The Edmond Sun

August 2, 2013

Doctor: EFD medical advance could save lives

Mark Schlachtenhaufen
The Edmond Sun

EDMOND — A technological advance initiated this week by the Edmond Fire Department will save the lives of local heart patients, a local cardiologist said.

In the body, arteries can become narrowed or blocked by deposits called plaque, according to MedlinePlus, a service of the U.S. National Library of Medicine and the National Institutes of Health. Plaque is made up of fat and cholesterol that build up on the inside of artery walls, a condition called atherosclerosis.

Each year about 250,000 Americans suffer a ST segment elevation myocardial infarction (STEMI), the deadliest form of heart attack, according to the American Heart Association.

Symptoms of a STEMI include: Chest discomfort with or without radiation to the arms, back, neck, jaw or epigastrium (abdomen); shortness of breath; weakness; diaphoresis (excessive medically-related sweating); nausea; and lightheadedness.

Of those who receive percutaneous coronary intervention only 40 percent are treated within the door-to-balloon (angioplasty) timeframe of 90 minutes recommended by the American Heart Association.

For STEMI patients, each passing minute equals more heart muscle damage, said Maj. Brian Davis, the Edmond Fire Department’s EMS director. Delays in treating this most lethal type of heart attack can result in catastrophic heart damage or death, Davis said. Rapid diagnosis and treatment dramatically increases a patient’s chance for survival, he said.

Until recently, emergency medical services providers lacked a fast, consistent method for transmitting high-quality 12-lead electrocardiograms (ECG), a recording of heartbeats, to receiving hospitals, Davis said.

On Thursday, the Edmond Fire Department began transmitting ECGs instantly from the field to nine metro hospitals including INTEGRIS Health Edmond, which has a new state-of-the-art heart lab.

Davis said the portable ECG machines mean more properly trained personnel are able to use them. The EFD has 11 ECG machines, which run about $50,000 each, with 30 trained paramedics and 110 emergency medical technicians to meet the growing demand for medical care, Davis said. Everybody on a rig has some medical training, he said.

Since EMTs are associated with paramedics, they are doing advanced practices, Davis said. For example, Edmond’s EMTs know how to put electrodes on a patient, Davis said.

“I’m real excited about it,” he said regarding the EFD’s technological advances. “It’s about what’s best for the citizens of Edmond.”

Davis said Fire Chief Jake Rhoades is engaged in the agency’s paramedic program and is up to date on the newest technology. If a citizen is having chest pains, they should call 911 and personnel will respond, Davis said.

Santosh Prabhu, lead cardiologist at INTEGRIS Health Edmond, said he believes the EFD’s advance will save lives. Information from the field will be received by the hospital, giving staff a head start on preparing for the incoming patient, Prabhu said. An ECG indicating a STEMI dictates certain protocols, he said.



HOW IT ALL WORKS

Davis said EFD rescue personnel working in the field use portable machines to record an ECG. The results are then electronically transmitted instantly to the receiving hospital, Davis said. EMSA is among other agencies with this ability.

INTEGRIS Health Edmond recently opened a heart lab with a state-of-the-art vascular imaging system. In the hospital, the information from rescue personnel in the field arrives at a computer monitored by staff, said Angie Smith, emergency room clinical director for INTEGRIS Health Edmond. An alert signal tells them if the incoming data is an ECG, Smith said.  

A cardiologist reads the ECG and looks for patterns among the heartbeats and rhythms to diagnose various heart conditions, Smith said. If further treatment is required, the patient is admitted to the hospital’s heart lab.

Scott Tulane, director of the hospital’s radiology department, said its vascular imaging system is used for a wide variety of radiology and cardiology applications including procedures that study the cardiovascular system to identify blocked arteries.

Prabhu said percutaneous coronary intervention is used to open narrowed or blocked blood vessels that supply blood to the heart.

In the hospital’s heart lab, a patient lies on a padded table where a doctor inserts a flexible tube (catheter) through a surgical cut into an artery, Prabhu said. A doctor uses live x-ray pictures to carefully guide the catheter up into the heart and arteries. Dye is injected into the body to highlight blood flow through the arteries. This helps the doctor see blockages in the blood vessels leading to the heart.

A guide wire is moved into and across the blockage. A balloon catheter is pushed over the guide wire and into the blockage. The balloon on the end is blown up (inflated), opening the blocked vessel and restoring proper blood flow to the heart.

A wire mesh tube (stent) may then be placed in this blocked area. It is inserted along with the balloon catheter. It expands when the balloon is inflated. The stent is left there to help keep the artery open.

Prabhu said the procedure can be completed in less than 20-45 minutes depending on the complexity of the case.

Tulane said INTEGRIS Health Edmond’s system design enables physicians to view different anatomical areas without repositioning the patient. Most cath lab technology requires clinicians to work from the right side only limiting procedures, Tulane said. Physicians can also process and view images in real-time, which helps speed up diagnosis and treatment planning.



marks@edmondsun.com | 341-2121, ext. 108