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  • Heart of the Matter

  • The few days before and after Gloria Ferguson's heart attack at Crater Lake National Park have been erased from her memory. Ferguson knows only that her survival is nothing short of "amazing."
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  • The few days before and after Gloria Ferguson's heart attack at Crater Lake National Park have been erased from her memory. Ferguson knows only that her survival is nothing short of "amazing."
    "If I had been in the city, a block away from the hospital, I might not have survived it," says the 53-year-old resident of Vancouver, Wash.
    She initially chalked up chest pains to the effects of high altitude while bicycling in the park last July with her 13-year-old son's Boy Scouts troop. The exertion, however, had triggered a total blockage in one of her heart's three main arteries. Known as acute ST-segment elevation, this type of heart attack is treated locally under a protocol that has dramatically reduced death rates over the past decade.
    "This is what can happen when teams work fluidly together," says Dr. Brian Gross, the Medford cardiologist credited with founding the Rogue Valley's ASSET, Acute ST-Segment Elevation Task Force.
    ASSET members and others involved in Ferguson's care were recognized in October as "heart heroes" by the American Heart Association. The prompt and proficient action of bystanders at Crater Lake complemented the work of emergency-medical crews under ASSET, according to an Asante Health System news release about the award.
    ASSET has treated nearly 1,500 cases like Ferguson's since 2003, when the approach was not common, particularly in areas as small as the Rogue Valley.
    "We empowered the EMS system," says Gross, who won last year's Carpenter Award for significantly influencing and improving medical care in Jackson County.
    "He's the one who came up with the idea," says Dr. Paul Rostykus, supervising physician of Jackson County's emergency medical services. "He's the one who came to me."
    Gross started lobbying more than a decade ago for a more efficient procedure to identify patients in need of "emergent stenting," which he calls one of the most "complex" and "time-sensitive" interventions in the world of medicine.
    The procedure involves inserting a catheter into a large artery in a patient's leg to open a blocked artery near the heart. Then, with a wire the width of a human hair, doctors can repair damaged tissue with miniscule metal coils.
    "The newer stents, you can get them almost anywhere," says Gross. "We keep building better mousetraps."
    Successful treatment for more patients, however, required the Rogue Valley's physicians, hospitals and emergency-medical crews to build a partnership that actually left two local hospitals — Providence Medford Medical Center and Ashland Community Hospital — out of the action.
    Under ASSET, emergency-medical crews diagnose ST-segment elevation (STEMI) in the field and notify Rogue Regional Medical Center. Awaiting the patient's arrival, the cardiologist on call is ready to go to work.
    "You just literally save two hours," says Gross, explaining that STEMI patients previously were taken to the nearest hospital, diagnosed and then transferred by ambulance to RRMC.
    ASSET worked so efficiently in Ferguson's case that her blocked arteries were reopened about an hour after care providers at Crater Lake started fast, deep chest compressions. A Mercy Flights helicopter was next to arrive at the park and radioed results of Ferguson's electrocardiogram to RRMC.
    Dr. Kent Dauterman was on the hospital's helipad for the crew's arrival less than 30 minutes later. Once blood flow was restored, Ferguson's heart resumed its rhythm after 12 electric shocks, and she spent five days recovering in a medically induced coma.
    "I was lucky it happened there — in the Medford area," says Ferguson.
    In fact, most communities with sizeable medical centers on the Interstate 5 corridor now have programs such as ASSET in place, says Gross. But 10 years ago, he says, Medford was one of the only locales in the country where providers followed such a protocol all hours of the day or night, 365 days of the year.
    "People often talk about the Rogue Valley," says Gross. "We were one of the early ones, and we're often quoted."
    With local STEMI mortalities almost immediately reduced from about 11 percent — a national average — to about 3 percent, there was never any question that ASSET was a success. Gross has published several articles in medical journals about RRMC's outcomes. The Rogue Valley also was cited, he says, in a recent paper by Dr. Ivan Rokos of University of California at Los Angeles' Department of Emergency Medicine.
    "The data was overwhelming when we finished that first year and a half," says Gross. "(Deaths) dropped dramatically."
    The statistics even bear out under extreme circumstances like Ferguson's. After every link in the chain of care contributed to saving her life, she returned home to Vancouver 12 days later. Her brain deprived of oxygen for a time, Ferguson underwent rehabilitation and soon resumed full-time employment as a teacher.
    "It keeps getting better," she says.
    Although Ferguson can't recall the players, she says it's clear everyone was in the right place at the right time.
    "I was impressed by the information they shared," she says. "It really is amazing."
    Reach reporter Sarah Lemon at 541-776-4487 or slemon@mailtribune.com.
    Correction: Providence Medford Medical Center has had two cardiac catheterization labs since 2007. Providence Medford Medical Center also does not currently transfer patients to Rogue Regional Medical Center under the local program called ASSET (Acute ST-Segment Elevation Task Force). Patients experiencing heart attack symptoms who go to Providence are treated and stented as necessary at that site.
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