New protocol is good news for heart attack patients

The pain started in his jaw and then went away, but what didn’t go away was a total feeling of malaise. He went into the bathroom and his body immediately vacated. He felt cold, clammy and dizzy. After he lay down on the bathroom floor for a minute he told his wife to call 911. A sharp pain then started on his right side. He was having a heart attack.

It’s a true story. Thanks to the tenacity of Bonner County EMS medical director and cardiologist Ron Jenkins to develop the current procedures and protocols, the patient was taken directly to Kootenai Medical Center’s heart catheterization lab where he was stabilized and stents were inserted to keep his arteries open.

On scene the paramedics had the ability to send confidentially via a smart phone the EKG (heart tracing) to both Bonner General’s emergency department physician and the 24-hour per day on call cardiologist in Coeur d’Alene. The two doctors made the decision of where to transport the patient. En route to the catheterization lab, the EMTs were directed to administer special medications that are available for heart attack patients.

Jenkins established this protocol for patients apparently suffering Segment Elevation Myocardial Infarction (STEMI for short) in Bonner County in November of 2010.

“This allows us to confirm the diagnosis of a heart attack when the paramedics get there,” said BGH director of emergency medicine, Kenneth Gramyk. “Then we can significantly save time to the initial opening of the blocked arteries. The longer a patient has symptoms the more damage may occur. And the less damage that occurs, the better chance there is for a good and a complete recovery.”

Gramyk said that symptoms of discomfort in the chest over a broad area, a feeling of pressure or squeezing that continues more than 15 minutes, shortness of breath, nausea, cold sweat and a radiating pain in the jaw, back or either arm are classical. Women do not always get all of the more common symptoms and some may only have a feeling of shortness of breath and fatigue or weakness.

“Some people get crushing chest pain, like an elephant standing on their chest, but not always” Gramyk said.

With the purchase of a transport ventilator and the cooperation of cardiologists, administration of both hospitals, emergency room physicians and the EMS so far eight patients have been sent directly to the catheterization lab.

Gramyk credits the improved communication between EMS the ER and the cardiologists with the ability for the paramedics to administer treatment. With the confirmation of a heart attack the paramedics are now able to give medications in the ambulance that they normally wouldn’t get pre-hospital. This protocol is innovative and unique to Bonner County.

“Quality assurance processes are in place and functional, and the system as a whole is now really excellent,” Jenkins said.

“I am currently collecting and evaluating data from 2009 to the present so we can compare the old and new ways of doing things. So far all the patients who have bypassed the emergency department have done well and have survived without major issues. I hope that trend continues!” Jenkins concluded.

Both physicians emphasized the importance, at the onset of symptoms, for the patient a friend, or family member to call 911. Saving minutes can save lives. Do not drive to the hospital; it may be a waste of critical time. Do administer an adult dosage of aspirin and be sure to tell the paramedics that you have done so.

Kathy Hubbard is a trustee on Bonner General Hospital Foundation Board. She can be reached at kathyleehubbard@yahoo.com or 264-4029.