HEMET – In an effort to work more efficiently between doctors and paramedics, Hemet Valley Medical Center is working toward achieving STEMI, or segment elevation myocardial infarction, certification. Once the hospital receives the certification, STEMI protocols will allow the hospital to treat patients when it matters most – right after the suspected heart attack – before they enter the hospital.
After a heart attack, an immediate goal is to quickly open blocked arteries and return blood flow to the heart muscles. The sooner blood flow is restored, the less extensive the heart muscle damage, thus preserving the heart’s ability to move blood through the circulatory system. STEMI certification will save valuable time for those patients who have suffered from a heart attack and in turn, save lives, according to medical professionals.
STEMI is a distinct department that specializes in quick response to a heart attack or stroke and a whole process of what happens when a person is having chest pains.
Hemet Valley Medical Center, with a renowned heart staff and state-of-the-art catheter lab, is setting up STEMI to achieve its goal of providing state of the art medical care to patients and save more lives.
“We’re expecting at the start of 2018 to have everything in place, and we will probably be getting ready for the state of California to come in and review the program and get us this certification blessing to become a STEMI Center,” Chief Nursing Officer and Chief Operations Officer at Physicians for Healthy Hospitals Kathryn McLaughlin said.
How does STEMI work?
As a coordinated process between paramedics and hospitals, when a patient has chest pains at home and calls 9-1-1, paramedics arrive and hook the patient to a portable electrocardiogram or EKG machine that immediately sends electronic reports hospital staff, all while the patient remains in their home or in transit.
An emergency room doctor then reads the reports, determining if the patient is experiencing a cardiac episode or heart attack. If the patient is in trouble, the entire team, including cardiologists and support staff needed for cardiac catheterization or other treatment, is called into the hospital where they await the patient’s arrival.
By the time the paramedics arrive at the hospital, the staff is ready. The patient bypasses the emergency department and goes straight onto a table where the problem resolved, immediately minimizing damage to the heart muscle.
“The whole point is you might be either trying to grab that little clot or you may be trying to open up a blood vessel, anything to support a blood flow into the heart before tissues begin to die,” McLaughlin said. “The goal is 30 minutes from the time of symptoms, so basically once you’re coming in the door and the wheels of the gurney roll onto the hospital floor, we have you on a table and have a balloon open the vessels,” in 30 minutes.
California has clear guidelines for STEMI accreditation. Certain policies and procedures, specific equipment, the on-call response process of who gets called and how they get called are all part of the requirements. Data needs to be collected, drills need to be done and everything from outcomes to average timing on patient care before the state will even consider licensing a hospital to provide the service.
STEMI benefits those who live close by the hospital, in this case Hemet Valley Medical Center. Residents of Menifee, Winchester, Hemet and San Jacinto who are suffering from a cardiac related episode would all see the benefits of STEMI, while people who live in areas such as Temecula or Murrieta would be better off going to a hospital closer to them since time is of the essence when it comes to emergency medical care.
“A lot of damage could be done in a 30-minute ambulance ride,” McLaughlin said
A cardiovascular operating room is also planned. In addition to the STEMI protocols, Hemet Valley Medical Center will open a new cardiovascular operating room, hopefully in 2018.
“If you’re in a cardiac cath lab trying to pass a small wire into one of the blood vessels that’s for the heart, there is always a risk of damage to the vessel they’re trying to float into fragile veins. At that point, you have to do open-heart surgery to repair the damage,” McLaughlin explained. “(We are building a new) cardiovascular surgery room, so if something like that happened patients would be able to get from the cardiac cath lab across the hallway directly into the cardiac surgery room where we would be able to immediately repair it.”
According to McLaughlin, open-heart surgery is being performed far less often than it was 20 years ago thanks to the high success rate of cardiac catheter labs.
“It’s almost to a point currently where you don’t even need a cardiovascular operating room because STEMI procedures are so successful,” she explained. “Twenty years ago, if you had a heart attack or cardiac cath procedure they would have taken you in, shaved your legs and everything, and you would have to consent to open-heart surgery immediately just in case. Most patients ended up in the open-heart room. Now many of those open-heart rooms are empty. They aren’t being utilized because of the high success rate of the cardiac cath labs.”
What about stroke victims?
According to McLaughlin, stroke is something completely different from a heart attack.
“A stroke victim isn’t exclusively having chest pains. Their symptoms may be that they cannot talk or be able to swallow or move their arm, or they may have a sudden weakness in some part of their body,” she said. “There’s no way of doing the tests at home to know from a call in if this is truly what is happening with a patient.”
When a stroke – bleeding in the brain or clot – is suspected, the patient is able to bypass the emergency department admitting process and be put directly onto a CT scanner, something that Hemet Valley Medical Center keeps handy for these instances in the emergency room.
“By the time they’re finished with admitting, they already have the test results and treatment is started,” McLaughlin said. “If there is bleeding in the brain that’s causing the one-sided weakness, we will truly know.”
According to McLaughlin, the patient goes into the emergency department as the nurses are admitting, the patient settles in a bed and a radiologist looks at the CT scan. The radiologist meets with the emergency room doctor and presents the results.
“Then there is a decision made as to the care and treatment of the patient,” she explained. “The most common treatment for stroke is a medication that is also a clot buster, called TPA, and it goes to the clot and dissolves it before there is a lot of damage to the brain.”
There are two levels of stroke, and if a patient requires the second level, they have to go to a comprehensive stroke center for neurosurgery. They need more than the medication to dissolve clots; they have to operate right away.