May 15 heart attack.
    Medford cardiologists have been so successful in opening blocked arteries and keeping patients alive that they submitted a report on their work to the American Journal of Cardiology. The medical journal published their findings in May.
    "We just wanted to do the right thing," said Dr. Brian Gross, the cardiologist who pulled together all the people and organizations that make the program work. "We were just blown away with the results we got. Obviously the big boys were impressed with it, too."
    The results are eye-opening. Medford cardiologists reduced mortality for certain kinds of heart attacks to just 2.1 percent for 233 patients at Rogue Valley Medical Center during the period between June 2003 and December 2004. That's compared to 11.8 percent mortality for hospitals across the United States with similar staff and capabilities.
    In the past, paramedics took heart-attack patients to the nearest hospital. Emergency room physicians might eventually send the patient on to RVMC for treatment, but precious time was lost along the way, and a patient might lose part of the heart muscle, or die, before the blockage could be opened.
    Gross and his colleagues focused their energy on one particular kind of heart attack that physicians call "ST-segment elevation," after an unusual wave pattern the ailing heart produces on an electrocardiogram. Research in Denmark had shown that early treatment of ST-elevated heart attacks gave patients better survival and quicker recovery. Gross asked his Medford colleagues to work with him to find ways to treat patients faster.
    One of the keys to their success was equipping paramedics with sophisticated "12-lead" ECG machines that allow them to diagnose heart attacks in the field. When a patient has symptoms that indicate a blocked artery, the paramedic alerts RVMC, where a specially trained team is assembled to receive the patient on arrival.
    The pre-alert gives the doctor and other members of the treatment team time to assemble and prepare before the patient actually arrives at the hospital.
    "We're ready when they get there," Gross said.
    Ambulance companies and "first responders" such as the Medford Fire Department and Jackson County Fire District 3 had to buy into the concept and lay out the cash for the new ECG machines and training to use them. Ken Parsons, manager of Mercy Flights, said Jackson County's largest ambulance service spent about $300,000 for equipment and training.
    Gross' enthusiasm for improving patient care and his personal energy helped persuade ambulance services to try a new approach.
    "He was the torch-bearer to begin with and he lit fires under everybody," Parsons said. "His optimism was very contagious."
    Paramedics quickly grew into their new role of diagnosing heart attacks, said Dr. Paul Rostykus, supervising physician for emergency medical services in Jackson County.
    "EMTs like to do different things," Rostykus said. "They like to help people. That's why they're out there."
    EMTs hand their patients off to RVMC, where some two dozen nurses and radiology technologists have been organized into four-person teams that rotate through a 'round-the-clock duty schedule.
    "Everybody's had advanced cardiac training," said Mic Bradshaw, a nurse who coordinates the RVMC "cath lab," where physicians open clogged arteries by inserting an ultra thin wire into a large artery in the patient's leg and guiding it to the heart, where it releases a tiny balloon that opens the blockage.
    "Between the whole crew, we've had hundreds of years of experience and tens of thousands of cases," Bradshaw said. "We know what each person is supposed to do."
    That experience helps during anxious moments in the cath lab. If a patient's heart should stop beating, the team tries to shock the heart back into rhythm with a jolt of electricity. Moore's heart stopped repeatedly while the cath lab team was trying to treat him. He had to be shocked 34 times before Dr. Kent Dauterman opened his blocked artery.
    "I felt every single one of them," Moore recalled. "It felt like somebody was dipping my body in acid. Every nerve ending was burning."
    "I kept telling them in no uncertain terms to stop," he said. "I'm glad they didn't listen to me."
    The support team's experience helps the cardiologists work more efficiently, said Dr. Todd Kotler, one of the physicians who opens blocked arteries.
    "What we have now is a very, very well-oiled machine," Kotler said. "I don't need to tell anybody else what they need to be doing. They all know what they need to do and what they need to get. That in and of itself saves time."
    For the arrangement that Gross envisioned to work, hospitals in the region had to agree to let patients pass by their doors and go on to RVMC, which was the only hospital doing "interventional" procedures such as catheterization and stenting (inserting metal coils inside an artery to strengthen weak areas). Three Rivers Community Hospital in Grants Pass, Ashland Community Hospital, Fairchild Medical Center in Yreka, Calif., and Providence Medford Medical Center all agreed to send patients with specific heart-attack symptoms to RVMC.
    "There were a lot of meetings with a lot of people" over how to make things work, said Win Howard, RVMC's vice president of operations. "Brian Gross was a master facilitator to pull everyone together."
    "It was appropriate at the time for Providence (Medford Medical Center) to say 'bypass us' and go to the closest center that had an interventional lab," said Tom Hanenburg, Providence Health System's chief executive for the Southern Oregon region. "To bring them here and transfer them to RVMC would only postpone treatment."
    Gross said it's gratifying to see the transformation that occurs when a blocked artery is opened.
    "We can take a patient who is in major distress and within seconds of opening the artery watch their chest discomfort disappear, color return to their face, breathing become unlabored," he said, "and relief return to the faces of terrified families in the waiting rooms."
    Reach reporter Bill Kettler at 776-4492 or e-mail bkettler@mailtribune.com.
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