Fwd: [ekg_club] Victims treated by paramedics obtain life-saving treatment faster than hospital walk-ins, data shows

[Guest guest]

For once something good about what paramedics do.

GG

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http://www.latimes.http://www.lahttp://wwwhttp://www.latimhttp://www.latimhttp:

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> Victims treated by paramedics obtain life-saving treatment faster than

> hospital walk-ins, data shows.

> By Rong-Gong Lin II, Los Angeles Times Staff Writer

> March 27, 2008

>

> If you live in Los Angeles, Ventura, Orange or San Diego county and think

> you are having a heart attack, call 911 rather than have a friend or family

> member drive you to the hospital. It could mean the difference between life

> and death.

>

> That's the conclusion of a UCLA professor who reviewed data from counties

> around the nation -- including four in Southern California -- that have

> implemented a new approach to handling heart attack patients.

>

> By outfitting ambulances with devices that allow paramedics to more quickly

> diagnose serious heart attacks and call ahead to hospitals equipped to

> perform a specialized procedure, the protocol has sharply reduced the time

> it takes for patients to receive life-saving treatment, officials said.

>

> Currently, only about half of all heart attack victims arrive at hospitals

> by ambulance.

>

> When patients walk into emergency rooms on their own, long waits can delay

> diagnosis and treatment, health officials say.

>

> In October, , 33, collapsed and died after waiting more

> than three hours at Olive View-UCLA Medical Center in Sylmar complaining of

> severe chest pain. never received an electrocardiogram.

>

> " Had that patient called 911, he would have been identified by the

> paramedics " as having a heart attack, said Dr. Ivan C. Rokos, the emergency

> medicine physician and assistant clinical professor at the Geffen

> School of Medicine at UCLA who reviewed data on the new approach.

>

> " Fortunately for 911 [callers], paramedics take care of one patient at a

> time, " Rokos said. " If you go into an emergency room, the triage nurse is

> overloaded. "

>

> Even 15 minutes of delay in treating a heart attack increases the risk of

> death, he noted, and causes more damage to the heart.

>

> Ninety percent of heart attack patients who called 911 in Los Angeles County

> had necessary procedures performed within 90 minutes of arriving at the

> hospital -- the highest rate of the counties studied -- according to data

> Rokos will present Sunday to the American College of Cardiology in Chicago.

>

> Before the county instituted the protocol in December 2006, fewer than 50%

> were treated within 90 minutes.

>

> Other Southern California counties recorded similar improvements, with

> Orange and Ventura counties reporting that 85% of patients now receive

> treatment within 90 minutes and San Diego reporting a rate of 86%.

>

> Other regions that have adopted the protocol -- including Marin County,

> Atlanta, Minneapolis, Medford, Ore., and Oakland County, Mich. -- also have

> met the American College of Cardiology's recommendation of treating at least

> 75% of severe heart attack victims within 90 minutes, a key time frame in

> preventing irreversible damage.

>

> One central element of the protocol has been to equip ambulances with

> upgraded electrocardiogram machines that analyze the patient's condition and

> alert paramedics when patients are having serious heart attacks.

>

> The new approach was developed in response to growing evidence in the late

> 1990s that prompt care utilizing an improved procedure could save lives.

>

> The emergency angioplasty procedure involves inserting a tube into the

> patient's groin and threading it to the arteries near the heart.

>

> Once doctors determine where an artery is blocked, a small balloon on the

> tube's tip is inflated to force the fatty clot out of the way and restore

> blood flow to the heart. A metal stent can then be put in place to keep the

> artery open.

>

> The emergency treatment, known as PPCI, for primary percutaneous coronary

> intervention, has the best chance of success if it is performed within 90

> minutes of a patient's arrival at a hospital. Since many hospitals are not

> staffed to perform the procedure, paramedics need to know whether patients

> are candidates for it.

>

> Before Orange County implemented the protocol, patients often waited two

> hours or more for treatment, said Dr. Stratton, medical director of

> Orange County's Emergency Medical Services.

>

> Now, all ambulances have been equipped with upgraded electrocardiogram

> machines and patients in need of the procedure are taken only to hospitals

> staffed to perform it 24 hours a day.

>

> Results are promising. Stratton said he is convinced that mortality rates

> have dropped in Orange County since the protocol was implemented in 2005,

> but didn't have comparative statistics. Also, many patients in Orange County

> are now sent home within three to five days, rather than seven to 10 days,

> Stratton said.

>

> The largest hurdle counties now face, Rokos said, is educating the public to

> call 911 when a heart attack is suspected.

>

> " The paramedics can provide you with one-on-one concierge service, " Rokos

> said. " If you go into the emergency department, you're fighting off the

> masses. "

>

> ron.lin@...

>

>

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