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Heart Attack Response

Karl Wiscombe of Casper rests in the Wyoming Medical Center intensive care unit while recovering from a massive heart attack on July 5.

Karl Wiscombe suffered a massive heart attack last month while putting away cans in his garage.

He felt tired and started sweating uncontrollably. Pain radiated through his chest, shoulders and neck. He could barely breathe.

“I couldn’t do anything,” he said. “It felt like I had a

10-ton elephant sitting on my chest.”

The 52-year-old Casper man dialed 911. Paramedics arrived and performed an EKG, a test that can detect heart problems. They sent the results to Wyoming Medical Center, giving doctors there time to prepare.

Wiscombe only stopped long enough in the emergency room for the medical staff to remove his clothing. From there, they whisked him to the cardiac catheterization lab, where a doctor used a balloon to open his blocked heart vessel.

It’s essential that doctors remove the blockage as quickly as possible. The longer it takes, the more heart muscle dies.

Two years ago, Wyoming Medical Center and local doctors began studying ways to speed up the process. They decided to wring as much inefficiency as possible from the path that starts with a 911 call and ends with an opened heart vessel. The changes have already cut nearly a half hour from the time when a patient arrives to when the blockage is removed, said Dr. Adrian Fluture, director of the hospital’s Regional Myocardial Infarction Care.

“We reduced everything that was redundant,” he said. “Once a patient comes to the emergency room and says, ‘I have chest pain,’ he’s looked as a top priority. Nobody sits on these patients anymore or postpones anything. They are addressed right away.”

Health experts suggest that no more than 90 minutes pass from when a person arrives at the emergency room until doctors can open a clogged heart vessel. Wyoming Medical Center averaged 77 minutes two years ago. The time dropped to

48 minutes by the end of last year.

The hospital ranks in the top 85 percent in the nation and its times are still improving, Fluture said.

“You save a lot of lives by doing it fast and efficient,” he said.

Pit stop

A lot has to happen before a doctor can open a blocked vessel. A patient calls for help. Paramedics arrive and begin treatment. A heart attack is diagnosed and the patient is readied for the cardiac catheterization lab.

Fluture and others found ways to speed the process. They made sure patients who arrive at the ER with chest pain are immediately treated. They eliminated unnecessary steps.

The staff performs their jobs in parallel. One nurse will put in an IV while another attaches a defibrillator. A third will grab medications from the computerized lockers the hospital uses.

Everyone — whether they work in an ambulance, the emergency room or the cath lab – performs as one team. Fluture likens it a pit crew at an auto race.

“When the car goes into the pit, there are a lot of people who jump on that car,” he explained. “The tires are changed at the same time. The car is tanked. Everything is done so the car gets out of the pit as fast as possible. We are applying similar processes.”

EKG

Other changes happen before the patient even reaches WMC. The hospital equipped its paramedics with technology that allows them to transmit EKG data to the emergency room. With that information, doctors can determine whether a patient is suffering a heart attack before the ambulance arrives at the hospital.

While that information is being sent, the medics are also starting IVs, removing clothing and giving aspirin, said Mark Meyer, hospital’s ambulance manager.

The procedures, combined with the EKG, can knock 10 to 20 minutes off the time to treatment. That means less damage to the heart.

“Time is muscle,” Meyer said.

Sending the EKG data remotely also gives staff at WMC more time to prepare. Providers who are at home can get a head start to the hospital. If the lab is already open, patients can sometimes skip the ER altogether, Fluture said.

The changes haven’t been in place long enough to know their effect on the survival rate of heart attack patients. But studies elsewhere have shown faster times mean fewer deaths, along with a better quality of life for those who survive.

Recognition

All of the changes won’t matter if patients don’t seek help. Unfortunately, many wait to call 911 because they don’t recognize they’re having a heart attack, they’re in denial about what’s happening, or they don’t trust the medical system, Fluture said.

“It’s important for the population to understand there is an efficient system that’s been put into place,” he said. “A lot of advancements have been done. They simply need to learn to pick up the phone and call 911.”

That’s exactly what Wiscombe did. While in pain, he prayed for help. Wiscombe said God directed him to call 911.

He spent six days in the hospital, but is now recovering at home.

“They did an amazing job,” he said. “I’m here alive because of it.”

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Contact Joshua Wolfson at 307-266-0582 or at josh.wolfson@trib.com. Visit http://trib.com/news/opinion/blogs/wolfjammies to read his blog. Follow him on Twitter @joshwolfson.

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