ST. GEORGE — Gold Cross Ambulance’s St. George division received the American Heart Association’s “Mission: Lifeline EMS Gold Plus Award” Friday for implementing quality improvement measures in treating patients experiencing severe heart attacks – the highest award presented by the organization and the only one given in Utah this year.
“This was no small feat, as many of you who work out in the field can attest to,” Victor Arredondo, community health director for the American Heart Association said.
The recognition honored paramedics in partnership with first responders from the St. George Fire Department and the Washington City Fire Department at a ceremony held at noon at Dixie Regional Medical Center’s Zion conference room.
To qualify for the award, three components must be in place and meet the criteria required, which include patient transport, first responders and hospital support. In this case, those components were all met by Gold Cross Ambulance, St. George Fire Department and Washington City Fire Department and Dixie Regional Medical Center.
Gold Cross was recognized for providing the best possible care in critical situations and for their part as one of the components in a rapid response system that covers the patient from the first 911 call all the way through to hospital care.
“The company’s St. George division received the award, so it was specific to this area,” Brooke Burton, quality director for Gold Cross Ambulance, said.
The emergency STEMI response team at Dixie Regional Medical Center was also recognized as the final component in an early intervention program that was developed by the hospital to address the deadliest of heart attacks – a STEMI, or ST-elevation myocardial infarction, also known as “the widow maker.”
Every year, more than 250,000 people experience these deadly heart attacks that require rapid restoration of blood flow as quickly as possible to prevent death.
One of the primary criteria that must be met to qualify for the award is to have the patient who just suffered a massive heart attack delivered to the hospital and into treatment within 90 minutes.
The award presented Friday included the “Gold” enhancement for meeting a particular component in rapid patient care which is treating individuals age 35 or younger who suffer a massive heart attack.
“Gold Cross and responders received the award with the ‘Plus’ measure, which is what needs to be highlighted here,” Arredondo said, “and is what sets your agencies apart from any other in the state.”
From the onset of a severe heart attack, the clock begins ticking, and the damage inflicted on the heart increases with every minute that passes, requiring rapid assessment, transport and treatment, Kelly Taysom, CV Manager at Dixie Regional Medical Center, said.
The reason behind this is that when an individual suffers a severe heart attack, blood flow to the heart is slowed or stopped usually because one or more coronary arteries becomes blocked from plaque buildup.
Oxygen-rich blood can no longer circulate properly, which causes damage to the heart muscle, and that damage increases on a cellular level with every passing minute until doctors are able to clear the blockage at the hospital.
The role paramedics and first responders play is critical because nearly half of those who die from a massive heart attack die outside of the hospital, according to the Centers for Disease Control.
To address this threat, paramedics perform a 12-lead ECG, a test that measures the electrical activity of the heart which can determine if a heart attack has occurred, even detecting the area of the heart most affected. This saves an enormous amount of time because prior to the ECG’s implementation, the patient wasn’t tested until they were already at the hospital.
Paramedics are then able to rapidly identify suspected heart attack patients and that information is quickly relayed to the emergency cardiology staff at Dixie Regional Medical Center, which triggers another rapid response.
At the hospital the emergency STEMI response team is assembled and the catheterization laboratory is prepped with doctors and support personnel standing by to remove the blockage quickly. This is done either by mechanically opening the blocked vessel or by providing clot-busting medication.
Burton added that the patient is wheeled directly from the ambulance to the cath lab since testing was done in the field.
“Multiple delays are avoided using this emergency response system,” she said.
If the fire department is first to arrive, then they can initiate care and start the ECG testing until Gold Cross paramedics arrive to take over, St. George Fire Battalion Chief Robert Hooper said.
To create a seamless transition when responding to calls involving STEMI patients, the St. George Fire Department purchased equipment that is identical to what is used by Gold Cross, allowing paramedics the ability to step in and take over quickly without having to make adjustments or conversions, Hooper said.
“Time is critical, and working as a seamless team we can speed up the emergency care process because only one thing matters at that point – saving the patient,” Hooper said.
Washington City firefighter Kelly Lang said firefighters first on scene initiate intermediate care, including starting the ECG so there is no time delay for the patient.
“With the ultimate goal of initiating STEMI care within 10 minutes of arrival,” he said.
Lang also said that the testing/notification process is particularly crucial when the responders are dispatched to a call in the middle of the night when the cath lab is closed. Using the early notification process allows hospital personnel to open and prepare the room, assemble the STEMI team and have everything ready by the time the patient arrives, he said.
Ongoing training plays a significant role in the rapid care process as well, and regular training sessions are provided at the hospital to arm paramedics and responders with an enhanced ability to read the ECG results with a higher level of accuracy, Taysom said.
“Providing ongoing training specific to emergency cardiac care makes sense,” he said, “because the statistics show that early intervention significantly improves survival and quality of life.”
Doctors are also able to trust that the information is accurate because of enhanced training by cardiac specialists at the hospital, which increases the degree of accuracy in the readings while reducing assessment time by hospital staff.
Continual improvements are made to the program with quarterly review meetings held at Dixie Regional Medical Center that provide a forum where physicians, paramedics and fire department personnel can get together and discuss what worked, what didn’t and where improvements can be made.
“Taking a multi-disciplinary approach, reviewing each case to see where improvements can be made and receiving early notification from paramedics at the scene improves that patient’s chances, for life and can improve the quality of that life,” Taysom said.
Their efforts seem to be paying off.
Before the early notification system was implemented, the number of minutes required from the 911 call to clearing the blockage was 80 minutes, which was still well below the national average.
Today that number is 58, which means the heart muscle isn’t dying for 22 additional minutes and more time for blood flow restoration, which can make all the difference to the patient.
“What we do know is that the sooner we can open up that vessel, the better,” he said.
The American Heart Association’s “Mission: Lifeline EMS Gold Plus Award” that was presented to local Gold Cross paramedics is the result of their efforts and striving to provide the best patient care, but they couldn’t have done it alone.
To meet the time criteria required, the efforts from dispatchers with the St. George Communications Center, paramedics and first responders with the St. George Fire Department and Washington City Fire Department and Dixie Regional Medical Center’s well-trained STEMI response team to make it all work.
“When the life of the patient matters, everything else is secondary,” Arredondo said.
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Copyright St. George News, SaintGeorgeUtah.com LLC, 2017, all rights reserved.
Copyright St. George News, SaintGeorgeUtah.com LLC, 2017, all rights reserved.