MUSC Annual Report 2011-2012
MUSC, EMS Among National Leaders in Saving Heart Attack Victims
South Carolina is awash in statistical databases showing it on the wrong end of many health and lifestyle categories. Amid all the bad news, however, may be an oasis of success when it comes to medical response to a heart attack, according to Eric R. Powers, M.D., professor of medicine and co-medical director of the Heart and Vascular Center at the Medical University of South Carolina.
A heart attack occurs when blood flow to the heart is stopped, which results in part of the heart muscle being injured or dying if the stoppage is long enough.
The Palmetto State is among the national leaders in restoring blood flow to the heart following an attack, thanks in large part to technological advances being made when first responders assess the patient. For several years now, Powers has chaired a statewide initiative to improve care heart attack patients receive. "An important part of that is early recognition that a patient is having a heart attack," Powers says.
MUSC and other medical centers throughout South Carolina possess the latest technology and have highly trained staffs to give patients the best chance of survival once they pass through the doors. The heart attack care network, South Carolina Mission: Lifeline, focuses on providing first responders - usually paramedics - with the training and equipment to quickly make a diagnosis and relay that information to the hospital. That early notification allows emergency departments to be ready and waiting for the patient when he comes in, thus cutting down on additional evaluation time.
This means additional training for EMS staffs and equipment to transmit electrocardiograms from remote areas to emergency departments. Where that's been done, the results are astonishing. Prior to the implementation of this practice, MUSC's median time to restore blood flow to the heart was about 120 minutes, considered typical among medical centers. With this recent advancement, it's down to 47 minutes, restoring blood flow to the heart more than an hour sooner.
That puts MUSC with the third best time in the nation, according to Powers.
"In large part, we know it's a heart attack before the patient gets here," Powers says. "It turns out that 60-80 minutes we save has a big impact on outcome - smaller heart attacks, fewer deaths, less late morbidity complications."
Powers emphasizes that this initiative is not confined to MUSC - all Charleston hospitals participate and all have shown improved response times. Nor is the network confined to the Charleston area - it is a statewide project, and in South Carolina's major metropolitan areas, response times overall are better than before, Powers notes.
"In South Carolina, about 65 percent of the time, when a patient's picked up by EMS, the heart attack is identified and that information is transmitted to the receiving hospital," Powers says. "Around the rest of the country - and everybody's trying to do this now - the rate is about 50 percent. So South Carolina is doing better than the rest of the country."
Don Lundy, Director of Charleston County Emergency Medical Service, considers this technological advancement a sea change in the health care field. "I've been doing this since 1974," says the EMS veteran. "I cannot think of a process that was more patient-centered and life-changing as this. All of the PCI (Percutaneous Coronary Intervention) - centered hospitals came together to make this happen for the patient. It is very humbling to know the difference we are all making as a team."
Charleston County paramedics are trained to interpret EKG data. If a heart attack is confirmed, that information is radioed to the hospital while the ambulance is en route, saving critical time. "What we didn't want to do was bog down the patient in technology," Lundy says, "so the process was developed that everything is done with the idea that the patient is always moving towards definitive care."
The 12-lead EKG, in which electrodes attached to the body record the heart's electrical activity, is the method in use by local EMS agencies and approximately 80 percent of EMS systems nationwide. Transmitting that data from the field to the hospital is not as widespread, according to Lundy. Although South Carolina is among the leaders in response times, there remains a gap between Charleston and other metropolitan areas compared to the rest of the state. Powers and Lundy agree there is more work to be done.
"We are always looking at the next step," Lundy says. "What can make it even better?"