HHS partnership with EMS helps save lives of heart attack patients
A joint effort by Hamilton’s emergency and hospital services is helping to save the lives of patients with a specific kind of high-risk heart attack by identifying potential patients in the community and getting them to the best hospital for faster care.
Nearly one year ago, Hamilton Emergency Services (EMS), Hamilton Health Sciences (HHS) and the Centre for Paramedic Education and Research (CPER) introduced a joint program to identify and treat Hamilton area residents experiencing a high-risk heart attack known as a STEMI. The program involves trained paramedics acquiring electrocardiograms (ECGs) to identify possible heart problems in the patient’s home or anywhere the patient is found.
By performing the ECGs at the patient’s side, paramedics are able to more accurately identify if he or she is having a heart attack and ensure that the patient gets to the right place - Hamilton General Hospital’s Heart Investigation Unit (HIU) - to receive the best care. Paramedics will also pre-alert the hospital to the patient’s condition even before they arrive. An ECG taken early by paramedics is useful to hospital staff when it is compared to ECGs taken after the patient has been treated.
“Having the paramedics acquire the 12-lead ECG in the ambulance and then taking those patients identified as having a heart attack directly to the General is one of the most important advances in cardiac care that the paramedic service has made in last 25 years,” said Brent Browett, Director of Emergency Medical Services, City of Hamilton.
This partnership also created a protocol to bypass other emergency departments even if they are closer, and transport specific patients directly to the General’s emergency department, and on to the HIU, where specialized services provide rapid and often life-saving treatment for these patients. The General’s HIU is a regional cardiac centre and one of the three largest in Canada, providing access to emergency coronary balloon angioplasty for high-risk heart attack patients 24 hours a day, seven days a week. State-of-the-art equipment and four cardiac catheterization laboratories support the delivery of cardiac care.
Previous to this partnership, patients were sent to any one of Hamilton’s four acute care hospitals, where an ECG was performed to determine if the patient should be transferred to the HIU at the General.
Since this program began, paramedics have acquired more than 100 ECGs per month, and transported more than 130 patients directly to the Hamilton General. As a result, percentage of patients being transported by paramedics directly to the General has increased from 50 to 80 per cent. With a North American guideline of less than 90 minutes from the time the patient arrives at the hospital to the time the patient receives specialized hospital treatment (known as door-to-balloon treatment time), this program has reduced the door-to balloon time from 88 minutes to 69 minutes. The ongoing research identifies that reducing door-to-balloon times decreases patient mortality and morbidity.
“These are significant milestones in our efforts to provide state-of-the-art care for patients suffering a heart attack,” said Dr. Madhu Natarajan, Director of the Heart Investigation Unit at Hamilton General Hospital. “We can safely say that no matter where you live in Hamilton, if you have severe chest pain and call 9-1-1, you are assured the best care.”
“The message is clear,” said Dr. Michelle Welsford, Medical Director of the Centre for Paramedic Education & Research, “paramedics can save lives – but you have to call 9-1-1 to let them help you. Since they can start treatment before arrival at hospital, manage complications that may occur en route, transport the patient to the correct centre, and notify staff to be ready, it is no wonder that paramedics save lives in this program.”
Research on this process will continue to study the benefits to patients.