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Published: Synapse, 2010 - Vol. 3
There are certain moments in life that stay with you - a wedding day; the birth of a child; a traumatic event. In the middle of an anything-but-typical October afternoon, I witnessed a life being saved. And, I can recall the details with great clarity.
At 3:01 pm, as I stood in the lobby of Ice Line, a local hockey rink, I watched a man slump to the floor with apparent pain in his chest. Within a minute, he was swarmed by onlookers and Ice Line staff members, who kicked into high gear to help him. They radioed the front desk to call 9-1-1, quickly retrieved the on-site AED (Automated External Defibrillator), and started CPR.
While one employee began chest compressions, another opened the yellow AED machine and listened for further directions - the AED provided audible step-by-step instructions on how to initiate care.
As I stood there watching them perform these life-saving measures, I couldn't help but think how this man's life was so dependent on the knowledge of those around him and of the accessibility of equipment like an AED.
By 3:05, the Ice Line staff had cut open his shirt to apply small sticky pads to his chest to deliver a shock to the heart. The machine directed everyone to stand clear of the man and a shock was delivered at 3:08 and again at 3:10. It worked; his pulse returned.
Even though only a few minutes had passed, I can imagine that time probably stopped altogether for the man's wife who stayed by his side. In just 11 minutes following the 9-1-1 call, The Chester County Hospital Medic 91 Unit arrived at the rink. At 3:12, the paramedic quickly attached a heart monitor to the man's chest to get a reading of his heart rhythm.
In anticipation of the ambulance's arrival, the paramedic performed a medical exam, gathered a brief medical history, and prepped the man for the ride to the Hospital. By 3:14, the ambulance from Goshen Fire Company pulled up to Ice Line. The EMTs assessed the man's condition with the paramedic as they readied him for transport. By 3:22, the man was in the ambulance and on his way to The Chester County Hospital Emergency Department.
The experience of watching a life being saved was eye-opening. And, as the Medics and EMTs worked efficiently to stabilize his condition, the only thought that kept going through my mind was ...
On October 14, The Chester County Hospital held the first of many planned STEMI drills. The first was at Ice Line, a local ice hockey and skating establishment. STEMI is an acronym for ST Segment Elevation Myocardial Infarction, which, in laymen's terms, means an acute heart attack with a prolonged period of blocked blood supply to the heart.
"When it comes to matters of the heart, 'time is muscle' and every minute when someone is experiencing chest pain is critical," says Ralph Smith, RN, BSN, Chest Pain Center Coordinator. The longer the blockage exists, the more heart muscle is damaged. That is why The Chester County Hospital is partnering with and educating community organizations, like Ice Line. He adds, "It helps everyone to practice the process of treating people experiencing chest pain at the site of the incident, during transport to the Hospital, and ultimately through the pathway to intervention at the Hospital."
To make the scenario as realistic as possible, the role of 'the man' with chest pain was being played by "3M Man." This life-size patient simulator equipped with realistic anatomy and active vital signs has the ability to receive and react to treatment in a life-like manner.
"Every minute from the time of an incident to when medical treatment is delivered is crucial. Knowing the signs of a heart attack, initiating CPR and/or using an AED can be the difference between life and death," reiterates Christopher Ware, MD, Emergency Medicine. Like many businesses, Ice Line purchased its AED machine because it recognized that emergency situations, like this scenario, could realistically occur at its facility.
Having an AED on-site was integral to saving "the man," as was the quick response of the staff, the paramedics and the ambulance. The ability of the paramedics to transmit the heart rhythm via an EKG (electrocardiogram) from "the man's" side directly to the Emergency Department (ED) was also a key life-saving factor.
When the EKG was received by the ED, the emergency team prepared to receive the patient and an emergency physician read the transmitted reading. Once realizing it indicated an acute heart attack, the doctor called a "Code PCI." This code rapidly mobilized the members of the ED, the interventional cardiologist and the cardiac catheterization team that a heart attack patient was en route to the Hospital. Instantly, an ED room was prepped, a nurse gathered and reviewed the transmitted information, an EKG machine was moved to the awaiting bedside, and the Catheterization Lab (Cath Lab) was readied to perform a catheterization, if necessary.
As the drill continued and the ambulance arrived with "the man" at 3:27, the ED's clinical team was already waiting to escort him to his exam room.
The ED team expedited his care. Within two minutes of his arrival, an emergency physician and nurse completed an assessment of the patient, another EKG was taken and intravenous medicine was started. By 3:33, a cardiologist greeted the patient and transported him to the Catheterization Lab. The team, including the paramedics and EMT personnel, continued on with the patient to follow through on the full continuum of his care.
By 3:38 - just 37 minutes after 9-1-1 was called - "the man" was in the Cath Lab. His information was reviewed and double-checked by the team and the Cardiologist simulated the beginning of the intervention. A cardiac intervention involves inserting a catheter guidewire into the blocked artery and inflating a small "balloon" to restore blood flow.
Ware says, "The national standard for "door-to-balloon time" - the time when a patient enters the Hospital's doors to the time they receive the cardiac intervention - is 90 minutes or less. The Chester County Hospital's average time is 64 minutes and through exercises like this, it intends to further decrease this time."
Just as they do in a real situation, all members involved in the continuum of care for this drill met afterward to discuss the process and identify areas for improvement.
"By conducting mock scenarios, the Hospital is looking to be even more efficient in the chest pain care that it provides to the community," says Smith. "It focuses on how the different emergency systems work together, including the 9-1-1 Dispatcher, Police, Paramedics, Basic Life Support Ambulances, the Emergency Department, the Cardiac Catheterization team and other key members of the Hospital's Chest Pain Center team."
And, by educating local businesses about how to help with the provision of emergency care, more heart muscle - and lives - can be saved.
By Lauren A. Speakman
Heart Attack Warning Signs
Cardiac Arrest Warning Signs
Sudden Loss of Responsiveness
*Source: American Heart Association
Last Updated: 12/22/2010