During a heart attack, time loss is muscle loss, said Angela Solesbee, RN, CCCC, STEMI Coordinator for Mission Heart. Delayed treatment can increase damage to the heart muscle and also increase the risk of death. In the past, this was a particular danger for heart attack patients who live and work in remote areas of western North Carolina due to the amount of time it took them to get to a hospital.
Now, residents of our region can expect one of the fastest door-to-treatment times in the country, thanks to Mission’s STEMI protocol, which creates real-time coordination between emergency medical services (EMS) and the Owen Heart Center at Mission Hospital.
Whisked to Safety
Kenneth Bennett of Spruce Pine is a testament to how efficiently the STEMI protocol works. The 57 year old was working third shift at his job in Bakersville when he started to experience heart attack symptoms. “At that time, I was about as far from Mission as you can get,” he said.
One of Bennett’s friends started driving him to Blue Ridge Regional Hospital (BRRH) when Bennett’s symptoms intensified and he realized he needed more urgent attention. Bennett’s friend dialed 911, and EMS met them to pick up Bennett. When EMS arrived, they performed an EKG and identified that he was having a heart attack. They quickly activated the STEMI protocol. Bennett was rushed to BRRH to rendezvous with the Mountain Area Medical Airlift (MAMA) helicopter, which then carried Bennett to Mission Hospital, where the cardiology team was waiting for him.
“The reason it went so well was because they already had the helicopter waiting for me,” said Bennett. “I remember the guy in the helicopter talking to me, then the next thing I knew I was waking up from surgery with the cardiologist telling me he had put a stent in. It all happened so fast, and I was already feeling better by the time I woke up.”
How the STEMI Protocol Works
STEMI stands for “ST-segment elevation myocardial infarction,” which is a segment of an electrocardiogram (EKG) that is elevated during a heart attack. A STEMI EKG reading lets EMS personnel know that a patient is having a heart attack. Mission’s STEMI protocol establishes a unique connection between Mission Hospital in Asheville, the regional hospitals and EMS units throughout western North Carolina, so that any EMS responder who performs an EKG and identifies a STEMI can immediately activate the STEMI protocol to initiate a readiness process for that patient.
“The EMS are on the scene and clinically adept at running EKGs, so they can diagnose a heart attack and activate the process, and begin lifesaving measures,” said Solesbee. “They call one specific number that lets the hospital know they’re inbound with a STEMI, and a blast page is sent out to everyone in the hospital who needs to prepare for the patient — the cardiac catheterization (cath) team, the cardiac intensive care unit (CICU), the cardiologists, the chaplain and anyone else who will be needed. We also have a device at our triage desk in the emergency department that sends the EKG reading out to all cardiologists on duty, so that they can get an immediate read on the situation.”
Mission’s typical response time after receiving the page is 30 minutes. This allows the cardiology team to be ready to receive the patient as soon as he or she arrives at the hospital. The STEMI protocol also bypasses emergency department admissions at other hospitals for patients who aren’t located in Asheville. This is done through the STEMI page, which also activates MAMA helicopter service. The EMS will take the patient to the helipad of the closest hospital, and MAMA will be waiting to take them to Mission Hospital, where the patient is rushed to the cath lab.
This streamlined process ensures that no time is lost in getting the patient to treatment. “If the patient is stable, our focus is to bring them into the cath lab with no pauses in between,” explained Solesbee.
On the Mend
Following his stent procedure, Bennett also had five bypasses. His recovery has gone smoothly, which he credits, largely, to the prompt attention and treatment he received. “This was my second heart attack,” he said. “If we had not decided to call 911 or if they had not gotten me to the cath lab so quickly, it probably wouldn’t have turned out well. But once the EMS got to me, they took over fast and got me there fast. The last thing I remember was the guy in the helicopter telling me, ‘We’ll take care of you’ … and they did.”
Solesbee emphasized that Bennett and his friend did the right thing by calling 911. “If you think you’re having a heart attack, driving yourself to the hospital — or having someone else to drive you — is a big no-no,” said Solesbee. “First responders can run that EKG and determine right then whether you’re having a heart attack. From there, they can initiate the process and get you to us quickly. In Bennett’s case, the EMS was able to get an EKG read on him within three minutes. From there, he was in the Mission cath lab with his heart vessel open within 89 minutes.
“That’s the kind of response our community can expect,” said Solesbee. “We have the ability and the technology to coordinate prompt, lifesaving care.”
Angela Solesbee, RN, CCCC, is a STEMI Coordinator for Mission Heart. (828) 274-6000